Optic chiasmal cavernous angioma: A rare suprasellar vascular malformation

Abstract

Background: Suprasellar cavernous malformation in the optic pathway is not commonly encountered. To date, there are only few reports present in the literature.

Case description: The authors report a rare case of suprasellar optic pathway cavernous malformation in a 33-year-old female who presented with progressive visual loss. Her imaging revealed a large heterogeneous, hyperintense, hemorrhagic right suprasellar extra-axial complex cystic structure, causing mass effect on the adjacent hypothalamus and third ventricle displacing these structures. Gross total resection of the lesion was achieved utilizing a right frontal craniotomy approach. Histopathological examination confirmed the diagnosis of suprasellar chiasmal cavernous malformation.

Conclusion: Although visual pathway cavernous malformation is a rare event, it should be included in the differential diagnosis of lesions occurring suprasellarly in the visual pathway and hypothalamus.

Keywords: Cavernoma; cavernous angioma; hypothalamus; optic pathway; suprasellar region.

Figure 1

Preoperative magnetic resonance imaging of the brain demonstrating a heterogeneous hyperintense T1 and T2 suprasellar mass compatible with acute/subacute hemorrhagic lesion measuring 3.1 × 2.9 × 2.1 cm with no clear evidence of enhancement allowing for intrinsic T1 hyperintensity (a, c, d). There is some adjacent extension of blood products into the right hippocampal sulcus (c). There is also a left-sided moderately-sized venous angioma in the basal ganglia (c, f). This represents a large hypothalamic region/subependymal cavernous angioma with recent hemorrhage and associated surrounding mild edema mainly in the right basal ganglia and thalamus. Moreover, displacement and mass effect on the surrounding structures including basal ganglia, subcapsular brain parenchyma, as well as hypothalamus and displacement of the cerebral peduncle with a mass effect on the midbrain is noted (a, c, d-f). An additional hemorrhagic focus in the left frontal horn of the lateral ventricle close to the foramen of Monro region is also seen (b, c). Specifically, there is a mass effect and anterior displacement of the partially visualized pituitary infundibulum as well as a mild mass effect on the optic chiasm particularly on the right side compressing and displacing it (c, e, f). No additional susceptibility foci are noted

Figure 2

Postoperative magnetic resonance imaging of the brain depicting complete removal of the suprasellar hemorrhagic cavernous malformation with no evidence of a residual lesion or recurrence with some adjacent extension of blood products into right hippocampal sulcus (a-d) and no hemosiderin staining of the ventricular surface on the gradient-echo imaging (e, f)