Cavernous Hemangioma of the Chiasm and Left Optic Nerve

Abstract

Cavernous malformations (CMs) of the optic nerves, chiasm, and optic tract are very rare. This report describes a 26-year-old man who presented with recurring headaches, loss of vision in his left eye, and elevated blood pressure. After being diagnosed with glioma of the chiasm, he was referred to our department. Magnetic resonance imaging revealed signs of a mass lesion of the left chiasmal area, a finding confirmed after transcranial biopsy. In February 2015, he underwent gross total resection of the cavernous angioma of the chiasm and the left optic nerve. Three months later, the patient's vision returned to normal. The absence of a typical clinical picture and the lack of radiological visualization can hinder pathologic diagnosis. Total microsurgical resection is the optimal treatment strategy for patients with CMs of the chiasm and optic nerve because it usually results in improved vision and long-term benefits. The results in this patient demonstrate the importance of rapid diagnosis and gross total surgical resection of CMs of the chiasm and left optic nerve.

Keywords: case report; cavernous angioma; optic chiasm; optic nerve; surgical resection.

Figure 1. Preoperative (A) axial and (B) sagittal MRI.

Hyperintense signal on T1-weighted MRI showing a mass lesion occupying the chiasm and left optic nerve.

Figure 2. Postoperative (A) axial and (B) sagittal MRI.

Figure 3. Microscopic structure of the resected cavernous malformation, showing heterochromous thromboses.

(A) Positive expression in the endothelium of small thin-walled vessels CD34 (clone QBEnd/10); 20-fold magnification. (B) Positive expression in the endothelium of small thin-walled vessels CD34 (clone QBEnd/10); 40-fold magnification. (C) Actin, smooth muscle Ab-1 (1A4) - positive expression in myoepithelium of enlarged thrombotic vessels. (D) Expanded, thrombotic thin-walled CD34 (clone QBEnd/10) - positive vessel, lined with cohesive endothelium.