Cavernous angioma of the optic chiasma：a case report

Abstract

A cavernous angioma arising from a cranial nerve is relatively rare, and ones originating from the optic nerve, in particular, have been reported to cause visual field disturbances. A case of a cavernous angioma that occurred at the optic chiasm is presented along with a review of the literature. The patient was a 52‒year‒old man who developed symptoms headache and bitemporal hemianopia. On the preoperative MRI, the chiasmal lesion was 15 mm×12 mm in size, showed iso‒intensity on T1 and low intensity on T2, and was Gd‒enhanced on its inner side. The lesion had low intensity on T2＊and was suspected to be a cavernous angioma. During the surgery, the lesion attached to the optic chiasm was checked；it was dark red in color with an incision, and hematoma outflow was observed. Remains of an old hematoma were also observed, which was found to be a soft tumor, grayish white in color；it was removed in a clump so as to not damage the surrounding tissue. After surgery, MRI showed the total removal of the lesion in the chiasm. The patient was discharged on the 26th postoperative day（Karnofsky Performance Status 90％）. On visual field examination, the bitemporal hemianopsia was improved. Considering the present case and published cases, gross total resection is the optimal treatment for patients with cavernous angiomas of the optic nerve in terms of accurate diagnosis and good clinical outcomes.