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.

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Growth hormone (GH)-secreting pituitary adenomas (PA) make up 15 to 20% of total amount of hormonally active adenomas. In addition to acromegaly and gigantism, these tumors cause deep metabolic disturbances. Its systemic impact leads to increased mortality ratio of 1.32 compared with general population. Surgical removal remains the priority treatment option in controlling acromegaly and provides endocrinologic remission in up to 72% patients. A total of 92 patients were included in the study. All surgeries were performed via microscopic transsphenoidal approach (TSA) by the senior author in our institution between December 2009 and October 2019. Only patients who were followed-up with 75 g oral glucose tolerance tests (OGTTs), GH, and insulin-like growth factor I (IFG-I) measurements preoperatively, 1 week, and every 6 months postoperatively were analyzed. Based on standard preoperative 1.5-T MR imaging with contrast enhancement, the adenomas were identified and distributed according to the size and KNOSP classification. The efficacy depends on KNOSP grade, which is directly correlated with invasiveness to cavernous sinus (CS). Grades 3 and 4 are unfavorable factors influencing prognosis. Excluding grade 0 adenomas, as the surgery was not difficult with the excellent outcomes, we reached 75% (36 out of 48) remission in grade 1 to 2 groups. In contrast, only 17% (2 out of 12) had successful outcomes after surgery alone. In conclusion, the study demonstrates the efficiency of TS surgery in patients with confirmed GH-secreting PA.

Sphenoid wing meningiomas account for 11%-20% of all intracranial meningiomas, whereas meningiomas of the anterior clinoid process comprise about 34.0–43.9%. Assignment of these cranio-basal tumors to a separate group is due to the parasellar location and challenges in their surgical removal, mainly because of its anatomical syntopy: compression of the optic nerve, carotid artery inclusion, and invasion to the cavernous sinus. This chapter consists of the combination of current knowledge and our experience in understanding, diagnosis, surgical strategy, and complication avoidance with these tumors.

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