Cavernous hemangioma of optic chiasm, optic nerves and right optic tract

Manz, Herbert J.; Klein, Larry H.; Fermaglich, Joseph; Kattah, Jorge; Luessenhop, Alfred J.

doi:10.1007/bf01200902

Cited by 51 publications

(17 citation statements)

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“…Compression of the optic chiasma due to angiographically occult vascular malformations is extremely rare. Only 12 cases of histologically proven cavernous malformations of the optic nerve and/or chiasma have been previously reported [3,4,9,[15][16][17][18][19]26]. The other lesions which caused chiasreal apoplexy were cryptic arteriovenous malformations and venous angiomas.…”

Section: Discussionmentioning

confidence: 94%

Cavernous malformations of the optic chiasma

et al. 1995

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Two cases of cavernous malformation of the optic chiasm are reported, and 12 previously reported cases are reviewed. The first patient presented with gradually progressive and the second patient with a subacute chiasmal syndrome. Total excision was performed in both cases. Visual function improved slightly after surgery in the first patient while the other showed marked improvement. Although cavernous malformations are angiographically occult, pre-operative diagnosis has become possible based on the characteristic features such as repeated haemorrhages in multiple sinusoidal structures as revealed by magnetic resonance imaging (MRI). A gliotic interspace between the malformation and normal neural tissue provides a plane of cleavage for dissection which permits total excision without causing new deficits. Review of previously reported cases revealed that chiasmal cavernous malformations haemorrhage more frequently than those in the brain. Early diagnosis with total excision is the treatment of choice for cavernous malformations of the optic chiasma.

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Section: Discussionmentioning

confidence: 94%

Cavernous malformations of the optic chiasma

et al. 1995

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“…A total of 64 OPH CM cases were identified. 2,[8][9][10][12][13][14][15]18,19,21,22,[25][26][27][29][30][31][36][37][38][39][40][41][42][46][47][48]51,52,[57][58][59][60][61][62][63][64]67,68 We also report an additional case in this paper, making a total of 65 cases that were reviewed. Each case was analyzed for clinical presentation, lesion location, radiographic features, surgical treatment, and neurological and visual outcome (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Liu

Lü

Raslan

et al. 2010

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Object Cavernous malformations (CMs) of the optic pathway and hypothalamus (OPH) are extremely rare. Patients with these lesions typically present with chiasmal apoplexy, characterized by sudden visual loss, acute headaches, retroorbital pain, and nausea. Surgical removal is the recommended treatment to restore or preserve vision and to eliminate the risk of future hemorrhage. However, the anatomical location and eloquence of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature for reported cases of OPH CMs to analyze clinical and radiographic presentations as well as surgical approaches and neurological outcomes. Methods A MEDLINE/PubMed search was performed, revealing 64 cases of OPH CMs. The authors report an additional case in the study, making a total of 65 cases. Each case was analyzed for clinical presentation, lesion location, radiographic features, treatment method, and visual outcome. Results In 65 patients with OPH CMs, the optic chiasm was affected in 54 cases, the optic nerve(s) in 35, the optic tract in 13, and the hypothalamus in 5. Loss of visual field and acuity was the most common presenting symptom (98%), followed by headache (60%). The onset of symptoms was acute in 58% of patients, subacute in 15%, and chronic progressive in 26%. Computed tomography scans revealed hyperdense suprasellar lesions, with calcification visible in 56% of cases. Magnetic resonance imaging typically demonstrated a heterogeneous lesion with mixed signal intensities suggestive of blood of different ages. The lesion was often surrounded by a peripheral rim of hypointensity on T2-weighted images in 60% of cases. Minimal or no enhancement occurred after the administration of gadolinium. Hemorrhage was reported in 82% of cases. Most patients were surgically treated (97%) using gross-total resection (60%), subtotal resection (6%), biopsy procedure alone (6%), biopsy procedure with decompression (23%), and biopsy procedure followed by radiation (2%). Those patients who underwent gross-total resection had the highest rate of visual improvement (85%). Two patients were treated conservatively, resulting in complete blindness in 1 patient and spontaneous recovery of vision in the other patient. Conclusions Cavernous malformations of the OPH are rare and challenging lesions. Gross-total resection of these lesions is associated with favorable visual outcomes. Emergent surgery is warranted in patients presenting with chiasmal apoplexy to prevent permanent damage to the visual pathway.

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“…La apoplejía quiasmática consiste en el desarrollo súbito de un déficit quiasmático que suele acompañarse de cefalea. Los ACs y las MAVs son las causas principales debido a hemorragia dentro del quiasma óptico 9,18,23,26 . La etiología no hemorrágica es poco frecuente, como puede suceder en la enfermedad arterioesclerótica, infecciones micóticas o por micobacterias, tumores, e incluso más raro aún en enfermedades desmielinizantes 25 .…”

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“…El diagnostico diferencial más importante debe hacerse con la apoplejía hipofisiaria; sin embargo, en esta ultima patología se encontrarán más frecuentemente cambios en el perfil hormonal, una morfología alterada de la silla turca, y la presencia casi invariablemente de una lesión en la región selar (la que generalmente será un adenoma de hipófisis), supraselar (como un craneofaringioma), o de planum esfenoidal (como en caso de un meningioma) 25,29 . Aproximadamente, 53% de los casos en la revisión de la literatura debutaron con el desarrollo de una apoplejía quiasmático u óptica, mientras que 47% presentaron un curso más bien subagudo o progresivo del deterioro visual [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][17][18][19][20]22,24,[26][27][28][29][30][31][32]35 . Los angiomas cavernosos se incluyen dentro del grupo de lesiones angiográficamente ocultas del SNC 5,16,32 .…”

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“…La microcirugía inmediata es óptima en casos de cavernomas que involucran aI segundo nervio craneal con la finalidad de realizar la descompresión del tracto visual y de realizar el diagnostico definitivo [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][17][18][19][20]22,24,[26][27][28][29][30][31][32]35 . La meta debe ser la resección total para alcanzar la mejoría de la función visual.…”

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Angioma cavernoso del segundo nervio craneal y apoplejía quiasmática

Santos-Ditto¹,

Santos-Franco²,

Pinos-Gavilanes

2007

Neurocirugía

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ResumenPresentamos el caso de una paciente que presentó un cuadro de apoplejía quiasmática asociada a alteraciones menstruales cuya tomografía computarizada de cráneo mostró hemorragia supraselar. Fue intervenida con el diagnostico de tumor hipofisiario, pero presentó una lesión hemorrágica en quiasma y la porción proximal del nervio óptico izquierdo. El diagnostico histopatológico fue de un cavernoma. El angioma cavernoso constituye cerca del 15% de todas las malformaciones vasculares del sistema nervioso central, y los del aparato visual son infrecuentes. Se debe sospechar cuando el paciente presenta apoplejía quiasmática u óptica. Su exéresis es útil para evitar empeoramiento o un nuevo déficit visual.PALABRAS CLAVE: Angioma cavernoso. Apoplejía quiasmática. Nervio óptico. Cavernous angioma of the second cranial nerve and chiasmatic apoplexy SummaryWe present the case of a female patient who developed chiasmatic apoplexy and menstrual alterations. CT scanning showed a suprasellar hemorrhage. She underwent surgery with the presumptive diagnosis of pituitary tumor. At surgery, we find a brown-grayish lesion involving left optic nerve and chiasm. Cavernous angioma was diagnosed by histopathology. Cavernous angiomas constitute nearly 15% of all central nervous system vascular malformations. Location at the optic pathway is very rare, but must to be ruled out in the diagnosis of a patient with chiasmatic and/or optic apoplexy. Surgery is useful in preventing worsening of the previous deficit or a new visual defect.KEY WORDS: Cavernous angioma. Chiasmatic apoplexy. Optic nerve. IntroducciónLos angiomas cavernosos están incluidos dentro de la clasificación de las malformaciones vasculares del sistema nervioso central 5,21,32 . Cerca del 80% están localizados en la región supratentorial, mientras que la afección de nervios craneales es rara, con menos de 60 casos reportados en la literatura mundial 1-6,7-17-20,22,24,26-32,35 . El involucro de la vía visual es también infrecuente. En el presente artículo describimos el caso de una paciente con un angioma cavernoso del quiasma que se presentó como una apoplejía quiasmá-tica, una manifestación clínica también infrecuente. Caso clínicoPaciente femenino de 39 años quien súbitamente presentó cefalea y disminución de la agudeza visual en dos ocasiones. Ambos episodios remitieron espontáneamente, el primero con recuperación "ad integrum", y el segundo con secuela visual. Además, desarrolló alteraciones menstruales, por tal motivo visitó inicialmente a un endocrinó-logo, quien la envió a nuestro servicio neuroquirúrgico con la probabilidad de una apoplejía hipofisiaria. Vimos a la paciente a los veinte días de iniciado su cuadro. La exploración neurológica reveló una hemianopsia bitemporal con pérdida de la visión central del ojo izquierdo, e importante atrofia papilar ipsilateral.La tomografía computarizada de cráneo mostró una lesión supraselar hiperdensa sin muchas modificaciones al uso de material de contraste (figura l). La panangiografía cerebral fue normal. No se real...

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Cavernous hemangioma of optic chiasm, optic nerves and right optic tract

Cited by 51 publications

References 13 publications

Cavernous malformations of the optic chiasma

Cavernous malformations of the optic chiasma

Cavernous malformations of the optic pathway and hypothalamus: analysis of 65 cases in the literature

Angioma cavernoso del segundo nervio craneal y apoplejía quiasmática

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