Cavernous Malformation of the Optic Nerve and Chiasm: Prompt Suspicion and Surgery Matter

Kostic, Maja; Subramanian, Prem S.; Falcone, Steven; El-Swaify, Seif Tarek; Sur, Samir; Spasic, Smiljana; Miller, Neil R.; Morcos, Jacques J.; Lam, Byron L.

doi:10.1097/wno.0000000000001238

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…[1][2][3][4] Patients with CMON often present with sudden-onset visual disturbances termed "chiasmal apoplexy" due to extralesional hemorrhage, as in our case. 1,[5][6][7][8][9][10] Some patients present less acutely with progressive visual disturbances, likely secondary to progressive expansion caused by intralesional hemorrhage. [11][12][13][14][15] Although these two groups of patients are not described as separate entities in the literature, we believe they warrant individualized treatment.…”

Section: Discussionmentioning

confidence: 99%

Acute management of ruptured cavernous malformation of the optic nerve: illustrative case

Kawalec,

Del Bigio,

Kaufmann

2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND A cavernous malformation of the optic nerve (CMON) is a rare condition that often presents with an abrupt decline in vision. Acute management of ruptured optic nerve cavernous malformations is generally surgical, although the timing of surgery is controversial. OBSERVATIONS A 47-year-old female experienced the sudden loss of vision in her left eye. Examination showed that this eye was nearly blind, and her right eye had a temporal field defect. Neuroimaging showed hemorrhage in her left optic nerve and optic chiasm. She was taken to the operating room on an emergent basis where the optic canal was decompressed, the hemorrhage was evacuated, and a vascular malformation with features of a cavernoma was removed from the optic nerve. Over the next 2 days, the vision in her right eye significantly recovered. LESSONS CMONs remain rare, and it is unlikely that enough cases can be gathered to form a larger trial to compare the role and timing of surgery. On the basis of our experience with this case, the authors recommend that acute CMON-related hematomas should be treated as a surgical emergency and managed with acute optic nerve decompression, hematoma evacuation, and cavernoma resection to improve chances of vision recovery and prevent further vision loss.

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Section: Discussionmentioning

confidence: 99%

Acute management of ruptured cavernous malformation of the optic nerve: illustrative case

Kawalec,

Del Bigio,

Kaufmann

2024

Journal of Neurosurgery: Case Lessons

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Diagnosis and treatment status of suprasellar optic pathway cavernous malformations

Xu,

Yang

2023

J Int Med Res

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Cerebral cavernous malformations constitute a subtype of cerebral vascular malformation typically located in the cerebral cortex. However, their occurrence in the suprasellar optic pathway is relatively rare. There is some uncertainty surrounding the clinical diagnostic methods and optimal treatment strategies specific to suprasellar optic pathway cavernous malformations. In this narrative review, we retrospectively analyzed relevant literature related to suprasellar visual pathway cavernous malformations. We conducted a study involving 90 patients who were postoperatively diagnosed with cavernous malformations, including the 16-year-old male patient mentioned in this article. We have summarized crucial clinical data, including the patient age distribution, sex ratio, lesion locations, primary symptoms, and surgical approaches. The comprehensive analysis of this clinical information underscores the critical importance of timely intervention in relieving symptoms and improving neurological deficits in affected patients. These findings provide valuable guidance and insight for clinical practitioners and researchers dealing with this specific medical condition.

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Cavernous Malformation From Cranial Nerves: A Systematic Review With a Novel Classification and Patient-Level Analysis

Li,

Chen,

Wang

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Cavernous malformations (CMs) occurring in the cranial nerve (CN) are extremely rare, and there is currently no comprehensive review on CN CMs, leading to a lack of sufficient understanding of CN CMs. We aimed to systematically review all published CN CM cases; summarize the epidemiology, clinical manifestations, treatment, and prognosis of CN CMs; and identify factors influencing the prognosis of CN CMs. METHODS: This systematic review identified all cases potentially diagnosed with CN CM through a systematic search of PubMed, SCOPUS, Web of Science, and Cochrane databases. This represents the most comprehensive systematic review to date. We classified CN CMs based on their anatomic origins. Patient characteristics, disease manifestations, treatment approaches, and prognosis were summarized descriptively. Further analysis was conducted to identify factors influencing the prognosis of CN CMs. RESULTS: The final analysis included 108 articles (127 individual patient cases). The optic nerve (49/128, 38.3%) is the most commonly affected nerve. Notably, CN CMs can be categorized into 3 types: Intraneural, Perineural, and Extraneural. Preoperative nerve function status and novel classification were associated with the prognosis of CN CMs (P = .001; P < .001). The postoperative neurological deterioration rate for the Intraneural type was 19/37 (51.4%); for the Extraneural type, it was 13/69 (18.8%); and for the Perineural type, it was 1/22 (4.5%) (P < .001). CONCLUSION: We reviewed all the published CN CMs to date, offering a comprehensive description of CN CMs for the first time and identifying prognostic factors. The classification of CN CMs proposed in this study could serve as guidance for the selection of intraoperative treatment regimens. The findings of this systematic review are expected to provide a foundation for clinical decision-making in this crucial rare disease and lay the groundwork for developing relevant clinical guidelines.

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Cavernous Malformation of the Optic Nerve and Chiasm: Prompt Suspicion and Surgery Matter

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 4 publications

References 14 publications

Acute management of ruptured cavernous malformation of the optic nerve: illustrative case

Acute management of ruptured cavernous malformation of the optic nerve: illustrative case

Diagnosis and treatment status of suprasellar optic pathway cavernous malformations

Cavernous Malformation From Cranial Nerves: A Systematic Review With a Novel Classification and Patient-Level Analysis

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