Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm.

Regli, Luca; Tribolet, N. De; Régli, F; Bogousslavsky, J

doi:10.1136/jnnp.52.9.1095

Cited by 36 publications

(19 citation statements)

References 16 publications

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“…Cavernous angioma located on the brain surface or the surface of the optic nerve is very rare, [2][3][4]7,12) so the present study represents the unusual ICG-VAG findings of an unoperated lesion.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Videoangiography of Optic Cavernous Angioma -Case Report-

Murai

Adachi

Koketsu

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The intraoperative findings of an indocyanine green videoangiography (ICG-VAG) study of a cavernous angioma located in the optic chiasm are reported. A 23-year-old Japanese man suddenly developed visual field loss, and magnetic resonance imaging suggested the presence of a suprasellar tumor in contact with the optic chiasm. Preoperative angiography did not clearly show any tumor shadow. Right fronto-temporal craniotomy was performed, and an aggregation of blood vessels was seen on the right surface of the optic chiasm. Cavernous angioma was suspected. ICG-VAG was begun 22 seconds after the beginning of contrast agent infusion via a peripheral blood vessel. The lesion remained unstained, although the brain surface, an artery superior to the optic nerve, and veins were visualized. The cavernous angioma was resected following surface coagulation. ICG-VAG is currently being evaluated for future application in the differential diagnosis based on imaging findings, and the present case provides an important example of intraoperative ICG-VAG imaging of an unoperated cavernous angioma.

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Section: Discussionmentioning

confidence: 99%

Indocyanine Green Videoangiography of Optic Cavernous Angioma -Case Report-

Murai

Adachi

Koketsu

et al. 2011

Neurol. Med. Chir.(Tokyo)

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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

FOC

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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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“…3) However, radiosurgery is not recommended for chiasmal and/or optic nerve lesions, because of the high risk of optic neuropathy. 8) Surgical treatment can be justified for diagnostic purposes, for decompression of the optic chiasm and/or nerve, and for prophylaxis of lesion growth to prevent repeat hemorrhage and consequent deterioration, 7,24,26,34) although complete cure may be difficult to obtain, particularly for AVMs.…”

Section: Discussionmentioning

confidence: 99%

Chiasmal and/or Optic Nerve Apoplexy Due to Rupture of Vascular Malformation -Case Report-

Sasagawa

Akai

Sasaki

et al. 2008

Neurol. Med. Chir.(Tokyo)

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An 8-year-old boy presented with a rare case of optic nerve apoplexy caused by an arteriovenous malformation (AVM) manifesting as severe headache and blurred vision. Computed tomography (CT) showed a hyperdense suprasellar mass. Magnetic resonance (MR) imaging indicated a hematoma in the right optic nerve. MR angiography showed normal vessels. Right fronto-temporal craniotomy identified an aggregate of abnormal, nidus-like vessels adhering to the medial surface of the swollen right optic nerve and a drainer-like ectatic red vein. The diagnosis was probable AVM. To avoid optic nerve damage, the malformation was left intact. Two years later, the boy was readmitted with headache. CT showed bleeding, and angiography revealed feeder arteries and nidus in the suprasellar lesion. The diagnosis was optic nerve apoplexy due to AVM. His symptoms improved without intervention within days. He has not experienced any recurrence of the bleeding for 2 years.

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Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm.

Cited by 36 publications

References 16 publications

Indocyanine Green Videoangiography of Optic Cavernous Angioma -Case Report-

Indocyanine Green Videoangiography of Optic Cavernous Angioma -Case Report-

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

Chiasmal and/or Optic Nerve Apoplexy Due to Rupture of Vascular Malformation -Case Report-

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