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Ruparelia J, Patidar R, Gosal JS, Garg M, Jha DK, Vishwajeet V, Tiwari S, Kaur M, Singh S, Bhaskar S. Optochiasmatic Cavernomas: Updated systematic review and proposal of a novel classification with surgical approaches. Neurosurg Rev 2024; 47:53. [PMID: 38238497 DOI: 10.1007/s10143-024-02288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Cavernomas are histologically benign vascular malformations found at different sites in the brain. A rare site for such cavernomas, however, is the anterior optic pathway, comprising the optic nerve, chiasma, and optic tract-called optochiasmatic cavernomas (OCC). These lesions usually present with sudden onset or progressive vision loss, headache, and features mimicking pituitary apoplexy. In this paper, we describe a case of OCC operated at our center. We carry out an updated review of literature depicting cases of OCC, their clinical presentation, management, and postoperative complications. We also propose a novel classification system based on lesion location and further analyze these cavernoma types with respect to the surgical approach used and visual outcome. A 30-year-old lady had presented with a 3-week history of progressive bilateral vision loss and headache. Based on imaging, she was suspected to have a cavernous angioma of the chiasma and left optic tract. Due to progressive vision deterioration, the lesion was surgically excised using pterional craniotomy. Postoperatively, her visual symptoms improved, but she developed diabetes insipidus. Clinical and radiological follow-up has been done for 18 months after surgery. A total of 81 cases have been described in the literature, including the present case. Chiasmal apoplexy is the most common presentation. Surgical excision is the standard of care. Our analysis based on lesion location shows the most appropriate surgical approach to be used for each cavernoma type. Visual outcome correlates with the preoperative visual status. Visual outcome is good in patients presenting with acute chiasmal apoplexy, and when complete surgical excision is performed. The endonasal endoscopic approach was found to provide the best visual outcome. In addition to preoperative visual status, complete surgical excision predicts favorable visual outcomes in OCC. Our proposed classification system guides the appropriate surgical approach required for a particular location of the cavernoma.
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Affiliation(s)
- Jigish Ruparelia
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Rajnish Patidar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Deepak Kumar Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vikarn Vishwajeet
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Sarbesh Tiwari
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Manbir Kaur
- Department of Anesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Sharma R. The rare case of optic nerve cavernoma: A case report depicting the diagnostic challenge. Radiol Case Rep 2024; 19:190-199. [PMID: 38028314 PMCID: PMC10630766 DOI: 10.1016/j.radcr.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
The manuscript describes a case of Cavernous Malformation in the optic pathway which is extremely rare, accounting for less than 1% of central nervous system cavernomas. This case report highlights a patient initially diagnosed with a glioma, but subsequent MRI changes and extensive analysis ruled in favor of a hemorrhagic optic neuropathy caused by an optic nerve cavernoma. The patient experienced temporary vision loss but fully regained her vision within a week. Based on clinical, biochemical, and radiological findings, it was confirmed as a rare case of optic nerve cavernoma, and the patient was managed expectantly due to her complete recovery of vision. Follow-up imaging after 1 year indicated a stable lesion with evolving characteristics consistent with a cavernoma. This study provides an informative review of the condition and highlights the key radiologic features of this disease.
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Xu S, Yang L. Diagnosis and treatment status of suprasellar optic pathway cavernous malformations. J Int Med Res 2023; 51:3000605231219167. [PMID: 38147640 PMCID: PMC10752090 DOI: 10.1177/03000605231219167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023] Open
Abstract
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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Affiliation(s)
- Songbai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Liu Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Fiorindi A, Gallinaro P, Marton E, Canova G, Fontanella MM, Longatti P. Opto-chiasmatic apoplexy as a compartment syndrome? Anatomical and surgical considerations on two bleeding cavernous malformations. Clin Neurol Neurosurg 2020; 201:106439. [PMID: 33418335 DOI: 10.1016/j.clineuro.2020.106439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Opto-chiasmatic (OC) cavernous malformations are sporadic lesions that are often misdiagnosed clinically and radiologically. Presenting symptoms range from incidental findings to the more frequent and dramatic "chiasmal apoplexy." The present study aims to evaluate the potential role of arachnoidal membranes of the basal cisterns in the onset of OC apoplexy. A possible mechanism resembling a compartment syndrome is discussed through the description of two cases of bleeding cavernomas. METHODS We describe clinical, radiological, intraoperative findings in two cases of young patients presenting with OC apoplexy from bleeding cavernoma. The first was a 38-year-old man diagnosed with optic neuritis at the first episode of visual acuity deterioration. The second patient was a 22 -year-old woman who suffered two OC apoplexy episodes from a recurrence, which also presented with bleeding. RESULTS Both patients were operated on via pterional craniotomy and presented a postoperative improvement of visual symptoms. The second patient experienced deterioration 30 months after surgical resection due to rebleeding from a recurrence and required a second operation. Follow-up revealed a good recovery of visual disturbances; MRI at 6 and 3 years showed in both patients an apparent complete removal of the cavernous malformations. CONCLUSION The cisternal environment where OC cavernous malformations develop and the paradigm of a compartment syndrome could explain the clinical presentation variability. This very rare subset of cavernomas would benefit from a classification system using ad hoc neuroimaging protocols and consistent indications.
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Affiliation(s)
| | - Paolo Gallinaro
- Neurosurgical Unit, Treviso Hospital - University of Padova, Treviso, Italy
| | - Elisabetta Marton
- Neurosurgical Unit, Treviso Hospital - University of Padova, Treviso, Italy
| | - Giuseppe Canova
- Neurosurgical Unit, Treviso Hospital - University of Padova, Treviso, Italy
| | - Marco M Fontanella
- Neurosurgical Unit, Spedali Civili - University of Brescia, Brescia, Italy
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Sbeih I, Darwazeh R, Shehadeh M, Nisah M, Sbeih A, Abu-Farsakh H, Asseidat I. Anterior interhemispheric approach for microsurgical resection of an optic chiasm cavernoma. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Alafaci C, Grasso G, Granata F, Cutugno M, Marino D, Salpietro FM, Tomasello F. Cavernous malformation of the optic chiasm: An uncommon location. Surg Neurol Int 2015; 6:60. [PMID: 25949848 PMCID: PMC4405893 DOI: 10.4103/2152-7806.155256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cavernous malformations (CMs) of the optic chiasm are rare lesions often presenting with acute chiasmal syndrome or a progressive visual loss. The case of a 48-year-old female with an intrachiasmatic CM is presented. CASE DESCRIPTION The patient presented with an insidious history of progressive visual loss. Magnetic resonance imaging (MRI) showed a CM in the suprasellar region. The patient was operated via a right pterional approach with a complete lesion removal. The postoperative course was uneventful. Early postoperative ophthalmological examination revealed minimal improvement of the vision in the left eye. CONCLUSION The clinical, neuroradiological, and intraoperative findings are presented, along with a review of the literature.
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Affiliation(s)
| | - Giovanni Grasso
- Experimental Biomedicine and Clinical Neurosciences (BIONEC), Section of Neurosurgery, University of Palermo, Italy
| | | | | | - Daniele Marino
- Department of Neurosurgery, University of Messina, Italy
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Tan T, Tee JW, Trost N, McKelvie P, Wang YY. Anterior visual pathway cavernous malformations. J Clin Neurosci 2015; 22:258-67. [DOI: 10.1016/j.jocn.2014.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/15/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
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Ning X, Xu K, Luo Q, Qu L, Yu J. Uncommon cavernous malformation of the optic chiasm: a case report. Eur J Med Res 2012; 17:24. [PMID: 22892383 PMCID: PMC3488017 DOI: 10.1186/2047-783x-17-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 07/30/2012] [Indexed: 11/10/2022] Open
Abstract
Cavernous malformation (CM) is a vascular malformation disorder characterized by a berry-like mass of expanded blood vessels. CM, originating from the optic chiasm. usually leads to chiasma syndrome presenting with bitemporal hemianopsia. We report a 28-year-old male presenting with left homonymous hemianopsia. Magnetic resonance imaging (MRI) revealed an occupied lesion located in the right side of the optic chiasm, and a clinical diagnosis of chiasmal CM was made. Microsurgical excision was performed via anterolateral pterional craniotomy. The patient showed good recovery with slight improvement of the visual field deficits after the operation. No CM recurrence was discovered during the follow-up MRI scans.
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Affiliation(s)
- Xianbin Ning
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, People's Republic of China
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