Cavernous angioma of the optic chiasm--case report

A 31-year-old female presented with cavernous angioma originating from the optic chiasm manifesting as sudden onset of right retroorbital pain and right visual disturbance. She had a psychomotor seizure 10 years ago. Cavernous angioma at the right basal ganglia had been partially removed at that time. After the operation, the patient had left hemiparesis, but gradually improved. Neurological examination revealed decreased right visual acuity, left homonymous hemianopsia, and left hemiparesis. Magnetic resonance imaging revealed a mixed signal intensity mass at the right optic nerve to the optic chiasm with a low signal intensity rim on T2-weighted imaging, situated at the right basal ganglia where the cavernous angioma had been partially resected. Right frontotemporal craniotomy was performed by the pterional approach. A subpial hematoma was situated at the right optic nerve to the optic chiasm. The hematoma with an angiomatous component was completely resected from the surrounding structure. Histological examination of the specimens confirmed cavernous angioma. Postoperatively, her right visual acuity was slightly improved, but the visual field defect was unchanged. We emphasize the importance of correct diagnosis by magnetic resonance imaging and subsequent resection for preserving and improving the visual function of patients with cavernous angiomas of the optic chiasm.