Neuro-ophthalmic manifestations of intracranial cavernous hemangiomas

To describe the neuro-ophthalmic manifestations of patients with intracranial cavernous hemangiomas (cavernomas).

A retrospective review of all patients with intracranial cavernomas with neuroophthalmic manifestations who were treated at the Royal Adelaide Hospital in Australia between 1994 and 2004.

There were nine patients (three men and six women), with a mean age of 39 years (range 22-61). There was one cerebellar lesion, two thalamic, four pontine, one midbrain/pontine, and one midbrain. Ophthalmic presentations included internuclear ophthalmoplegia (one patient), third cranial nerve (CN) palsy (one patient), fourth CN palsy (one patient), and sixth CN palsy (six patients). Three patients underwent extraocular muscle surgery, and six were treated medically or observed. In five patients the diplopia resolved, in three it was only mild, and in one patient no significant change was noted during the follow-up period.

Diplopia is the main neuro-ophthalmic manifestation of intracranial cavernomas. Sixth CN palsy is the most common cause. Neurosurgical or conservative treatment leads to improvement in most cases, and later use of spectacles or extraocular muscle surgery may lead to further improvement.