[Cavernous hemangioma of anterior visual pathways--a rare cause of visual loss]

To report cases of cavernous hemangioma (CH) of the anterior visual pathways (AVP) and analyze the cLinical and radiographic presentation, as well as the surgical approach of this very rare entity.

The authors report two cases of patients presenting with headache and visual loss due to anterior visual pathways hemangioma, and conducted a PubMed search for previously reported cases. Each case was analyzed for clinical presentation, imaging characteristics, location of the lesions, treatment methods and visual outcomes.

Loss of vision was present in all reported cases, followed by headache and periorbital pain in 60% of the patients. The onset of symptoms was apoplectic in 66% of patients. Sixteen patients suffered from previous episodes of vision loss. MRI was the most sensitive and specific imaging modality, typically demonstrating heterogeneous lesion with mixed signals suggestive of blood of different ages. The gradient echo sequence is the most sensitive to hemorrhagic components. Most patients were surgically treated (93.2%). In 82% of cases visual stabilization or improvement was achieved. Two patients were treated conservatively resulting in complete blindness in one and spontaneous recovery in the other. The two patients reported by the authors were followed-up with spontaneous visual recovery.

Vascular lesions of the AVP are very rare, but should always be considered in the differential diagnosis of acute painful visual loss. Resection of these lesions can be associated with favorable visual outcomes; therefore, rapid diagnosis is warranted to prevent permanent damage to visual pathways.