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Updated: Aug 12, 2026
Optic Nerve Transection: A Model of Adult Neuron Apoptosis in the Central Nervous System
Published on: May 12, 2011
Microsurgical resection of an intrinsic optic nerve cavernous malformation through a transsylvian approach:
Oguz Baran1, Furkan Almas1, Talat Kiris2
1Department of Neurosurgery, School of Medicine, Koç University, Istanbul.
Background:
Optic pathway cavernous malformations (CMs) are rare lesions that may cause progressive or fluctuating visual deterioration through recurrent hemorrhage and chronic compression. Optimal management and surgical timing remain controversial.
Observations:
A 30-year-old male presented with progressive right-sided visual decline after recurrent episodes of visual loss since 2018. Initial near-complete visual loss was followed by spontaneous recovery, supporting conservative follow-up. Sustained deterioration later prompted reevaluation. Neuro-ophthalmological examination demonstrated optic disc pallor, retinal nerve fiber layer defects on optical coherence tomography, and severe temporal and inferior visual field deficits. MRI revealed a hemorrhagic lesion intrinsic to the right optic nerve adjacent to the internal carotid artery bifurcation, consistent with a CM. The lesion was resected through a right pterional transsylvian approach with optic canal unroofing and falciform ligament release. Gross-total resection was achieved while preserving the pial vascular supply and surrounding perforators. Postoperative imaging confirmed complete excision, and visual function partially improved at 3 months.
Lessons:
Timely microsurgical treatment may be considered for symptomatic optic nerve CMs with progressive or recurrent visual deterioration before irreversible injury develops. A transsylvian approach with optic canal decompression can provide favorable exposure while limiting manipulation of the optic apparatus and adjacent neurovascular structures. https://thejns.org/doi/10.3171/CASE26503.
