[A case of cavernous hemangioma with acute visual disturbance (author's transl)]

The authors report a case of parasellar cavernous hemangioma having grown to the suprasellar region within 3 year's period and showing acute visual disturbance caused by intratumoral hemorrhage. A 44-year-old woman, who had experienced spontaneous intracerebral hematoma in the left inferior frontal lobe 3 years ago and then obtained good recovery in the post-operative period had suddenly developed decreased visual acuity of the left eye without other neurological deficit. CT scan revealed an irregular mass lesion in the chiasmal region, which had a crown-like high density area over the suprasellar low density. Carotid angiogram showed a suprasellar avascular mass and the left A1 segment showed marked narrowing. Neither tumor nor venous pooling was visible in the capillary and venous phase. Surgery disclosed a reddish dark tumor with thin capsular wall, extending from the left cavernous sinus to the suprasellar region, and it was accompanied by intratumoral hemorrhage compressing the left optic nerve. The tumor was subtotally removed. High density area on the precontrast scan was confirmed to be intratumoral hemorrhage and the low density area was of organized tissue due to thrombosis. Histological finding was compatible to cavernous hemangioma. Postoperatively visual acuity of the patient was well recovered, but left 3rd and 6th cranial nerve palsy followed. The authors discussed the mechanism of acute onset and CT findings of the cavernous hemangioma arising in the chiasmal region with a review of literature.