Anterior interhemispheric approach for microsurgical resection of an optic chiasm cavernoma

Abstract

Background: Optic chiasm cavernoma (OCC) is an uncommon lesion. A limited number of case reports have been published. We report a case of OCC with 48 months follow-up after complete microsurgical resection. Additionally, we provide a pertinent literature review. Case description: A 44-year-old female presented with headaches and decreased visual acuity and visual fields in both eyes for 2 months duration. A complete neurological and ophthalmological exams, as well as preoperative optical coherence tomography (OCT) images, were performed. Magnetic resonance imaging (MRI) showed a suprasellar mass lesion involving the optic chiasm. An inter-hemispheric transbasal approach was performed and complete excision was achieved. Postoperative follow-up showed marked improvement of visual deficits. Histopathologic examination revealed a lesion consistent with a cavernoma. Follow-up brain MRI at 3, 11, 20, 26 and 48 months showed no residual or recurrence. Conclusions: The current case emphasizes that OCC can be completely excised with the dramatic improvement of the visual deficits. Furthermore, MRI is the modality of choice to detect such lesions. Additionally, preoperative OCT can be a good adjuvant technique to predict postoperative-visual-outcome. Moreover, OCC should be included in the differential diagnosis of a space-occupying lesion of the optic chiasm.

Keywords

• Case report
• Cavernoma
• Cavernous malformations
• Optic chiasm
• Optic nerve
• Visual field deficit