A 63-year-old woman experienced the sudden onset of left retro-orbital pain and left visual disturbance. Neurological examination revealed decreased left visual acuity. Magnetic resonance imaging revealed a mass with mixed signal intensity at the left optic nerve and optic chiasm ([Figure]). Left frontotemporal craniotomy was performed using the pterional approach, and histological examination of the specimens confirmed cavernous malformation. Postoperatively, the patient’s left visual acuity improved slightly, but the visual field defect was unchanged.
Figure MRI, STIR (A,B), and T1-weighted images before (C) and after (D) gadolinium administration, showing the optochiasmatic cavernous malformation (white arrow) surrounded by a hemosiderin ring with no gadolinium enhancement. MRI: magnetic resonance imaging; STIR: short tau inversion recovery.
Cavernous malformations of the optic chiasm are unusual lesions. The presenting symptoms range from progressive vision loss or pituitary disturbances to chiasmal apoplexy syndrome. Symptomatic cavernous malformations of the optic chiasm are generally treated surgically[1],[2].
