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Ruparelia J, Patidar R, Gosal JS, Garg M, Jha DK, Vishwajeet V, Tiwari S, Kaur M, Singh S, Bhaskar S. Optochiasmatic Cavernomas: Updated systematic review and proposal of a novel classification with surgical approaches. Neurosurg Rev 2024; 47:53. [PMID: 38238497 DOI: 10.1007/s10143-024-02288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Cavernomas are histologically benign vascular malformations found at different sites in the brain. A rare site for such cavernomas, however, is the anterior optic pathway, comprising the optic nerve, chiasma, and optic tract-called optochiasmatic cavernomas (OCC). These lesions usually present with sudden onset or progressive vision loss, headache, and features mimicking pituitary apoplexy. In this paper, we describe a case of OCC operated at our center. We carry out an updated review of literature depicting cases of OCC, their clinical presentation, management, and postoperative complications. We also propose a novel classification system based on lesion location and further analyze these cavernoma types with respect to the surgical approach used and visual outcome. A 30-year-old lady had presented with a 3-week history of progressive bilateral vision loss and headache. Based on imaging, she was suspected to have a cavernous angioma of the chiasma and left optic tract. Due to progressive vision deterioration, the lesion was surgically excised using pterional craniotomy. Postoperatively, her visual symptoms improved, but she developed diabetes insipidus. Clinical and radiological follow-up has been done for 18 months after surgery. A total of 81 cases have been described in the literature, including the present case. Chiasmal apoplexy is the most common presentation. Surgical excision is the standard of care. Our analysis based on lesion location shows the most appropriate surgical approach to be used for each cavernoma type. Visual outcome correlates with the preoperative visual status. Visual outcome is good in patients presenting with acute chiasmal apoplexy, and when complete surgical excision is performed. The endonasal endoscopic approach was found to provide the best visual outcome. In addition to preoperative visual status, complete surgical excision predicts favorable visual outcomes in OCC. Our proposed classification system guides the appropriate surgical approach required for a particular location of the cavernoma.
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Affiliation(s)
- Jigish Ruparelia
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Rajnish Patidar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Deepak Kumar Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vikarn Vishwajeet
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Sarbesh Tiwari
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Manbir Kaur
- Department of Anesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Sharma R. The rare case of optic nerve cavernoma: A case report depicting the diagnostic challenge. Radiol Case Rep 2024; 19:190-199. [PMID: 38028314 PMCID: PMC10630766 DOI: 10.1016/j.radcr.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
The manuscript describes a case of Cavernous Malformation in the optic pathway which is extremely rare, accounting for less than 1% of central nervous system cavernomas. This case report highlights a patient initially diagnosed with a glioma, but subsequent MRI changes and extensive analysis ruled in favor of a hemorrhagic optic neuropathy caused by an optic nerve cavernoma. The patient experienced temporary vision loss but fully regained her vision within a week. Based on clinical, biochemical, and radiological findings, it was confirmed as a rare case of optic nerve cavernoma, and the patient was managed expectantly due to her complete recovery of vision. Follow-up imaging after 1 year indicated a stable lesion with evolving characteristics consistent with a cavernoma. This study provides an informative review of the condition and highlights the key radiologic features of this disease.
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Xu S, Yang L. Diagnosis and treatment status of suprasellar optic pathway cavernous malformations. J Int Med Res 2023; 51:3000605231219167. [PMID: 38147640 PMCID: PMC10752090 DOI: 10.1177/03000605231219167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023] Open
Abstract
Cerebral cavernous malformations constitute a subtype of cerebral vascular malformation typically located in the cerebral cortex. However, their occurrence in the suprasellar optic pathway is relatively rare. There is some uncertainty surrounding the clinical diagnostic methods and optimal treatment strategies specific to suprasellar optic pathway cavernous malformations. In this narrative review, we retrospectively analyzed relevant literature related to suprasellar visual pathway cavernous malformations. We conducted a study involving 90 patients who were postoperatively diagnosed with cavernous malformations, including the 16-year-old male patient mentioned in this article. We have summarized crucial clinical data, including the patient age distribution, sex ratio, lesion locations, primary symptoms, and surgical approaches. The comprehensive analysis of this clinical information underscores the critical importance of timely intervention in relieving symptoms and improving neurological deficits in affected patients. These findings provide valuable guidance and insight for clinical practitioners and researchers dealing with this specific medical condition.
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Affiliation(s)
- Songbai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Liu Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Srinivasan VM, Koester SW, Wang MS, Rahmani R, Ma KL, Catapano JS, Labib MA, Lawton MT. Cavernous Malformations of the Optic Nerve and Optic Pathway: A Case Series and Systematic Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 21:291-302. [PMID: 34460919 DOI: 10.1093/ons/opab284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although rare, cavernous malformations (CMs) of the optic nerve and anterior optic pathway (optic pathway cavernous malformations [OPCMs]) can occur, as described in several single case reports in the literature. OBJECTIVE To describe the technical aspects of microsurgical management of CMs of the optic pathway on the basis of an extensive single-center experience and review of the literature. METHODS A systematic literature review was performed to augment an earlier review, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In addition, an institutional database was searched for all patients undergoing surgical resection of OPCMs. Patient information, surgical technique, and clinical and radiographic outcomes were assessed. RESULTS Since the previous report, 14 CMs were resected at this institution or by the senior author at another institution. In addition, 34 cases were identified in the literature since the systematic review in 2015, including some earlier cases that were not discussed in the previous report. Most OPCMs were resected via pterional, orbital-pterional, and orbitozygomatic craniotomies. Visual outcomes were similar to those in earlier reports, with 70% of patients reporting stable to normal vision postoperatively. CONCLUSION OPCMs can occur throughout the anterior visual pathway and may cause significant symptoms. Surgery is feasible and should be considered for OPCMs presenting to a surface of the nerve. Favorable results can be obtained with resection, although optimal results are obtained with patients who present with milder symptoms without longstanding damage to the optic apparatus.
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Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michele S Wang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Redi Rahmani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kevin L Ma
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Voznyak O, Lytvynenko A, Maydannyk O, Kalenska O, Hryniv N. Cavernous Hemangioma of the Chiasm and Left Optic Nerve. Cureus 2020; 12:e8068. [PMID: 32420001 PMCID: PMC7224585 DOI: 10.7759/cureus.8068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cavernous malformations (CMs) of the optic nerves, chiasm, and optic tract are very rare. This report describes a 26-year-old man who presented with recurring headaches, loss of vision in his left eye, and elevated blood pressure. After being diagnosed with glioma of the chiasm, he was referred to our department. Magnetic resonance imaging revealed signs of a mass lesion of the left chiasmal area, a finding confirmed after transcranial biopsy. In February 2015, he underwent gross total resection of the cavernous angioma of the chiasm and the left optic nerve. Three months later, the patient's vision returned to normal. The absence of a typical clinical picture and the lack of radiological visualization can hinder pathologic diagnosis. Total microsurgical resection is the optimal treatment strategy for patients with CMs of the chiasm and optic nerve because it usually results in improved vision and long-term benefits. The results in this patient demonstrate the importance of rapid diagnosis and gross total surgical resection of CMs of the chiasm and left optic nerve.
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Affiliation(s)
| | | | - Oleg Maydannyk
- Centre of Neurosurgery, Clinical Hospital "Feofaniya", Kyiv, UKR
| | - Olga Kalenska
- Department of Pathology, Clinical Hospital "Feofaniya", Kyiv, UKR
| | - Nazarii Hryniv
- Department of Neurosurgery, Shupyk National Medical Academy of Postgraduate Education, Kyiv, UKR.,Centre of Neurosurgery, Clinical Hospital "Feofaniya", Kyiv, UKR
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Algoet M, Van Dyck-Lippens PJ, Casselman J, Sirimsi S, Fletcher CD, Van Den Berghe I, Vanopdenbosch L, De Muynck S, Vantomme N. Intracanal Optic Nerve Cavernous Hemangioma: A Case Report and Review of the Literature. World Neurosurg 2019; 126:428-433. [DOI: 10.1016/j.wneu.2019.02.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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