Michiel Algoet1, Pieter Jan Van Dyck-Lippens2, Jan Casselman3, Sabriya Sirimsi4, Christophe D M Fletcher5, Ivo Van Den Berghe4, Ludo Vanopdenbosch6, Stijn De Muynck7, Nikolaas Vantomme7. 1. University of Leuven, Leuven, Belgium; Department of Neurosurgery, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. Electronic address: michielalgoet@hotmail.com. 2. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium; Department of Neurosurgery, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. 3. Department of Radiology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. 4. Department of Pathology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. 5. Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA. 6. Department of Neurology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. 7. Department of Neurosurgery, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium.
Abstract
BACKGROUND: Cerebral cavernous malformations of the intracanalicular optic nerve are extremely rare lesions. Only a few case reports and 1 case series have been published. We report an additional case with atypical imaging and review the existing literature with attention to time to surgery and imaging characteristics. CASE DESCRIPTION: In a 38-year-old man with progressive visual field deficit, a lesion compressing the left optic nerve in the optic canal was diagnosed. On magnetic resonance imaging, this lesion had a homogeneous signal and was tentatively diagnosed as a meningioma. A left frontolateral craniotomy with extradural skull base approach with neuronavigation was performed for resection and definitive diagnosis of the lesion. Pathologic examination showed a lesion most consistent with a cavernous hemangioma. Follow-up magnetic resonance imaging at 6 months showed no remaining tissue or recurrence. Clinically, there was subjective and objective improvement of sight. CONCLUSIONS: A cerebral cavernous malformation should always be in the differential diagnosis of a lesion causing an optic neuropathy with visual acuity loss and visual field defect. Clinical presentation of an optic neuropathy requires medical imaging; magnetic resonance imaging is the modality of choice in the diagnosis of these lesions. The treatment of cerebral cavernous malformation is gross total resection.
BACKGROUND: Cerebral cavernous malformations of the intracanalicular optic nerve are extremely rare lesions. Only a few case reports and 1 case series have been published. We report an additional case with atypical imaging and review the existing literature with attention to time to surgery and imaging characteristics. CASE DESCRIPTION: In a 38-year-old man with progressive visual field deficit, a lesion compressing the left optic nerve in the optic canal was diagnosed. On magnetic resonance imaging, this lesion had a homogeneous signal and was tentatively diagnosed as a meningioma. A left frontolateral craniotomy with extradural skull base approach with neuronavigation was performed for resection and definitive diagnosis of the lesion. Pathologic examination showed a lesion most consistent with a cavernous hemangioma. Follow-up magnetic resonance imaging at 6 months showed no remaining tissue or recurrence. Clinically, there was subjective and objective improvement of sight. CONCLUSIONS: A cerebral cavernous malformation should always be in the differential diagnosis of a lesion causing an optic neuropathy with visual acuity loss and visual field defect. Clinical presentation of an optic neuropathy requires medical imaging; magnetic resonance imaging is the modality of choice in the diagnosis of these lesions. The treatment of cerebral cavernous malformation is gross total resection.