Cavernous Hemangioma of the Optic Chiasm: A Surgical Review

 

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ABSTRACT

Objectives: To report a new case of cavernous hemangioma of the optic chiasm and to review all previously published cases with regard to presentation, surgical treatment, and outcomes. Design: Case report and literature review. Main Outcome Measures: Cases identified though PubMed and published literature. Presentation states of patients in terms of visual loss and pituitary function. Surgical approaches, operations performed, and outcomes of the surgery. Results: thirty-nine previously reported cases were studied with the present case. All 40 patients presented with visual failure. Where documented, there was an 20% pituitary dysfunction rate. A total of 32 craniotomies were reported. Seventy-eight percent of patients underwent decompression including hematoma evacuation and partial or complete removal of the cavernoma, with improvement in visual function in 87% of these patients. The patients undergoing only biopsy showed stable visual function in 50% with further deterioration in 50%. Conclusions: We conclude that this rare condition can be managed with good outcomes in terms of visual improvement, provided a high index of suspicion is maintained and the goals of surgery for emergency patients are maintained to include chiasmal decompression. Although complete resection of the lesion is frequently possible, it should not be the primary aim of surgery.

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Matthew CrockerM.R.C.S. 

Specialist Registrar, Department of Neurosurgery

St George's Hospital, Tooting, London SW17 0QT, United Kingdom

Email: matthewcrocker@blueyonder.co.uk