• Michiel Algoet, Pieter Jan Van Dyck-Lippens, Jan Casselman, Sabriya Sirimsi, Christophe D M Fletcher, Ivo Van Den Berghe, Ludo Vanopdenbosch, Stijn De Muynck, and Nikolaas Vantomme.
• University of Leuven, Leuven, Belgium; Department of Neurosurgery, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium. Electronic address: michielalgoet@hotmail.com.
• World Neurosurg. 2019 Jun 1; 126: 428-433.

BackgroundCerebral 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 DescriptionIn 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.ConclusionsA 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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