A 53-year-old woman was admitted to our institution complaining of a mild fever, severe headache, and progressive visual loss that had started 4 days before. On admission, the general condition of the patient and the results of the gross neurological examination were unremarkable. Goldmann perimetry testing showed bitemporal hemianopsia. Her visual acuity was 20/400 in the right and 20/200 in the left eye. A computed tomography scan showed a hyperdense, hemorrhagic mass measuring approximately 2.5 cm in diameter in the suprasellar region []. A magnetic resonance (MR) imaging scan [ and ] better outlined the mass: it affected both the pituitary stalk and the hypothalamus while reaching cranially the left Monro foramen and compressing the optic nerves and chiasm, a clear signal of an ongoing edema. Cerebral angiography showed no vascular malformation. The results of routine blood and serum examinations were normal. Endocrinological studies of the pituitary function were unremarkable. After 3 days, the patient underwent a gross-total resection of the lesion through an extended endoscopic, endonasal, transsphenoidal route. The resection of the lesion was combined with the opening of the third ventricle through the lamina terminalis. A careful reconstruction of the skull base was performed, with abdominal fat, nasal septal flap, and fibrin glue. After the operation, the visual symptoms improved immediately. On discharge, visual acuity was 20/50 in the right eye and 20/20 in the left eye. The patient had a transient incomplete hypopituitarism and mild diplopia which improved after few weeks. After 1 month, the neurological examination was unremarkable. Postoperative MR scan is showed in and . Histological findings confirmed the presence of a CM, showing hemosiderin, reactive fibrohistiocytic, ectatic vascular channels, and dilated cavernous spaces. On immunohistochemistry, the lesion was positive for CD34 staining, marker for endothelial lining, and was negative for elastin staining, thus ruling out an arteriovenous malformation. See showing the main steps of the endoscopic surgery.\nThe PubMed search engine () was used to perform an internet Medline literature research based on the following keywords “chiasma,” “optic,” “sovrasellar,” “CM,” “endoscopic,” and “transsphenoidal” with different combination. There were no limitations as to the timeframe, language, and publication type on the search process. We also cross-checked the references of the articles retrieved by looking for further papers of potential interest.
A 16-year-old boy presented progressive visual disturbance that started 5 months prior with headache. The headache had subsided; however, the visual symptoms persisted. His visual acuity was 0.02 in his left eye and 0.3 in his right eye. The Goldmann perimetry field test revealed a large central scotoma of his left eye field and a temporal hemianopsia of his right eye field (). Brain MR imaging showed a heterogeneous hemorrhagic mass in the optic chiasm, extending posteriorly along the bilateral optic tracts with no definitive contrast enhancement (). The presumptive diagnosis was an unusual CM involving the optic pathway. Following left pterional craniotomy and sylvian dissection, the optic chiasm, which was mottled with dark dots, was visualized. A small window was made on the lateral side of the optic chiasm. Chocolate-colored tissue mixed with old blood was partially evacuated (). The pathology report confirmed the diagnosis of CM. Following surgery, the patient's visual acuity in his left eye slightly improved (0.03/0.3). The central scotoma of his left eye field had resolved; however, he subsequently acquired a nasal hemianopsia in his left eye field. At the patient's 2-year follow-up, there were no episodes of headache, visual change, or documented bleeding on serial MR imaging ().