A 17-year-old boy complained of a 2-month history of visual field defects. Two months prior to this, he experienced sudden deterioration of visual acuity on his left eye and visual field defects on the right. His symptoms remained unchanged for the next 2 months. Upon admission, his visual acuity was 0.05 in the left eye and 0.7 in the right eye. Goldmann perimetry field test showed right homonymous hemianopsia without left eye foveal sparing. Brain MR imaging showed a poorly enhanced lesion 1.9 × 1.7 × 2.1 cm in size in the posteroinferior aspect of the optic chiasm (). The mass extended to the perimesencephalic cistern with multiple stages of hemorrhage. A differential diagnosis included CM, craniopharyngioma and germ cell tumor. To decompress the mass effect around the optic chiasm and improve the patient's visual symptoms, surgical decompression via subfrontal interhemispheric approach was performed. A brownish discoloration was noted around the left side of optic chiasm and tract. A dark chocolate-colored hematoma gushed out, and a mulberry-like lesion was removed. The pathological diagnosis was consistent with the CM. The postoperative MR imaging showed partial resection of CM (). At the patient's 1-year follow-up, his visual acuity improved (1.0/0.4), although visual field defect remained unchanged. However, 2 years after the first operation, the patient complained of worsening visual acuity (0.3/finger count 10 cm). Visual field examination showed impairments in which the left eye only detected the right lower quadrant in the visual field and the right eye had nasal hemianopsia. MR imaging revealed recurrent bleeding (). The patient underwent a second operation resulting in a partial resection. Immediately following the second operation, his visual acuity (0.4/finger count 10 cm) and field improved slightly.
A 40-year-old female patient came to our attention with complains of sudden headache and vision loss. Examination revealed bitemporal hemianopia, diminished visual acuity in both eyes and nuchal rigidity. MRI showed multiple CMs, one of which localized in the optic chiasm, revealing recent bleeding \n[]. The patient had undergone four previous craniotomies at another institution for removal of bleeding CMs in different locations without sequelae. The senior author (JAMC) decided to perform emergent surgical exploration through a right pterional craniotomy, removing the clot and the lesion. Histopathological examination was reported as a CM. On the follow-up, the vision improved and the patient is capable of reading and driving, but 11 years after the surgery a right homonymous hemianopsia persists.