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 48-year-old female was admitted with a 6-month history of progressive decrease in the vision. At admission, the neurological examination showed bitemporal hemianopsia and a decreased pupillary reaction to light in both eyes. Fundus oculi examination showed a light papilla bilaterally. The patient did not complain of pituitary dysfunction.\nBrain magnetic resonance imaging (MRI) showed a 2 cm hypointense lesion on T2-weighted images inside the optic chiasm in the suprasellar region. On T1-weighted images, the lesion appeared as an intraaxial lesion inside the optic chiasm without contrast enhancement after gadolinium administration []. The patient underwent cerebral angiography that did not reveal any vascular malformation.\nSurgery was performed via a right pterional approach. The lesion was dissected out from arachnoid adherences and coagulated by using a quantum molecular resonance-based bipolar coagulation (Vesalius®). This device uses a relatively low temperature that does not exceed 45–50°C, having minimum effect on nervous tissues, nerves, and blood vessels. The cavernoma was shrunk and dissected out from the chiasma []. The postoperative course was uneventful. On the 5th day following surgery, the patient underwent ophthalmological examination that revealed improvement in vision on the left eye without changes in the visual field. The histopathological analysis of the resected lesion confirmed the preoperative diagnosis of CM. Five months following the operation, MRI showed complete removal of the vascular lesion [].