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 ().
A 49-year-old female patient presented to our hospital with a 3 years history of right trigeminal neuralgia in the territory of the first division of the trigeminal nerve refractory to the best medical therapy. Neurological examination was normal. Magnetic resonance imaging (MRI) showed multiple CMs, one of which located on the cisternal segment of the right trigeminal nerve []. We performed a right retrosigmoid craniotomy and total removal of the CM. Histopathological study was compatible with a CM. On the follow-up 28 months later the patient is pain and medication free.