A 42-year-old woman presented with a 6-day history of severe headache and a 3-day history of blurred vision. She had visual field defect in the confrontation test with no other neurological deficits. Ophthalmologic evaluation revealed central scotoma on both eyes () with normal visual acuity. Funduscopic examination showed intact optic discs with no abnormalities. A computed tomography scan showed a 1.3 cm high density ovoid lesion in the right suprasellar area (). Magnetic resonance (MR) imaging showed that the lesion was hypointense in the T2-weighed and T2* gradient-echo (GRE) images and isointense in the T1-weighted images with no vascular abnormalities (). Transfemoral cerebral angiography did not reveal any vascular abnormalities. On the presumptive diagnosis of a hemorrhagic mass such as thrombosed aneurysm, meningioma or CM, craniotomy was performed via a right supraorbital keyhole approach to relieve the mass effect. Once the frontal lobes were retracted, a mulberry-shaped lesion was present at the junction of the right optic nerve and optic chiasm with no connection to the anterior cerebral artery (). The mass was completely removed with no damage to the optic apparatus Histologic analysis confirmed a diagnosis of CM (). The patient made an uneventful recovery after surgery. One year after surgery, the patient's visual symptoms remained unchanged.
A 27-year-old gentleman, presented with 3 months history of blurring of vision associated with headache. There was no history of loss of consciousness, seizures, or weakness in limbs. Visual examination showed acuity of 6/6 bilaterally with left temporal field defect.\nMRI of brain, T1W, T2 axial, contrast and multiplanar sequences were performed which showed evidence of lobulated mixed signal intensity lesion seen in the optic chiasm, measuring 18 × 11 mm. Multiple hemorrhagic foci of varying sizes were seen within the lesion. No obvious enhancement was seen after IV contrast material injection. On the right side, the lesion was extending anteriorly up to the optic canal and superiorly abutting the hypothalamus. The features were suggestive of CM of the optic chiasm [Figures and ].\nThe lesion was removed neuro-endoscopically through the trans-nasal trans-sphenoidal route. After reaching the sella, dura opened and the pituitary gland was displaced. Under-surface of chiasm was visualized. The lesion was seen on the surface with brownish discoloration. A small incision was made and the lesion could be removed. Post–operatively, there was a transient worsening left temporal field defect. The histopathological examination and features are consistent with organizing hematoma.