A 26-year-old man was admitted for recurrent headaches, loss of vision in his left eye, and elevated blood pressure. His loss of sight had been gradual, manifesting for over six months before hospitalization. He also exhibited episodes of inadequate behavior with some aggression. The patient was conscious at admission, and no other meningeal or focal neurological symptoms were found. The patient consented to publication of his protected health information.\nHis right and left eyes had logarithm of the minimum angle of resolution visual acuities of 1.0 and 0.2, respectively. T1-weighted magnetic resonance imaging (MRI) showed a hyperintense signal mass lesion occupying his chiasm and left ON (Figure ). These findings led to a diagnosis of high-grade glioma of the chiasm and left ON, or CM.\nSurgery was performed with the patient in the supine position, with his head slightly elevated and turned to the right side about 30 degrees. A left frontolateral craniotomy was performed to optimize the approach to the chiasm and left ON. Fenestration of the basal cistern and aspiration of cerebrospinal fluid yielded a relaxed brain with satisfactory gravity retraction. The left optic canal was unroofed, and several blood clots at different stages of resorption were evacuated through the longitudinal dissection of the ON. Minimal coagulation currents were applied to occlude the feeding vessels with their sharp sections. Resection was estimated to be gross total (Video ).\nThere were no surgical complications, and MRI performed six months later showed no signs of CM recurrence (Figure ). The patient was discharged after seven days, and his vision returned to normal three months later. He is still in touch with us and has reported no signs of visual deterioration or recurrent bleeding.\nThe microscopic structure of the resected CM with heterochromous thromboses is shown in Figure .
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 [].