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 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 ().