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 [].
A 40-year-old female patient came to our attention with complains of sudden headache and vision loss. Examination revealed bitemporal hemianopia, diminished visual acuity in both eyes and nuchal rigidity. MRI showed multiple CMs, one of which localized in the optic chiasm, revealing recent bleeding \n[]. The patient had undergone four previous craniotomies at another institution for removal of bleeding CMs in different locations without sequelae. The senior author (JAMC) decided to perform emergent surgical exploration through a right pterional craniotomy, removing the clot and the lesion. Histopathological examination was reported as a CM. On the follow-up, the vision improved and the patient is capable of reading and driving, but 11 years after the surgery a right homonymous hemianopsia persists.