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.
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.