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 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.