Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report

Cavernous malformations (CMs) are low-flow vascular lesions with an incidence of 0.1% to 0.7% in the general population. Less than 1% are found in the anterior visual pathway. The most common presenting symptoms are visual disturbances due to hemorrhage and the current standard of treatment is gross...

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Autores principales: DelPino, Brian, Durden, Jake, Deshaies, Eric M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402868/
https://www.ncbi.nlm.nih.gov/pubmed/30868033
http://dx.doi.org/10.7759/cureus.3819
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author DelPino, Brian
Durden, Jake
Deshaies, Eric M
author_facet DelPino, Brian
Durden, Jake
Deshaies, Eric M
author_sort DelPino, Brian
collection PubMed
description Cavernous malformations (CMs) are low-flow vascular lesions with an incidence of 0.1% to 0.7% in the general population. Less than 1% are found in the anterior visual pathway. The most common presenting symptoms are visual disturbances due to hemorrhage and the current standard of treatment is gross total resection. The authors report a case of a 42-year-old male with visual disturbance and findings on T1-weighted magnetic resonance imaging (MRI) suggesting CM of the right optic nerve and right optic chiasm. The patient underwent right pterional craniotomy for gross total resection of the lesion. One year postoperatively, the patient demonstrated improvement in visual deficits with no signs of recurrence on MRI. Thirty-two months postresection, MRI showed a small slightly lobulated area of T1 hyperintense material within the postoperative cavity along the right aspect of the optic chiasm. MRI at 39 months postresection showed previously seen small amounts of T1 hyperintensity in the central and right aspect of the optic chiasm, with significantly decreased conspicuity. These findings suggest a trace amount of recurrence in the 32-month postoperative imaging despite overall stable visual field testing. There is a paucity of literature concerning the retreatment of resected CM in the anterior visual pathway. The authors suggest serial imaging as an integral component of CM management. Although repeated visual field testing and clinical follow-up are important aspects of CM management, they are no substitute for the gold standard of MRI.
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spelling pubmed-64028682019-03-13 Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report DelPino, Brian Durden, Jake Deshaies, Eric M Cureus Ophthalmology Cavernous malformations (CMs) are low-flow vascular lesions with an incidence of 0.1% to 0.7% in the general population. Less than 1% are found in the anterior visual pathway. The most common presenting symptoms are visual disturbances due to hemorrhage and the current standard of treatment is gross total resection. The authors report a case of a 42-year-old male with visual disturbance and findings on T1-weighted magnetic resonance imaging (MRI) suggesting CM of the right optic nerve and right optic chiasm. The patient underwent right pterional craniotomy for gross total resection of the lesion. One year postoperatively, the patient demonstrated improvement in visual deficits with no signs of recurrence on MRI. Thirty-two months postresection, MRI showed a small slightly lobulated area of T1 hyperintense material within the postoperative cavity along the right aspect of the optic chiasm. MRI at 39 months postresection showed previously seen small amounts of T1 hyperintensity in the central and right aspect of the optic chiasm, with significantly decreased conspicuity. These findings suggest a trace amount of recurrence in the 32-month postoperative imaging despite overall stable visual field testing. There is a paucity of literature concerning the retreatment of resected CM in the anterior visual pathway. The authors suggest serial imaging as an integral component of CM management. Although repeated visual field testing and clinical follow-up are important aspects of CM management, they are no substitute for the gold standard of MRI. Cureus 2019-01-03 /pmc/articles/PMC6402868/ /pubmed/30868033 http://dx.doi.org/10.7759/cureus.3819 Text en Copyright © 2019, DelPino et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Ophthalmology
DelPino, Brian
Durden, Jake
Deshaies, Eric M
Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title_full Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title_fullStr Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title_full_unstemmed Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title_short Postoperative Management of Anterior Visual Pathway Cavernoma, a Unique Perspective: Case Report
title_sort postoperative management of anterior visual pathway cavernoma, a unique perspective: case report
topic Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402868/
https://www.ncbi.nlm.nih.gov/pubmed/30868033
http://dx.doi.org/10.7759/cureus.3819
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