Optic Pathway Cavernous Malformations: a systematic review of clinical course and treatment outcomes

As malformações cavernosas da via óptica são extremamente raras e muitas vezes podem ser esquecidas quando se pensa no diagnóstico diferencial de lesões que afetam a função visual. Os autores revisaram a literatura de 34 casos relatados para investigar a evolução clínica, estudos de imagens, abordagens cirúrgicas e resultados. A revisão foi realizada nos bancos de dados PubMed e Embase para relatos de casos entre 2000 e 2021. Em todos os casos, os sintomas mais prevalentes foram: distúrbios visuais (94,1%), seguido de cefaleia (44,1%) e dois pacientes eram assintomáticos. A ressonância magnética (RMI) foi o exame de escolha para o diagnóstico da malformação cavernosa, mostrando principalmente sinais de intensidade mista. Alguns outros exames podem ser utilizados para auxiliar no diagnóstico, como a tomografia computadorizada. Nos casos analisados 85,2% relataram tratamento cirúrgico, mas apenas 44,8% foram ressecções totais. Sobre o desfecho, 41,3% dos pacientes relataram melhora dos defeitos do campo visual e dois desenvolveram diabetes insípido após a cirurgia. A malformação cavernosa é um diagnóstico diferencial importante e deve ser considerado. A RMI é o exame mais importante para se chegar ao diagnóstico e o tratamento cirúrgico pode melhorar o resultado.

Cavernous malformations (CM) of the optic pathway are extremely rare and often can be forgotten when thinking about a differential diagnosis of lesions affecting the visual function. The authors reviewed the literature of 34 reported cases to investigate the clinical course, image studies, surgical approaches and outcomes. The review was performed on PubMed and Embase databases searching for case reports between 2000 and 2021. The most prevalent symptom was visual disturbances (94.1%) followed by headache (44.1%), and two patients were asymptomatic. Magnetic resonance imaging (MRI) is the exam of choice for cavernous malformation diagnosis, showing mostly mixed intensity signals. Some other exams can be used for helping to find the diagnosis, like computed tomography. In the analyzed cases 85.2% reported surgical treatment, but just 44.8% were total resections. About the outcome 41.3% of the patients reported improvement of the visual field defects and two developed diabetes insipidus after surgery. CM is an important differential diagnosis and should be considered. MRI is the most important exam to achieve the diagnosis and the surgical treatment can improve the outcome.

1.    Sbeih I, Darwazeh R, Shehadeh M, et al. Anterior interhemispheric approach for microsurgical resection of an optic chiasm cavernoma. Interdiscip Neurosurg. 2020;21:100766. http://dx.doi.org/10.1016/j. inat.2020.100766.
2.    Algoet M, Van Dyck-Lippens PJ, Casselman J, et al. Intracanal optic nerve cavernous hemangioma: a case report and review of the literature. World Neurosurg. 2019;126:428-33. http://dx.doi.org/10.1016/j. wneu.2019.02.202. PMid:30876990.
3.    Abou-Al-Shaar H, Bahatheq A, Takroni R, Al-Thubaiti I. Optic chiasmal cavernous angioma: a rare suprasellar vascular malformation. Surg Neurol Int. 2016;7(19, Suppl. 18):S523. http:// dx.doi.org/10.4103/2152-7806.187495. PMid:27583178.
4.    Paladino J, Rotim K, Pirker N, Gluncić V, Jurić G, Kalauz M. Minimally invasive treatment of cavernous angioma of the optic chiasm: case report. Minim Invasive Neurosurg. 2001;44(2):114-6. http://dx.doi. org/10.1055/s-2001-16008. PMid:11487797.
5.    Grob SR, Campbell AA, Gross A, Cestari DM. Hemorrhage within the optic nerve from a cavernous hemangioma of the optic disc. J Neuroophthalmol. 2015;35(3):277-9. http://dx.doi.org/10.1097/ WNO.0000000000000274. PMid:26132965.
6.    Newman H, Nevo M, Constantini S, Maimon S, Kesler A. Chiasmal cavernoma: a rare cause of acute visual loss improved by prompt surgery. Pediatr Neurosurg. 2008;44(5):414-7. http://dx.doi. org/10.1159/000149911. PMid:18703890.
7.    Trentadue M, Pozzi Mucelli R, Piovan E, Pizzini FB. Incidental optochiasmatic cavernoma: case report of an unusual finding on 3 Tesla MRI. Neuroradiol J. 2016;29(4):289-94. http://dx.doi. org/10.1177/1971400916648335. PMid:27145992.
8.    Gonçalves VM, Gonçalves V. Surgical management of cavernous malformation of the optic nerve with canalicular extension. Surg Neurol Int. 2014;5(13, Suppl. 12):S455-60. http://dx.doi.org/10.4103/2152- 7806.143723. PMid:25422788.
9.    Alafaci C, Grasso G, Granata F, et al. Cavernous malformation of the optic chiasm: an uncommon location. Surg Neurol Int. 2015;6(1):60. http://dx.doi.org/10.4103/2152-7806.155256. PMid:25949848.
10.    Muta D, Nishi T, Koga K, Yamashiro S, Fujioka S, Kuratsu J-I. Cavernous malformation of the optic chiasm: case report. Br J Neurosurg. 2006;20(5):312-5. http://dx.doi.org/10.1080/02688690601000238. PMid:17129880.
11.    Hempelmann RG, Mater E, Schröder F, Schön R. Complete resection of a cavernous haemangioma of the optic nerve, the chiasm, and the optic tract. Acta Neurochir. 2007;149(7):699-703. http://dx.doi.org/10.1007/ s00701-007-1163-8. PMid:17502987.
12.    Uppal S, Walker RA, Atkins EJ. Cavernous malformation of the optic chiasm - a diagnostic and treatment dilemma. Can J Neurol Sci. 2012;39(4):533-5. http://dx.doi.org/10.1017/S0317167100014104. PMid:22728866.
13.    Mano Y, Kumabe T, Saito R, Watanabe M, Tominaga T. Cavernous malformation of the optic pathway mimicking optic glioma: a case report. Childs Nerv Syst. 2014;30(10):1753-8. http://dx.doi.org/10.1007/ s00381-014-2465-9. PMid:24990123.
14.    Tomita Y, Fujii K, Kurozumi K, et al. Cavernous malformation of the optic chiasm with continuous hemorrhage in a pregnant woman: a case report. Interdiscip Neurosurg. 2019;18:100489. http://dx.doi. org/10.1016/j.inat.2019.100489.
15.    Ozer E, Kalemci O, Yücesoy K, Canda S. Optochiasmatic cavernous angioma: unexpected diagnosis. Case report. Neurol Med Chir (Tokyo). 2007;47(3):128-31. http://dx.doi.org/10.2176/nmc.47.128. PMid:17384496.
16.    Ning X, Xu K, Luo Q, Qu L, Yu J. Uncommon cavernous malformation of the optic chiasm: a case report. Eur J Med Res. 2012;17(1):24. http:// dx.doi.org/10.1186/2047-783X-17-24. PMid:22892383.
17.    Crocker M, Desouza R, King A, Connor S, Thomas N. Cavernous hemangioma of the optic chiasm: a surgical review. Skull Base. 2008;18(3):201-12. http://dx.doi.org/10.1055/s-2007-1023231. PMid:18978967.
18.    Panczykowski D, Piedra MP, Cetas JS, Delashaw JB Jr. Optochiasmatic cavernous hemangioma. Br J Neurosurg. 2010;24(3):301-2. http:// dx.doi.org/10.3109/02688691003780026. PMid:20465461.
19.    Shaikh A, Benjamin L, Kerr R. Chiasmal cavernous angioma. a rare case of progressive visual loss. Eye (Lond). 2002;16(5):655-7. http:// dx.doi.org/10.1038/sj.eye.6700103. PMid:12194090.
20.    Sun X-Y, Yu F. Microsurgical resection of a cavernous angioma that involves the optic pathway using a pterional approach: a case report and literature review. Br J Neurosurg. 2012;26(6):882-5. http://dx.doi. org/10.3109/02688697.2012.685820. PMid:22577850.
21.    Nishi T, Kaji M, Koga K, et al. Clipping on crossed wrapping method for ruptured blood blister-like aneurysm of the internal carotid artery: technical note and long-term results. World Neurosurg X. 2019;2:100005. http://dx.doi.org/10.1016/j.wnsx.2018.100005. PMid:31218280.
22.    Marnat G, Gimbert E, Berge J, Rougier M-B, Molinier S, Dousset
V. Chiasmatic cavernoma haemorrhage: to treat or not to treat? Concerning a clinical case. Neurochirurgie. 2015;61(5):343-6. http:// dx.doi.org/10.1016/j.neuchi.2015.05.005. PMid:26249271.
23.    Kehagias DT. A case of headache and disordered vision: cavernous hemangioma of the optic chiasm (2003:8b). Eur Radiol. 2003;13(11):2552-3. http://dx.doi.org/10.1007/s00330-003-1976-7. PMid:14631971.
24.    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34. http://dx.doi.org/10.1016/j.jclinepi.2009.06.006. PMid:19631507.
25.    Deshmukh VR, Albuquerque FC, Zabramski JM, Spetzler RF. Surgical management of cavernous malformations involving the cranial nerves. Neurosurgery. 2003;53(2):352-7. http://dx.doi.org/10.1227/01. NEU.0000073531.84342.C2. PMid:12925251.
26.    Glastonbury CM, Warner JEA, MacDonald JD. Optochiasmal apoplexy from a cavernoma. Neurology. 2003;61(2):266. http://dx.doi. org/10.1212/01.WNL.0000073981.50045.74. PMid:12874417.
27.    Son DW, Lee SW, Choi CH. Cavernous malformation of the optic chiasm: case report. J Korean Neurosurg Soc. 2008;44(2):88-90. http:// dx.doi.org/10.3340/jkns.2008.44.2.88. PMid:19096699.
28.    Cerase A, Franceschini R, Battistini S, Maria Vallone I, Penco S, Venturi C. Cavernous malformation of the optic nerve mimicking optic neuritis. J Neuroophthalmol. 2010;30(2):126-31. http://dx.doi. org/10.1097/WNO.0b013e3181ceb428. PMid:20351573.
29.    Jo KW, Kim SD, Chung EY, Park IS. Optochiasmatic cavernous angioma with rapid progression after biopsy despite radiation therapy. J Korean Neurosurg Soc. 2011;49(2):120-3. http://dx.doi.org/10.3340/ jkns.2011.49.2.120. PMid:21519502.
30.    Murai Y, Adachi K, Koketsu K, Teramoto A. Indocyanine green videoangiography of optic cavernous angioma - case report -. Neurol Med Chir. 2011;51(4):296-8. http://dx.doi.org/10.2176/nmc.51.296. PMid:21515953.
31.    Ramina K, Ebner FH, Ernemann U, Tatagiba M. Surgery of cavernous hemangioma of the optic nerve: case report and review. J Neurol Surg A Cent Eur Neurosurg. 2013;74(4):265-70. PMid:22855320.
32.    Takeda R, Fushihara G, Okada D, Kurita H. Rare and treatable cause of progressive visual loss. Neurol Clin Pract. 2013;3(2):171-2. http:// dx.doi.org/10.1212/CPJ.0b013e31828d9f3e. PMid:29473605.
33.    Katta M, Mehta H, Ho I, Garrick R, Chong R. Optical coherence tomography imaging of optic disc cavernous haemangioma. J Clin Neurosci. 2016;33:234-5. http://dx.doi.org/10.1016/j.jocn.2016.04.010. PMid:27469415.
34.    Rani PK, Peguda HK, Kaliki S, Chhablani J. Reverse fluorescein cap sign of cavernous haemangioma of optic nerve on OCT angiography. BMJ Case Rep. 2016;2016:bcr2016218176. http://dx.doi.org/10.1136/ bcr-2016-218176. PMid:27932437.
35.    Ribeiro BNF, Muniz BC, Wilner NV, Gasparetto EL, Marchiori E. Optochiasmatic cavernous malformation: a rare cause of acute vision loss. Arq Neuropsiquiatr. 2017;75(6):407. http://dx.doi.org/10.1590/0004- 282x20170065. PMid:28658413.
 36.    Kakuta K, Asano K, Katayama K, Kurose A, Ohkuma H. Cavernous angioma of the optic chiasma: a case report. Jpn J Neurosurg. 2021;30(6):462-8. http://dx.doi.org/10.7887/jcns.30.462.
37.    Zoia C, Bongetta D, Dorelli G, Luzzi S, Maestro MD, Galzio RJ. Transnasal endoscopic removal of a retrochiasmatic cavernoma: a case report and review of literature. Surg Neurol Int. 2019;10:76. http:// dx.doi.org/10.25259/SNI-132-2019. PMid:31528414.