Cavernous hemangioma of the intracranial optic pathways: CT and MRI

Purpose: The purpose of this work was to describe the CT and MR findings in three patients with cavernous hemangioma (CH) of the intracranial optic pa thways. Method: CT and MR studies of three patients with CH of the optic chiasm wer e reviewed. All patients underwent MRI of the chiasmal area, with coronal T 2- and T1-weighted studies as well as gadolinium-enhanced coronal and sagit tal T1-weighted studies. Results: The patients (mean age, 40 years) presented with chiasmal apoplexy (two cases) and progressive decrease of visual acuity tone case). In all c ases, MRI showed regular enlargement of the optic chiasm, with extension to the optic nerve in one case and to the left optic tract in one case. The c hiasmatic dimension was 2.5-3 cm in two cases and 1-1.5 cm in the other cas e. In all cases, MRI revealed an acute (isointense signal on T1-weighted an d hypointense signal on T2-weighted sequences) or subacute (hyperintense si gnal on T1- and T2-weighted sequences) hemorrhage with, adjacent to it, an area with signals of blood of different ages, highly suggestive of CH. CT s howed, in chiasmatic CHs, a suprasellar mass spontaneously denser than adja cent brain parenchyma. In two cases, microcalcifications were associated. I n two cases, CT and MRI revealed slight heterogeneous enhancement after con trast agent administration. In one case, no enhancement was observed. Two p atients underwent surgery by front-opterional craniotomy. The optic chiasma were swollen with an intrinsic bluish mass. The cerebrospinal fluid was no t xanthochromic. Microscope examination confirmed the diagnosis of CH. Afte r 12 months, the operated patients had improved visual acuity and visual fi eld but did not completely recover. The nonoperated patient (because of spo ntaneous rapid recovery of visual acuity) was followed clinically and on MR I over 18 months. Conclusion: CH in the optic chiasm must be suspected in the presence of an acute chiasmatic syndrome. MRI is the best imaging modality, showing either an acute or a subacute chiasmatic hemorrhage or the typical pattern of CH with heterogeneous alternation of foci of blood of different ages, with a c entral focus of methemoglobin, a peripheral rim of hemosiderin, adjacent fo ci of acute or subacute hemorrhage, and slight or no enhancement after gado linium administration.