Intra-Canal Optic Nerve Cavernous Haemangioma: A Case Report & Review Of The Literature.

BACKGROUND: Cerebral cavernous malformations (CCM) of the intracanalicular optic nerve are extremely rare lesions. Only a few case reports and one case series have been published about this subject. We report an additional case with atypical imaging and review the existing literature with attention for time to surgery and imaging characteristics.

CASE DESCRIPTION: A 38-year-old man with progressive visual field deficit was diagnosed with a lesion compressing the left optic nerve in the optic canal. On magnetic resonance imaging (MRI), this lesion had a homogenous signal and was tentatively diagnosed as a meningioma. A neuro-navigated left frontolateral craniotomy with extradural skull base approach was performed for resection and definitive diagnosis of the lesion. Pathological examination showed a lesion most consistent with a cavernous haemangioma. A follow-up MRI at 6 months showed no remaining tissue nor recurrence. Clinically there was a subjective and objective improvement of sight.

CONCLUSION: A CCM should always be in the differential diagnosis of a lesion causing an optic neuropathy with visual acuity loss and visual field defect. Clinical presentation of an optic neuropathy requires medical imaging, MRI is the modality of choice in the diagnosis of these lesions. The treatment of CCM is gross-total resection.