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Tomita, Yusuke Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Fujii, Kentaro Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Kurozumi, Kazuhiko Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences ORCID Kaken ID publons researchmap
Imoto, Ryoji Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Mitsui, Takashi Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Mishima, Sakurako Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Inagaki, Kenichi Department of Endocrine Center, Okayama University Hospital Kaken ID publons
Masuyama, Hisashi Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kaken ID publons researchmap
Date, Isao Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences ORCID Kaken ID publons researchmap
Abstract
Background Cavernous malformation of the anterior visual pathway is rare, especially in pregnant woman. Planning a treatment strategy with cross-disciplinary specialists is important.
Case description A 27-year-old pregnant woman presented with acute hemorrhage around the right optic nerve and chiasm, manifesting as poor vision in both eyes. Examination revealed right-eye deteriorated acuity and bilateral temporal hemianopsia. Computed tomography showed an oval high-density mass in the suprasellar region. Gradient echo-based T2-weighted magnetic resonance imaging showed the lesion to be hypointense (possibly a hematoma) and mainly in the optic chiasm. Fluid attenuated inversion recovery imaging showed a bilateral optic tract surrounding the lesion, which enlarged over 1 week, increasing the loss of visual function. Five days after admission, she delivered a healthy >2500-g baby by cesarean section (CS). Right frontotemporal craniotomy was performed 7 days after CS. Incision of the right optic nerve's lateral surface revealed clotted blood with abnormal vascular construction from the right side of the chiasm. We removed the hematoma and vascular lesion. Visual evoked potentials were detected only after optic chiasm decompression. Histological evaluation revealed a hematoma-like lesion with capsules and hemosiderin deposition, suggesting cavernous malformation. Her postoperative recovery was uneventful, with right visual acuity returning to normal, and her visual field not deteriorating any more.
Conclusion Devising a treatment strategy with the obstetrician was important in this case to manage the hematoma and cavernous malformation safely.
Keywords
Optic nerve
Cavernous hemangioma
Pregnant
Visual evoked potential
Published Date
2019-12-31
Publication Title
Interdisciplinary Neurosurgery
Volume
volume18
Publisher
Elsevier
Start Page
100489
ISSN
22147519
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
Copyright Holders
© 2019 The Authors. Published by Elsevier B.V.
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isVersionOf https://doi.org/10.1016/j.inat.2019.100489
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http://creativecommons.org/licenses/by-nc-nd/4.0/
Citation
Yusuke Tomita, Kentaro Fujii, Kazuhiko Kurozumi, Ryoji Imoto, Takashi Mitsui, Sakurako Mishima, Kenichi Inagaki, Hisashi Masuyama, Isao Date, Cavernous malformation of the optic chiasm with continuous hemorrhage in a pregnant woman: A case report, Interdisciplinary Neurosurgery, Volume 18, 2019, 100489, ISSN 2214-7519, https://doi.org/10.1016/j.inat.2019.100489.
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OA
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