Surgical Implication of a Cavernous Hemangioma of the Optic Chiasm Showing Recurrent Hemorrhage After Long-Term Clinical Stability: A Case Report

Cavernous hemangiomas of the optic chiasm are rare, and hemorrhage from cavernous hemangiomas causes acute visual loss. Although some cases have been reported, the appropriate treatment has not been determined yet because of the scarcity of these reports. Here, we describe a patient with recurrent hemorrhage from a cavernous hemangioma of the optic chiasm after a long clinically stable period, and we discuss the surgical implication of this lesion. A 45-year-old man sustained right visual loss due to hemorrhage from a cavernous hemangioma of the optic chiasm 20 years ago and was conservatively observed. He suffered from acute visual loss in the left eye following sudden onset of headache, and he was hospitalized in our hospital. The patient complained of severe visual disturbance in the left eye in addition to long-term right visual loss. Magnetic Resonance Imaging showed recurrent hemorrhage from the lesion, and the whole chiasm was affected. We performed total excision of the lesion, and his vision improved, enabling him to return to work. This is the first report of recurrent hemorrhage from a cavernous hemangioma of the optic chiasm. We recommend surgical resection, even in clinically stable patients, to prevent recurrence.