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Opto-chiasmatic apoplexy as a compartment syndrome? Anatomical and surgical considerations on two bleeding cavernous malformations
Clinical Neurology and Neurosurgery ( IF 1.9 ) Pub Date : 2021-02-01 , DOI: 10.1016/j.clineuro.2020.106439
Alessandro Fiorindi 1 , Paolo Gallinaro 2 , Elisabetta Marton 2 , Giuseppe Canova 2 , Marco M Fontanella 1 , Pierluigi Longatti 3
Affiliation  

OBJECTIVE Opto-chiasmatic (OC) cavernous malformations are sporadic lesions that are often misdiagnosed clinically and radiologically. Presenting symptoms range from incidental findings to the more frequent and dramatic "chiasmal apoplexy." The present study aims to evaluate the potential role of arachnoidal membranes of the basal cisterns in the onset of OC apoplexy. A possible mechanism resembling a compartment syndrome is discussed through the description of two cases of bleeding cavernomas. METHODS We describe clinical, radiological, intraoperative findings in two cases of young patients presenting with OC apoplexy from bleeding cavernoma. The first was a 38-year-old man diagnosed with optic neuritis at the first episode of visual acuity deterioration. The second patient was a 22 -year-old woman who suffered two OC apoplexy episodes from a recurrence, which also presented with bleeding. RESULTS Both patients were operated on via pterional craniotomy and presented a postoperative improvement of visual symptoms. The second patient experienced deterioration 30 months after surgical resection due to rebleeding from a recurrence and required a second operation. Follow-up revealed a good recovery of visual disturbances; MRI at 6 and 3 years showed in both patients an apparent complete removal of the cavernous malformations. CONCLUSION The cisternal environment where OC cavernous malformations develop and the paradigm of a compartment syndrome could explain the clinical presentation variability. This very rare subset of cavernomas would benefit from a classification system using ad hoc neuroimaging protocols and consistent indications.

中文翻译:

作为隔室综合征的视交叉中风?两种出血性海绵状血管畸形的解剖和手术考虑

目的视交叉 (OC) 海绵状血管畸形是散发性病变,在临床和放射学上经常被误诊。呈现的症状范围从偶然发现到更频繁和戏剧性的“交叉性中风”。本研究旨在评估基底池蛛网膜在 OC 中风发作中的潜在作用。通过对两例海绵状血管瘤出血病例的描述,讨论了类似于隔室综合征的可能机制。方法 我们描述了两例因海绵状血管瘤出血而出现 OC 中风的年轻患者的临床、放射学和术中发现。第一个是一名 38 岁的男性,在视力下降的第一次发作时被诊断出患有视神经炎。第二名患者是一名 22 岁的女性,她因复发而遭受两次 OC 中风发作,并伴有出血。结果 2例患者均经翼点开颅手术,术后视力症状均有改善。第二名患者在手术切除后 30 个月因复发再次出血而病情恶化,需要进行第二次手术。随访显示视力障碍恢复良好;6 年和 3 年时的 MRI 显示,两名患者的海绵状血管畸形均明显完全切除。结论 发生 OC 海绵状血管畸形的脑池环境和筋膜室综合征的范式可以解释临床表现的变异性。
更新日期:2021-02-01
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