Approaches for the Minimally Invasive Resection of Chiasmatic Cavernous Hemangioma: Analysis of 56 Cases in the Literature

Abstract

Background

Chiasmatic cavernous hemangioma (CCH) is a rare disease. Most cases are treated with surgical resection through approaches such as pterional and orbitozygomatic craniotomy. However, with advancements in surgical technique and heightened patient demand for improved postoperative quality of life, there have been reports in recent years exploring more minimally invasive surgical approaches, such as the subfrontal trans-eyebrow keyhole and endoscopic endonasal transsphenoidal approach. In this article, the cases of CCH in the reported literature are reviewed, the indications and techniques of minimally invasive surgery for the removal of CCH through the subfrontal trans-eyebrow keyhole approach are discussed, and the effects of different surgical approaches are analyzed.

Methods

We reviewed the literature on surgical cases of intracranial cavernous hemangiomas (with chiasma as the center) involving the visual pathway published from 2000 to 2023 in PubMed and other relevant databases; ultimately, 55 cases from 37 articles were retrieved, to which we added an additional case, making the total number of cases examined 56. We analyzed the patient's medical records, including pathological symptoms, relationship with the chiasma location, surgical approach, and prognosis.

Results

The analysis of the data of 56 cases indicated that most patients experienced a decrease in visual acuity (64.3%) and visual-field defects (58.9%). Gradual changes in pituitary function were also observed (43.8%). The surgical approach is determined by the location of the lesion. Over the past 5 years, although the pterional (46.4%) approach has remained the most common, the proportion of subfrontal (12.5%) approaches has gradually increased. In the case we report, we found that the lesion in the patient involved the anterior chiasma and the right medial optic nerve. The patient presented with acute visual deterioration, suggesting the possibility of hemorrhage in the hemangioma. We attempted the right-sided subfrontal trans-eyebrow keyhole approach and achieved complete resection of the cavernous hemangioma. Postoperatively, the patient showed improvement in visual acuity and visual field, with obvious recovery observed at the 3-month follow-up.

Conclusions

According to our results, the subfrontal trans-eyebrow keyhole approach for the resection of CCH is mainly suitable for cases in which the lesions are located above and anterior to the optic chiasm, the medial or superior aspect of the intracranial segment of the optic nerve is involved, and there is no invasion into the optic nerve canal. Compared with the traditional surgical approach, the minimally invasive subfrontal trans-eyebrow keyhole approach has demonstrated better clinical outcomes in the resection of CCH. However, according to the specific conditions of different patients, it is still necessary to comprehensively consider the choice of surgical approach. This study provides a valuable reference for further exploration of the treatment of CCH.