Cognitive impairment associated with suprasellar cavernous malformation: A case report and review of the literature.

Background: Cavernous malformations (CMs) are benign vascular anomalies that most commonly occur in intra-axial locations but rarely develop in the suprasellar region. Suprasellar CMs pose unique diagnostic and therapeutic challenges due to their proximity to critical neurovascular structures, such as the optic chiasm, pituitary stalk, and hypothalamus. Although visual disturbances and headaches are typical symptoms of suprasellar CMs, cognitive impairment, especially memory loss, has rarely been reported.

Case description: We present the case of a 58-year-old woman who developed progressive memory impairment for over 1 year. Magnetic resonance imaging revealed a 2.5 cm heterogeneous, lobulated lesion in the suprasellar region, exerting a mass effect on the optic chiasm and hypothalamus. The patient underwent endoscopic endonasal transsphenoidal resection with pituitary hemitransposition to achieve complete removal of the lesion. Pathological examination confirmed the diagnosis of CM. At the 6-month follow-up, the patient demonstrated modest improvement in memory function, which remained stable through the extended follow-up period of 31 months.

Conclusion: This case highlights the rare presentation of memory impairment in suprasellar CM and underscores the importance of considering CMs in the differential diagnosis of suprasellar lesions. The endoscopic endonasal approach with pituitary hemitransposition provides an effective surgical pathway that allows complete resection. Early diagnosis and tailored surgical intervention may improve outcomes of patients with a suprasellar CMs. Further research is necessary to understand the relationship between suprasellar CMs and cognitive dysfunction.