PMC4235118_01
Preoperative CC. (a) LE CC: Normal; (b) Supero-inferior arciform defect in the RE
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F1
LE CC was normal [Figure 1].
Noncontrast CT scan reveals a spontaneously hyperdense lesion with a punctuate calcification. (a) Axial; (b) Sagittal; (c) Coronal views
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F2
No evidence of subarachnoid or intraventricular hemorrhage [Figure 2].
CTA demonstrating normal vessels. No lesions were documented
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F3
She completed the diagnostic neuro-imaging evaluation with a CT angiography (CTA) [Figure 3], a magnetic resonance imaging (MRI), and a MR angiography (MRA) of the brain.
Preoperative MRI presenting a lesion affecting the right intracranial prechiasmatic optic nerve (sparing the chiasm). (a) Axial T1W; (b) Sagittal T1W; (c) Coronal T1W; (d) Coronal T2W
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F4
The T1-weighted noncontrasted sequence showed a spontaneously hyperintense lesion [Figures 4a-c]. In the T2-weighted MRI, the lesion exhibited a heterogeneous signal intensity and a peripheral hypointense rim [Figure 4d.
Preoperative MRA: (a) The lesion appears as an hyperintense mass (arrow) due to hemosiderin; (b) 3D reconstruction demonstrating an intimate relation of the right ophthalmic artery (arrow) with the ipsilateral optic mass
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F5
No enlarged vessels were identified [Figure 5].
Intraoperative microsurgical images: (a) Right optocarotid cistern exposition; (b, c) Microsurgical resection of the CM arising from the intracranial segment of the right optic nerve at the entrance of the optic canal; (d) Unroofing of the optic canal through a drilling technique using a 3 mm diamond drill; (e) Opening of the dura of optic canal; (f) Resection of the canalicular component of the CM; (g) Optic nerve and the emergence of the ophthalmic artery after complete removal of the CM
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F6
An intradural optic canal unroofing, through a drilling technique, was performed to completely expose and microsurgically remove the CM [Figure 6].