Suprasellar aneurysm presenting as cavernous hemangioma caused vision impairment: a case report

Abstract

Introduction. Large and thrombosed aneurysms can often be mistaken for a solid mass. Thrombotic intracranial aneurysms are related to worse prognosis and complicated treatment due to massive intra-aneurysmal thrombi and calcifications. Case description. A 10-year-old child presented with progressive visual impairment that worsened over several months. Initially, the patient experienced blurred vision, especially in the peripheral visual field, and later developed headaches, usually localized to the forehead, which worsened during physical activity. The patient also endured episodic nausea and transient loss of consciousness. Neurological examination revealed bitemporal hemianopsia but no other significant neurological deficits. Blood pressure and other vital signs were within normal limits. An initial CT scan revealed a suprasellar mass with calcifications and hemorrhage. CT angiography was performed urgently and the mass did not show significant enhancement, no clear connection with adjacent arteries. In MRI (TW1, T2W FLAIR), a mass with signs of hemorrhage was detected. In MRA (3D TOF) and Digital subtraction angiography – no significant abnormalities were confirmed, however, the MRA result suggested an aneurysm or flow artifacts. As the mass affected the chiasm, the patient was hospitalized for further examination and surgical removal of the mass. It macroscopically resembled an AVM (cavernous hemangioma), but the pathological examination revealed that it was a thrombosed aneurysm compressing the surrounding structures. After surgery, the patient’s vision began to improve, although some impairment remained due to prolonged compression of the optic nerve junction. Summary. We present a case of a thrombosed aneurysm resembling a tumor mass. Conclusions. Early diagnosis is essential to detect aneurysms and thrombosis on time. Instrumental examinations allow accurate assessment of cerebral blood flow, and timely surgical intervention remains vital, as the complications related to pressure on the structures of the brain may be irreversible if the pressure lasts too long.