Gyrus Rectus Herniation Causing Visual Pathway Compression in Children: A Case report with Updated Literature Review

Gyrus rectus herniation (GRH) compressing the anterior visual pathway is a rare cause of visual disturbance in the paediatric population, most often secondary to a neoplastic or dysplastic process; true idiopathic herniation is uncommon. We present two cases of male children with GRH compressing the optic nerve and/or optic chiasm. The first patient is a 12-year-old boy who presented with unilateral visual loss without trauma, managed conservatively with complete resolution of symptoms and radiologically stable findings on six-year follow-up. The second patient is an 11-year-old boy who presented with bilateral visual loss following a road traffic accident; MRI demonstrated incidental right gyrus rectus herniation abutting the optic chiasm in the context of traumatic optic neuropathy. These cases illustrate the fact that GRH can deform the paediatric anterior visual pathway, and may represent either a potentially contributory finding or an incidental anatomical variant, emphasizing the importance of clinical concordance.