Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography

AIM:To evaluate the predictive value of superficial retinal capillary plexus(SRCP)and radial peripapillary capillary(RPC)for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer(pRNFL)and ganglion cell complex(GCC).METHODS:This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery.Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness preand post-operatively and with healthy controls.Logistic regression models were used to assess the relationship between preoperative GCC,pRNFL,SRCP,and RPC parameters and visual field recovery after surgery.RESULTS:The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls.Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values.The best predictive GCC and pRNFL models were based on the superior GCC[area under the curve(AUC)=0.866]and the tempo-inferior pRNFL(AUC=0.824),and the best predictive SRCP and RPC models were based on the nasal SRCP(AUC=0.718)and tempo-inferior RPC(AUC=0.825).There was no statistical difference in the predictive value of the superior GCC,tempo-inferior pRNFL,and tempo-inferior RPC(all P>0.05).CONCLUSION:Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion.This reduction persists despite the recovery of the visual field after decompression surgery.GCC,pRNFL,and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.

Prognostic Value of Retinal Nerve Fiber Layer and Ganglion Cell Complex after Optic Chiasmal Decompression

This paper is an attempt to ascertain the role of the optical coherence tomography by measuring the retinal nerve fiber layer thickness and ganglion cell complex area to predict postoperative visual outcome after chiasmal decompression. 16 eyes scheduled for chiasmal decompression surgery were assessed before and 3 months after surgery with standard automated perimetry and OCT (optical coherence tomography). Preoperative RNFL (retinal nerve fibre layer) thickness and GCC (ganglion cell complex) area were compared with 20 normal control eyes. 13 cases were operated by microscopic assisted endoscopic endonasal transsphenoidal approach;the remaining 3 cases were operated transcranially. Spearman’s correlation analysis was used to evaluate the relationship between preoperative RNFL thickness, GCC area, postoperative mean deviation and temporal visual field sensitivity (1/Lambert). Preoperative measurements of RNFL thickness and all GCC area were significantly reduced in the patients compared with normal control. 3 months postoperative evaluation showed improvement of the visual field, but reduction in global and sectorial RNFL thickness except for nasal sector. Moreover, absolute postoperative (not pre-post change) visual field parameters were significantly correlated to preoperative RNFL (P = 0.00399 for mean deviation, P = 0.0023 for temporal sensitivity), GCC thickness (P = 0.00736 for mean deviation, P = 0.0469 for temporal sensitivity), with FLV (focal loss value) (P = 0.0012 for mean deviation, P = 0.0021 for temporal sensitivity) showed a higher correlation. Reduced RNFL thickness mainly, and GCC area minimally, were associated with the worst visual field outcome. FLV is a new prognostic value.

Central Retinal Microperimetry by Scanning Laser Ophthalmoscopy in Chiasmal Patients with Visual Inattention Temporally at Monocular Visual Acuity Testing

Background: In a previous study, a specific visual behaviour was described in four chiasmal patients. It manifested as inattention/ignorance within the temporal visual space (“visual blocking”) at monocular visual acuity testing. Moreover, in 3 out of the 4, the process of reading a text appeared cognitively impaired. Methods: As a supplement to conventional visual field testing, the present analysis focus was on microperimetry by Scanning Laser Ophthalmocopy (SLO). Our aim was to identify the perceptual retinal counterparts to the temporally located visual field defects as caused by the visual pathway lesion on a chiasmal level, possibly also to indicate the apparently ineffective saccadic movements underlying that only part of the line on the chart could be given. Results and Conclusions: The central retinal areas with lacking recognition by SLO testing were given by black rectangles expressing scotomatous points;they clustered in a zone extending nasally from the fixation area, as expected. The methodology further depicted an orderly fixation in two cases, and only minor deviation in two. Fixation saccades thus were considered by and large within normal and with only exceptional outlier points recorded. All considered, the shortcomings of the perceptual mechanisms underlying the lateralised visual inattention as observed in the four patients have remained without a satisfactory explanation.

Neuropsychologic Testing in Chiasmal Patients Exhibiting Inattention in the Temporal Visual Space during Monocular Visual Testing

Objective: By means of neuropsychologic tests, to further analyse a specific chiasmal monocular visual testing behaviour, here labelled temporal blocking because of the elective ignorance of optotypes on the temporal side of the chart. Often it is combined with impairment of reading and other cognitive impairments. Methods: Eighteen patients with lesions to the chiasm and some degree of temporal blocking aged 24 - 76 years underwent: 1) tests for visual neglect (Gothenburg test;behavioural inattention tests: star cancellation;line bisection);2) visuo-perceptual tests;and 3) a test involving reading a crowded ten-letter and cipher bar. Results: The temporal blocking in two patients recovered after emergency neurosurgery and their results were normal when subsequently tested. Of the 16 patients with deficiencies, 14 had a poorer left eye (p Conclusions: The best neuropsychologic tests appeared to be those for visual neglect and the crowded bar test. In most cases, the right cerebral hemisphere’s lack of some crossed information from the left eye, usually needed for normative saccades and adjustment to visual space, may be a factor underlying the specific visual behaviour.

视觉诱发电位对鞍区肿瘤手术前后视觉功能变化的动态观察

目的 了解视神经、视交叉减压前后视觉功能的变化规律。 方法 采用半视野图形翻转视觉诱发电位 (H -PRVEP) ,以P1 0 0 潜伏期为主要评价指标 ,结合一般视觉检查 ,对 3 2例成人鞍区肿瘤手术前后的视觉功能进行动态随访。 结果 发现 1 H -PRVEP检查的敏感性高于临床一般视觉检查 ,而且能反映视路纤维不同部份的受损程度。 2 视神经、视交叉减压后半月内 ,视觉功能改善程度最大 ,以后变化不明显。 结论 H -PRVEP检查可以准确反映视路减压后视觉功能改善的程度。

鞍膈的解剖特点及其临床意义

目的研究鞍膈的解剖特点，探讨其临床意义。方法应用成人15例尸头标本，在显微镜下进行解剖观察和测量。结果视交叉偏向蝶鞍左侧20％（3例），居于中线上66．7％（10例），偏向右侧13．3％（2例）。鞍隔孔完全被视交叉覆盖73．4％（11例），未被完全覆盖26．6％（4例）。鞍隔孔相对于视交叉的位置偏向左侧26．7％（4例），居于中线上66．7％（10例），偏向右侧6．6％（1例）。从上面观，鞍膈呈下凹型80％（12例），平坦型13．3％（2例），上凸型6．7％（1例）。鞍隔孔测量前后径为2．20-12．10mlTl，左右径为3．10～13．40mm；依据鞍隔孔的大小将鞍膈分为3种类型：紧密型，占13．3％（2例）；常见型，占73．4％（11例）；扩大型，占13．3％（2例）。垂体柄靠近鞍背前缘占53．3％（8例），居中占40％（6例），6．7％（1例）位于鞍结节后缘。结论鞍隔孔大小的变异可影响垂体瘤的生长方式，熟悉鞍膈及其周围解剖结构对鞍区手术具有重要意义。．

松果体和视交叉上核对大鼠体温昼夜节律的调节机制

探讨松果体和视交叉上核对大鼠体表和深部体温昼夜节律的调节方式。方法采用核团毁损、褪黑素及其合成抑制剂干涉试验。结果两个核团分别对体温昼夜节律的控制起着不同的作用。在体温绝对值的改变上 ,松果体发挥着上调而视交叉上核呈现下调的效应。在体温节律的发生和维持上 ,视交叉上核可能是皮肤温度昼夜节律的中枢起搏器 ,而深部体温的昼夜变化主要受松果体的支配。结论松果体和视交叉上核经由神经和内分泌通路相互偶联并构成统一协调的体温振荡系统。

经终板入路手术间隙的应用解剖研究

目的:探讨视交叉后间隙的显微解剖特征,为经终板入路手术提供解剖学基础。方法:利用15例经福尔马林固定的国人成人尸头,在显微镜下对视交叉后间隙相关结构进行详细地显微解剖、测量和统计。结果:视交叉后间隙由视交叉后缘、两侧视束内侧缘和终板后缘构成,与其有关的结构有大脑前动脉近段(ACA-A1)、前交通动脉(ACOA)、Heubner回返动脉(RAH)及其各自发出的穿动脉。沿视交叉后间隙打开终板和三脑室底部进入脚间窝,可以显露桥脑、基底动脉(BA)分杈及其发出的丘脑穿支、大脑后动脉(PCA)以及动眼神经。结论:沿视交叉后间隙打开终板可以充分显露位于视交叉后上方的肿瘤,辅以视交叉前间隙和视神经—ICA三角可以有效地分块切除肿瘤。熟悉间隙相关结构的显微解剖是提高临床疗效的关键。

57例垂体瘤患者视野分析

目的分析垂体瘤患者的视野特征。方法回顾性研究57例垂体瘤患者的视野报告及MRI影像资料。结果早期垂体微腺瘤患者,视野大多正常。随着肿瘤增大,典型的视野缺损表现为垂直性颞侧、双颞侧偏盲。视野缺损与视交叉自身解剖位置密切相关。视交叉位置正常者,视野缺损呈典型改变。视交叉前置或后置者,视野表现为同向偏盲、视敏度下降、中心暗点或交界性暗点。结论双颞侧偏盲是垂体瘤视交叉受压上抬典型的视野改变。视野缺损与视交叉解剖位置相关,前置型、后置型的视交叉者,视野缺损趋于多样性。

原发性开角型青光眼前视路形态变化及与视网膜神经纤维层厚度的关系

目的探讨原发性开角型青光眼(POAG)患者视束、视交叉的形态变化特征,分析其与视网膜神经纤维层厚度(RNFLT)的关系。方法对37例POAG患者(POAG组)行全脑磁共振T1加权三维磁化强度预备快速梯度回波序列扫描,利用多基线、多平面重建技术显示视束、视交叉结构,测量视束脑池段横径(TD1)及高径(H1)、视束大脑脚周段横径(TD2)及高径(H2)、视交叉横径(OC-TD)、高径(OC-H)及前后径(APD)。以1000名健康志愿者作为对照组。采用两样本t检验比较两组各径线测量值,采用Pearson检验对POAG组各径线与RNFLT进行相关性分析。结果①POAG组双侧TD1、H1、TD2、H2均小于对照组(P均<0.05)。②POAG组OC-TD、OC-H小于对照组(P均<0.05),而两组APD差异无统计学意义(P>0.05)。③POAG组双侧TD1之和、H1之和、TD2之和及H2之和均与双眼RNFLT之和呈正相关性(r=0.77、0.77、0.81、0.77,P均<0.05)。④POAG组OC-TD、OC-H与双眼RNFLT之和呈正相关(r=0.44、0.60,P均<0.05),而APD与双眼RNFLT之和无相关性(r=0.10,P>0.05)。结论 POAG患者视束、视交叉萎缩与视网膜神经纤维缺损有关。

儿童鞍区肿瘤的视觉传导通路DTI特征分析

目的应用磁共振弥散张量成像(DTI)和弥散张量纤维束成像(DTT)评估儿童鞍区肿瘤的视神经受损情况。方法对24例儿童鞍区肿瘤(其中视交叉胶质瘤12例、鞍区颅咽管瘤7例、三脑室畸胎瘤2例、下丘脑错构瘤2例、斜坡脊索瘤1例)病例进行DTI和DTT检查,计算双侧视神经的部分各向异性(FA)值,并进行统计学分析。结果根据显示的视交叉位置形态以及与肿瘤的空间结构关系,24例患儿可分为视交叉破坏组(12例)和视交叉压迫组(12例)。破坏组双侧视神经FA值均明显低于压迫组(P<0.05)。结论 DTI和DTT检查可以清晰的显示儿童鞍区肿瘤与视路神经纤维束的空间关系,其获得的参数FA值可以用来评价视路损伤的性质和程度。

人体视交叉的血管构筑

目的 :为视交叉的血流动力学研究提供形态学资料。方法 :对 2 2例新生儿尸体采用乳胶灌注、有机玻璃铸形、明胶墨汁灌注 3种方法进行了研究。结果 :视交叉上组血管平均 4.1条 ,主要来自大脑前动脉 ,有时前交通动脉和颈内动脉亦有分支供给。下组血管平均 9.7条 ,主要来自垂体前上动脉和后交通动脉 ,有时颈内动脉亦有分支供给。视交叉实质内毛细血管密度 ( % ) 区约为1 .1 9, 区为 1 .0 9, 区为 1 .1 9, 区为 0 .42 , 区中央板部为 1 .2 9, 区侧部约为 0 .79。结论 :视交叉血液供应障碍是多因素的结果 , 区和

MRI评价正常人视交叉及其前间隙的解剖结构

目的通过MRI研究活体视交叉及其前间隙的立体形态,并测量相关参数。方法对160名健康志愿者行视交叉区T1W MP-RAGE、T2W TSE序列扫描;采用MPR技术测量视神经颅内段、视交叉各径线长度、各角度、视神经与垂体柄夹角。比较男女、视神经颅内段左右侧之间及各年龄段间的差异。结果视神经颅内段长度左侧为(18.23±3.12)mm,右侧为(17.27±3.31)mm(t=0.27,P>0.05);视交叉前间隙大致呈三角形,面积为(44.04±7.73)mm2;视交叉轴位前后径为(8.81±1.14)mm,横径为(13.78±1.22)mm,厚度为(3.73±0.41)mm,前、后角度数分别为(70.72±7.38)°、(76.74±8.49)°,左、右侧角度数分别为(123.03±9.42)°、(124.18±10.31)°;视交叉与垂体柄的夹角为(46.54±10.29)°。男女间测量结果差异无统计学意义(P均>0.05)。各年龄段左右视神经颅内段、视交叉前后径、横径及厚度差异有统计学意义(P均<0.05);视交叉各角、视交叉与垂体柄夹角、视交叉前间隙面积间差异无统计学意义(P均>0.05)。结论 MR成像及其后处理技术可清晰显示视交叉及其前间隙的立体形态,建立正常人群相关参数的标准参考值,可为临床诊断及手术提供基本影像学依据。

颅内视神经-视交叉胶质瘤的诊断及手术治疗

目的讨论颅内视神经-视交叉胶质瘤的临床特点及手术治疗。方法对我科近6年来手术治疗和病理证实的11例视神经-视交叉胶质瘤患者的临床资料进行回顾性分析。结果视力下降、视野缺损及视神经萎缩是该类肿瘤的主要表现,82%为低级别星形细胞瘤,M RI可良好显示肿瘤生长特点及与周围结构的关系。手术全切除4例、次全切5例、部分切除2例,仅1例术后视力恶化,无死亡病例,总体恢复良好。结论颅内视神经-视交叉胶质瘤有其特点,显微神经外科手术治疗效果好、应该作为该类肿瘤的首选治疗方法。

半视野图形翻转视觉诱发电位各参数反映视交叉损伤价值比较

应用半视野图形翻转视觉诱发电位（Ｈ－ＰＲＶＥＰ）测试３３例有视力、视野及眼底异常的鞍区肿瘤的视觉功能，所用参数为Ｎ－ＰＲＶＥＰ主要成份Ｐ１００波的绝对数及相对数指标，如Ｐ１００潜伏期、波幅、时程，和Ｐ１００眼间、眼内潜伏期差、波幅比、时程差等，经比较、分析发现：有关Ｐ１００潜伏期指标能敏感反映视交叉受损情况，应作为主要评价参数。

Semaphorin 3a对小鼠胚胎视交叉发育的作用

目的:探讨细胞因子Semaphorin 3a(Sema 3a)在小鼠胚胎视交叉发育过程中发挥的作用。方法:E13至E15小鼠胚胎的眼球至视束部分制备成脑厚片,置于含10%的小牛血清的DMEM/F12的培养液中,在37℃的恒温的滚动培养箱中培养5h。实验组中将Sema 3a抗体加入培养液中。培养结束后,将脑厚片以4%多聚甲醛固定,将DiI颗粒置于一侧视盘。7d后,在手术显微镜下,暴露被标记的视神经纤维,在激光扫描共聚焦显微镜下观察。结果:用Sema 3a抗体阻抑Sema 3a的功能,可引起E13跨越中线的视神经纤维减少以及神经纤维走行错误。结论:在视交叉形成的早期,Sema 3a可能吸引视神经纤维跨过中线,并且这个过程可能是短暂的。

视神经与视交叉压迫性神经萎缩形态学研究及其临床意义

目的为脑底肿瘤压迫视神经、视交叉引起视野缺损原因提供形态学依据。方法80个成人脑研究视交叉及其相邻的垂体、颈内动脉及其供血小动脉的形态和毗邻。结果视交叉的前角,最大角度为100°,以前置型多见,最小角度为40°,以后置型为主。颈内动脉与视神经、视交叉相接触的占88.5%,动脉可对视神经颅内段,视交叉造成压迫引起视神经萎缩等病理改变。结论颅底肿物引起不同类型的视野缺损的原因与压迫视神经、视交叉相关。

颅咽管瘤的临床相关因素分析

目的对34例确诊的颅咽管瘤患者的性别、年龄、双眼视野特征、以及肿瘤体积进行数据分析,探讨其之间有无相关性。方法随机选取2010年7月至2011年8月于北京天坛医院神经外科经病理确诊为颅咽管瘤的34例患者,提取相关信息,包括性别、年龄、肿瘤体积、视野表现。运用统计学,对年龄与肿瘤体积进行相关分析,年龄与视野表现、性别与肿瘤体积、肿瘤体积与视野表现进行差异检验,性别与视野情况做卡方检验。结果在34例颅咽管瘤患者中,男性19例,女性15例,年龄9~70岁(均值35.3636±17.3292),肿瘤体积从3.12~80.84 cm3(均值21.7732±19.98359),视野表现分为双眼颞侧偏盲者19例;双眼同向偏盲者3例;双眼不规则暗点6例;一眼颞侧偏盲,另一眼不规则暗点3例;一眼眼全盲,另一眼眼不规则暗点1例;正常视野2例。通过数据分析,患者的年龄与体积没有显著的相关关系;不同视野表现的调查对象在年龄水平上,不同性别的调查对象在肿瘤体积上,以及不同视野表现的调查对象在肿瘤体积水平上,性别与调查对象的视野表现上均无显著的差异。结论颅咽管瘤的视野表现以双眼颞侧偏盲为主要表现,视野的缺损形态与肿瘤压迫视交叉的位置有关,与年龄、性别、肿瘤体积无明显关系。

视交叉外压性病变引起视力障碍的MRI表现

目的 :探讨MRI诊断视交叉外压性病变引起视力障碍的临床价值。方法 :回顾性分析 44例临床表现双侧视力障碍的MRI资料。MRI包括横断面、矢状面及冠状面。结果 :鞍内、鞍上肿瘤 3 3例 ,包括垂体瘤 19例 ,蝶鞍外肿瘤14例 ;脑积水 11例。MRI显示视交叉受压移位及变性 ,MRI显示视交叉T2 加权像上呈不均匀高信号 ,增强后扫描有异常强化。结论 :除鞍区肿瘤外 ,脑积水也是使视交叉受压、视力受影响的重要原因。MRI不仅可以显示视交叉受压的原因 ,而且可以显示视交叉变性。

经终板手术入路的临床解剖学研究

目的：为经终板手术入路的临床应用提供显微解剖学资料，以利于术中重要血管、神经结构的辨认和保护。方法：在手术显微镜下对12例国人成人头颅湿标本进行显微解剖，详细观察终板及其邻近结构，并进行测量和拍照。结果：终板为一薄层灰质膜，连于前连合与视交叉中部上表面之间，弧形长度（14．4±2．8）mm，最大宽度（4．8±1．3）mm，厚度（0．274±0．16）mm；视交叉上隐窝位于视交叉中线区后半的上表面，前后长度为（5．6±1．5）mm；与终板关系密切的血管结构是前交通动脉复合体及其穿支血管。结论：经终板入路是打开终板后所获得的手术间隙，由视交叉后缘、左和右视束内缘和终板后缘构成。中嵴或中央区膨隆是安全切开终板的重要标志。