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.

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.

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.

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.

Toward a Multi-Layered Chiasme-Focused Topology: A Reading of Merleau-Ponty's Later Writings

This paper traces the genealogy of reversibility,chiasma,and chiasme in Merleau-Ponty's writings and offers a new characterisation of his later ontology in terms of a multi-layered chiasme-focused topology informed by subtle differences and interconnections among these notions.We need to grasp the significance of reversibility not only in terms of constant recoil and impossible overlap but also of its situatedness in the crisscrossing between Dasein and things,and between the inside/invisible and the outside/visible."Chiasma" was initially introduced as a reference to the intersection of perspectives.Merleau-Ponty deploys it to articulate macroscopic insights concerning the nature of philosophy and the interweaving connections between self,other,and the world.In comparison,"reversibility" is primarily used to describe the microscopic bond between touching-touched and perceiving-perceived.I argue that,as Merleau-Ponty's ultimate choice of wording,"chiasme" incorporated the significance of both "reversibility" and "chiasma." A chiasme-focused topology that retains the significance of all three of the terms would serve to better convey the import of Merleau-Ponty's later ontology,which aims to dissolve and to re-configure our conceptions about being,body,self,and the other from within and from below.

Biomechanics of human optic chiasmal compression: ex vivo experiment and finite element modelling

The mechanism of bitemporal hemianopia arising as a result of chiasmal compression is unknown.In this study,we combined an ex vivo experiment and finite element modelling(FEM)to investigate its potential mechanism.A cadaveric human optic chiasm was scanned using micro-CT before and after deformation by inflation of Foley catheter,to simulate tumour growth from beneath.The geometry of the same chiasm was reconstructed and simulated using finite element analysis.Chiasmal deformations were extracted from the simulation and compared with those observed during micro-CT scanning.In addition,nerve fibre models examining variation in local fibre distribution patterns of the chiasm were incorporated to investigate the strain(deformation)distributions of the chiasm at an axonal level.The FEM model matched the micro-CT scans well both qualitatively and quantitatively.Compression of the chiasm induced high strains in the paracentral portions of the chiasm where the crossing optic nerve fibres are located.At an axonal level,the magnitude of strains affecting crossed fibres were greater than those affecting uncrossed fibres.The high strains in the paracentral portions of the chiasm,combined with the differences in strain between crossed and uncrossed nerve fibres,are consistent with a biomechanical explanation for the pattern of visual field loss seen in chiasmal compression.

French Chiasm Communicology and the Discourse Model of the Human Sciences

The French discourse model of human communication is largely an engagement of the problematic concept of enlightenment as a product of the ability to reason by thinking.The engagement as speaking and writing becomes thematic,when one considers that,the product called“reason”also should explicate the process wherein the conscious experience of being is essentially“reasonable”in doing as listening and reading.The engaged analysis of reason differentiates among parole,discours,langue,and langage as a synthesis of logic mediating rhetoric and grammar as models of expression and perception.The method is known as the trivium in the Medieval universities of Europe,subsequently adopted as a pedagogy throughout Europe,and last,adopted by C.S.Peirce as a foundational semiotic methodology for science(methodeutic).The influence of the human science adaptations emerges in France with the philosophic cross-over and intertwined(chiasm)positions of Existentialism,Phenomenology,Structuralism,and Semiology.Doing the reasonable requires metaphor and metonymy,simile and synecdoche in the service of expression,yet,it also demands the perception of their respective counterparts in allegory,analogy,allegoresis,and aphorism.The human journey from thinking to speaking to doing and the return(renvoi)is one of ingenuity made eloquent in the face of crisis.It was so for the Ionian enlightenment,it was so for the European enlightenment,and it is so for us.

Communicology Chiasm： The Play of Tropic Logic in Bateson and Jakobson

Gregory Bateson is famous for his description of the "double bind" that occurs when human(and animal) communication interaction becomes dysfunctional. His principal example is the "nip versus bite" opposition that he observed when a human and a dog(or two monkies) "play"(nip) and then play turns to "work"(bite).The model is a semiotic failure by not accounting for negation, i.e., "labor"(not-nip) and "leisure"(not-bite). Thus, if there is a double bind, there must be a foundational apposition condition of single-bind(functional communication) in the system, i.e., the possibility of an actual choice, which logically entails a not-choice [potential "new" choice]. The play/work versus leisure/labor distinction by combination goes back at least to Plato, and in modernity to Ernst Cassirer and Karl Bühler, but has its most strategic communicological development in Maurice Merleau-Ponty's tropic logic thesis on Chiasm. The thesis is better known through its application by Roman Jakobson and Claude Lévi-Strauss as a tropic logic of metaphor(attribute—substance quality) and metonymy(part—whole quantity). My analysis illustrates the tropic logic by contrasting a fundamental metaphysical thesis that Being/Having(Play—Work) and Becoming/Doing(Leisure—Labor) must be phenomenological(tropic) as a basis for Semiotics(logic). Thus in Communicology, Play is a "pretend reality" of actual agency, and, Playing is a "pretended action in Play" of symbolic agency.

经视神经颈内动脉间隙切除视交叉前置型垂体大腺瘤

本文报告了经视神经颈内动脉间隙显微手术切除视交叉前置型垂体大腺瘤13例,其中全切除1例,次全切除6例,大部切除5例,部分切除1例。术后均获视力改善。本文着重讨论了有关局部显微解剖、手术方法及技术要点。

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。

Shh对发育中小鼠视觉传导通路的影响(英文)

目的探察Shh对E13-E15小鼠胚胎中视觉传导通路发育的影响。方法E13至E15小鼠胚胎的眼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℃恒温滚动培养箱中培养5h。实验组中将Shh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,在激光扫描共聚焦纤维镜下观察。结果用Shh抗体阻抑Shh的功能,可引起E13跨越中线的视神经纤维减少以及E15投射至同侧的视束的神经纤维的增多。结论在视交叉形成的早期,Shh引导视神经纤维跨越中线。在视交叉形成的后期,Shh引导视神经转弯。

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。

Sonic Hedgehog及其受体Patched在小鼠视交叉发育过程中的表达

在小鼠胚胎发育过程中,胚胎第13d(E13)至15d(E15)是视交叉发育的主要阶段。在本研究中,我们观察了在E13～E15,Sonic Hedgehog(Shh)及其受体Patched(Ptc)在视觉传导通路的表达。结果发现:在视交叉和视束中,Shh在视神经纤维接近中线时表达上调,越过中线后表达下调,并且主要表达在较深的区域。Ptc在E13～E14的视网膜和E14～E15的视束中有表达,但在视交叉中无表达。Ptc,而不是Shh,表达在体外培养的生长锥中。Shh和Ptc在视觉传导通路发育中的表达提示Shh可能在引导视神经生长方面发挥一定作用。

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

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。