Avoidance and Improvement in Visual Field Defect after Surgery for Metastatic Brain Tumors in the Parietal and the Occipital Lobe

Background: Occipital transtentorial approach for selected posterior third ventricular or retrosplenium region tumors provides an ergonomic and safe access. Over centuries, the opponents of this approach highlight the problem of postoperative visual field defect, related to the retraction of occipital lobe. The aim was to describe the surgical nuances of gravity-assisted retractor-less occipital-transtentorial approach (GAROTA) as a modification of originally described GAROTA to minimize the complications with a similar ease of surgery. Methods: In this study, we have retrospectively analyzed our prospectively maintained surgical databases of patients operated by occipito-transtentorial from 2015 to 2019. Demographic variables, preoperative and postoperative neurological deficits (especially visual field defect) were analyzed. Radiological data included relation of veins with tumor, presence of hydrocephalus, size, and extent of lesion. Results: Fifteen patients underwent GAROTA (right-sided extension, n = 7; left-sided extension, n = 4; and midline lesions, n = 4). Headaches (73.3%) and diplopia (40%) were the most common symptoms. No patient had any postoperative visual deficits in both short-term and long-term follow-up. Conclusion: A thorough anatomical knowledge of posterior third interhemispheric region in the semi-prone position is required for GAROTA. Meticulous arachnoid dissection around the deep venous complex and release of cerebrospinal fluid through the cisterns is required. Postoperative cortical vision loss may be prevented by following the key surgical principles in GAROTA.

Download Full-text

Prevention of postoperative visual field defect after the occipital transtentorial approach: anatomical study

Journal of Neurosurgery ◽

10.3171/2017.4.jns162805 ◽

2018 ◽

Vol 129 (1) ◽

pp. 188-197 ◽

Cited By ~ 5

Author(s):

Satoshi Matsuo ◽

Serhat Baydin ◽

Abuzer Güngör ◽

Erik H. Middlebrooks ◽

Noritaka Komune ◽

...

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Occipital Lobe ◽

Microsurgical Anatomy ◽

Inferior Surface ◽

Fiber Dissection ◽

Occipital Transtentorial Approach ◽

Optic Radiations ◽

Field Defect ◽

Transtentorial Approach

OBJECTIVEA postoperative visual field defect resulting from damage to the occipital lobe during surgery is a unique complication of the occipital transtentorial approach. Though the association between patient position and this complication is well investigated, preventing the complication remains a challenge. To define the area of the occipital lobe in which retraction is least harmful, the surface anatomy of the brain, course of the optic radiations, and microsurgical anatomy of the occipital transtentorial approach were examined.METHODSTwelve formalin-fixed cadaveric adult heads were examined with the aid of a surgical microscope and 0° and 45° endoscopes. The optic radiations were examined by fiber dissection and MR tractography techniques.RESULTSThe arterial and venous relationships of the lateral, medial, and inferior surfaces of the occipital lobe were defined anatomically. The full course of the optic radiations was displayed via both fiber dissection and MR tractography. Although the stems of the optic radiations as exposed by both techniques are similar, the terminations of the fibers are slightly different. The occipital transtentorial approach provides access for the removal of lesions involving the splenium, pineal gland, collicular plate, cerebellomesencephalic fissure, and anterosuperior part of the cerebellum. An angled endoscope can aid in exposing the superior medullary velum and superior cerebellar peduncles.CONCLUSIONSAnatomical findings suggest that retracting the inferior surface of the occipital lobe may avoid direct damage and perfusion deficiency around the calcarine cortex and optic radiations near their termination. An accurate understanding of the course of the optic radiations and vascular relationships around the occipital lobe and careful retraction of the inferior surface of the occipital lobe may reduce the incidence of postoperative visual field defect.

Download Full-text

Diffusion Tensor Imaging in Cases With Visual Field Defect After Anterior Temporal Lobectomy

Yearbook of Ophthalmology ◽

10.1016/s0084-392x(08)70377-0 ◽

2006 ◽

Vol 2006 ◽

pp. 208-211

Author(s):

A.E. Flanders

Keyword(s):

Diffusion Tensor Imaging ◽

Visual Field ◽

Visual Field Defect ◽

Diffusion Tensor ◽

Temporal Lobectomy ◽

Anterior Temporal Lobectomy ◽

Field Defect

Download Full-text

Visual Field Examination in Glaucoma Patients : Humphrey Visual Field Analysis vs Amsler Grid

Ophthalmologica Indonesiana ◽

10.35749/journal.v43i2.152 ◽

2017 ◽

Vol 43 (2) ◽

pp. 124

Author(s):

Ivana Tanoko ◽

Fifin L Rahmi

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Glaucoma Patient ◽

Field Analysis ◽

Glaucomatous Optic Neuropathy ◽

Visual Field Examination ◽

Cross Sectional ◽

Rnfl Thickness ◽

Amsler Grid ◽

Field Defect

Introduction and Objective: Glaucoma is the leading cause of global irreversible blindness, signed by glaucomatous optic neuropathy related to visual field defect. The purpose of the study is comparing visual field defect examination using HVFA to Amsler Grid in glaucoma patient at dr. Kariadi Hospital. Methods: This is a cross-sectional study. Amsler Grid were performed to the patients who have reliable HVFA at last 6 months and presented as descriptive analytic results. Result: There were 40 eyes involved in this study from 27 patients (15 men, 12 women), 26-68 years old and visual acuity 1/60-6/6. Seventeen eyes showed visual field defect in HVFA and Amsler Grid had average MD - 24.97 dB, CDR 0.89 and RNFL thickness 51.74. We found that 11 eyes didn’t showed in both of examination had average MD -8.06, CDR 0.63 and RNFL thickness 103.23 and those parameters are significantly different to the 17 eyes before (p<0.05). Data from 12 eyes that showed visual field defect only one of examination (9 only in HVFA and 3 in Amsler Grid) didn’t show difference statistically each other. Conclusion: HFVA and Amsler Grid seemed to be comparable in detecting visual field defect in advanced glaucoma.

Download Full-text

Acute Zonal Occult Outer Retinopathy: Vision Loss in an Active Duty Soldier

Case Reports in Medicine ◽

10.1155/2013/240607 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Courtney M. Crawford ◽

Bruce A. Rivers ◽

Mark Nelson

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Vision Loss ◽

Fundus Autofluorescence ◽

Final Diagnosis ◽

Active Duty ◽

Visual Field Defects ◽

Fundus Photographs ◽

Optical Coherence Tomograph ◽

Field Defect

Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient.Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography.Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR.Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.

Download Full-text

Association of ocular blood flow and contrast sensitivity in normal tension glaucoma

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05235-8 ◽

2021 ◽

Author(s):

David Kuerten ◽

Matthias Fuest ◽

Peter Walter ◽

Babac Mazinani ◽

Niklas Plange

Keyword(s):

Blood Flow ◽

Visual Field ◽

Contrast Sensitivity ◽

Visual Field Defect ◽

Prospective Trial ◽

Normal Tension Glaucoma ◽

Ocular Blood Flow ◽

Retinal Blood Flow ◽

Control Group ◽

Field Defect

Abstract Purpose To investigate the relationship of ocular blood flow (via arteriovenous passage time, AVP) and contrast sensitivity (CS) in healthy as well as normal tension glaucoma (NTG) subjects. Design Mono-center comparative prospective trial Methods Twenty-five NTG patients without medication and 25 healthy test participants were recruited. AVP as a measure of retinal blood flow was recorded via fluorescein angiography after CS measurement using digital image analysis. Association of AVP and CS at 4 spatial frequencies (3, 6, 12, and 18 cycles per degree, cpd) was explored with correlation analysis. Results Significant differences regarding AVP, visual field defect, intraocular pressure, and CS measurement were recorded in-between the control group and NTG patients. In NTG patients, AVP was significantly correlated to CS at all investigated cpd (3 cpd: r = − 0.432, p< 0.03; 6 cpd: r = − 0.629, p< 0.0005; 12 cpd: r = − 0.535, p< 0.005; and 18 cpd: r = − 0.58, p< 0.001), whereas no significant correlations were found in the control group. Visual acuity was significantly correlated to CS at 6, 12, and 18 cpd in NTG patients (r = − 0.68, p< 0.002; r = − 0.54, p< .02, and r = − 0.88, p< 0.0001 respectively), however not in healthy control patients. Age, visual field defect MD, and PSD were not significantly correlated to CS in in the NTG group. MD and PSD were significantly correlated to CS at 3 cpd in healthy eyes (r = 0.55, p< 0.02; r = − 0.47, p< 0.03). Conclusion Retinal blood flow alterations show a relationship with contrast sensitivity loss in NTG patients. This might reflect a disease-related link between retinal blood flow and visual function. This association was not recorded in healthy volunteers.

Download Full-text