scholarly journals Optic nerve compression in craniopharyngioma by taut anterior cerebral arteries visualized in frontal and transsphenoidal exposures: illustrative cases

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Pediatric Patients ◽  
Anterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Initial Exposure ◽  
Visual Deficits ◽  
Visual Field Deficits ◽  
Optic Nerve Compression

BACKGROUND During initial exposure and removal of craniopharyngioma in pediatric patients with severe visual field deficits, the authors have encountered severe deformation of the optic apparatus by taut anterior cerebral arteries as seen during both frontal craniotomy and transsphenoidal exposures. OBSERVATIONS The authors report two pediatric patients with craniopharyngioma whose severe preoperative visual deficits were associated not only with large suprasellar masses but also with severe optic nerve and chiasm compression by taut anterior cerebral arteries. In each patient, the optic nerves were partially cleft by these vessels’ indenting them. LESSONS The role of a taut anterior cerebral artery complex in compression of the optic apparatus in patients with suprasellar tumors has been reported previously, but the intraoperative images in these two cases dramatically reveal this phenomenon.

scholarly journals Optic Nerve Vascular Compression in a Patient with a Tuberculum Sellae Meningioma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Cezar José Mizrahi ◽  
Samuel Moscovici ◽  
Shlomo Dotan ◽  
Sergey Spektor
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Vascular Compression ◽  
Case Description ◽  
Tuberculum Sellae Meningioma ◽  
Documented Case ◽  
Suprasellar Tumor ◽  
Tuberculum Sellae

Background. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature.Case Description. We present a unique, well-documented case of optic nerve strangulation by the A1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The patient presented with pronounced progressive visual deterioration. Following surgery, there was immediate resolution of her visual deficit.Conclusion. Vascular strangulation of the optic nerve should be considered when facing progressive and/or severe visual field deterioration in patients with tumors proximal to the optic apparatus.

scholarly journals The role of awake craniotomy in reducing intraoperative visual field deficits during tumor surgery

2015 ◽  
Vol 10 (3) ◽  
pp. 139 ◽  
Author(s):  
RicardoJ. Komotar ◽  
Racheal Wolfson ◽  
Neil Soni ◽  
AshishH. Shah ◽  
Ananth Sastry ◽  
...  
Keyword(s):  
Visual Field ◽  
Awake Craniotomy ◽  
Tumor Surgery ◽  
Visual Field Deficits

scholarly journals P14.104 The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii92-iii92
Author(s):  
K Hwang ◽  
Y Kim ◽  
C Kim ◽  
J Han
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Pituitary Adenomas ◽  
Surgical Intervention ◽  
Tumor Resection ◽  
Nerve Compression ◽  
Nonfunctioning Pituitary Adenomas ◽  
The Mean ◽  
Optic Nerve Compression

Abstract BACKGROUND We investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) abutting on optic nerve. MATERIAL AND METHODS Eighty-three patients with asymptomatic NFPAs with documented optic nerve compression on magnetic resonance imaging (MRI) at the time of detection between 2000 and 2016 were included in this study. Patients were evaluated with a hormone test, visual acuity test, visual field test and MRI at the time of diagnosis, and then, yearly, without any treatment (including surgery and radiation). RESULTS The mean age was 57.7±13.6 (range, 15 - 81) years. The mean follow-up duration was 66.6±39.0 (range, 12 - 184) months. Tumor volume growth ≥ 20% was observed in 64 (77.1%) patients. Ten (12.2%) patients experienced any kind of hormonal dysfunction, and gonadotropin deficiency was the most common type of hormonal deficiency [n=9 (10.8%)]. Visual deterioration quantified by Visual Impairment Scale was seen 27 (32.5%) patients. There was no statistically significant factor for tumor growth or visual aggravation. Fourteen (16.9%) patients eventually underwent tumor resection. From multivariate analysis, the significant predictors for eventual surgical intervention were cavernous sinus invasion (OR=20.95; 95% CI, 2.754–159.3; p=0.003) and last follow-up visual field defect score (OR=1.170; 95% CI, 1.049–1.305; p=0.005). All patients who underwent surgery did not experience any neurologic or endocrinological deficits postoperatively. CONCLUSION The clinical outcomes of conservatively observed NFPAs with optic nerve compression can be acceptable. The decision for surgical intervention should be made by balancing the risk and benefits.

Microvascular decompression of the optic chiasm

2011 ◽  
Vol 114 (3) ◽  
pp. 857-860 ◽  
Author(s):  
Nancy McLaughlin ◽  
Michel W. Bojanowski
Keyword(s):  
Visual Field ◽  
Mr Imaging ◽  
Cerebral Artery ◽  
Microvascular Decompression ◽  
Anterior Cerebral Artery ◽  
Visual Fields ◽  
Optic Chiasm ◽  
Visual Deficits ◽  
Visual Field Deficit ◽  
The Right

Elongation of the anterior cerebral artery (ACA) and subsequent compression of the chiasm rarely have been reported as causes of a visual field deficit. Neither has microvascular decompression of the chiasm been described in this circumstance. The authors report on a case of progressive visual deficits caused by compression of the optic apparatus by a right elongated ACA as documented on MR imaging. Microvascular decompression was proposed as treatment. The right A1 segment was larger than usual and tortuous, transmitting its pulsations into the chiasm. A piece of Teflon was inserted between the A1 segment and the chiasm. Following surgery, the visual field deficit progressively improved. At 4 months after surgery, the patient's visual fields were normal. Therefore, an elongated ACA can compress the chiasm and result in a visual field deficit. In such circumstances when facing a progressive visual field deficit, microvascular decompression may improve vision.

Predictor of Visual Impairment Following Paraclinoid Aneurysm Surgery: Special Consideration of Surgical Microanatomy Related to Paraclinoid Structures

2020 ◽  
Vol 20 (1) ◽  
pp. 45-54
Author(s):  
Nakao Ota ◽  
Ioannis Petrakakis ◽  
Kosumo Noda ◽  
Takanori Miyazaki ◽  
Tomomasa Kondo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Impairment ◽  
Multivariate Logistic Regression Analysis ◽  
Visual Deficits ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Visual Field Deficits

Abstract BACKGROUND Microsurgical clipping with extradural anterior clinoidectomy (EDAC) for paraclinoid aneurysm is an established technique with good angiographic outcomes, although postoperative worsening of visual acuity remains a concern. Multiple reports show visual acuity deteriorating after clipping, yet the cause remains unclear. OBJECTIVE To analyze results of asymptomatic paraclinoid aneurysm surgeries treated with EDACs, specifically focusing on the microanatomy of paraclinoid structure dissection. This determined the causes of delayed visual impairment and microsurgical indications. METHODS Results of the treatment with EDAC of 94 patients with cerebral aneurysm and normal preoperative visual acuity but also full visual fields were retrospectively analyzed. RESULTS The mean aneurysm size was 6.2 (±3.3) mm. Clipping was performed in 87 cases and trapping in 7 cases. Complete angiographic occlusion was observed in 91 patients. In 26 cases, a postoperative visual deficit occurred. A total of 20 cases exhibited partial visual field deficits, including 5 who were asymptomatic. Visual deficits were only detectable by postoperative ophthalmologic testing. Six showed light perception impairment or blinding. Of the 15 patients with symptomatic partial visual field deficits, 5 showed improvement at follow-up. Visual deficits persisted in 22 patients at the last follow-up. Multivariate logistic regression analysis revealed that medial projecting aneurysm (adjusted odds ratio [OR]: 10.43) and the opening of the carotidoculomotor membrane (adjusted OR: 5.19) were significantly related to visual impairment. CONCLUSION Excess dissection of carotidoculomotor membranes causes postoperative delayed visual worsening. For treating small, asymptomatic paraclinoid aneurysms, carotidoculomotor membranes should not be opened, and microsurgical clipping should not be performed for preoperative asymptomatic medial projecting aneurysms.

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