Uchino M, Nemoto M, Ohtsuka T, Kuramitsu T, Isobe Y
Department of Neurosurgery, Saiseikai-Yokohamashi Nanbu Hospital, Yokohama, Japan.
No Shinkei Geka. 1999 Feb;27(2):189-94.
A case of unilateral visual field defect due to optic nerve compression by a sclerotic internal carotid artery was reported. A 71-year-old woman was admitted to our department because of constricted visual field of the right eye. MRI showed elevation of the right optic nerve compressed by an internal carotid artery. The right carotid angiography revealed elevation and distortion of the C1-2 portion. Frontal craniotomy was carried out and the optic nerve was visualized on this side. The right optic nerve was found to have been compressed by the sclerotic internal carotid artery. The optic canal was then unroofed. The post-operative course was uneventful. The visual field was improved. When last seen 6 months after surgery, her visual field remained in the improved condition. Nasal field abnormalities are most frequently encountered in retinal and anterior optic nerve pathology. Our success in improving the visual field disturbance may be accounted for by the fact that the preoperative period was short and the operation was performed before atrophy of ocular fundi occurred. Nasal field loss caused by intracranial lesions of the optic pathway is rare. It is probably impossible to determine degree of the symptomatology caused by direct-pressure compression as opposed to that caused by ischemia secondary to occlusion of small arterial supply branches. Vascular compressive neuropathy of optic nerve should not be diagnosed simply by the radiological finding of the optic nerve dislocation. However, optic nerve compression by surrounding arteries should be remembered as one of the possible causes of visual field defect which needs to be treated surgically.
报告了一例因硬化的颈内动脉压迫视神经导致单侧视野缺损的病例。一名71岁女性因右眼视野缩小入住我科。MRI显示右侧视神经被颈内动脉压迫而抬高。右侧颈动脉血管造影显示C1 - 2段抬高和扭曲。进行了额部开颅手术，在此侧观察到视神经。发现右侧视神经被硬化的颈内动脉压迫。然后对视神经管进行了去顶减压。术后过程顺利。视野得到改善。术后6个月最后一次随访时，她的视野仍保持改善状态。鼻侧视野异常在视网膜和视神经前部病变中最为常见。我们成功改善视野障碍可能是因为术前时间短且在眼底萎缩发生之前进行了手术。由视路颅内病变引起的鼻侧视野缺损很少见。与小动脉供应分支闭塞继发的缺血所导致的症状相比，可能无法确定直接压迫所导致的症状程度。视神经血管压迫性神经病变不应仅通过视神经移位的影像学表现来诊断。然而，应记住周围动脉对视神经的压迫是视野缺损的可能原因之一，需要手术治疗。
