Freiman Thomas M, Surges Rainer, Vougioukas Vassilios I, Hubbe Ulrich, Talazko Jochen, Zentner Josef, Honegger Jürgen, Schulze-Bonhage Andreas
Department of Neurosurgery, Neurocenter, University Clinics, Albert-Ludwigs-University, Breisgau, Germany.
J Neurosurg. 2004 Nov;101(5):846-53. doi: 10.3171/jns.2004.101.5.0846.
The development of visual hallucinations after loss of vision is known as the Charles Bonnet syndrome. This phenomenon was first described in 1760 by Charles Bonnet and others during their observations of elderly patients with degeneration of the retina or cornea. To date a clear association between visual hallucinations and neurosurgical procedures has not been reported. Because of their clear demarcation, however, surgical lesions in the cerebrum offer a unique opportunity to determine the pathoanatomical aspects of visual hallucinations. During a 3-year period, 41 consecutive patients who acquired visual field defects after neurosurgery were examined for the occurrence of visual hallucination. Postoperatively, four of these patients experienced visual hallucinations. In two of them an upper quadrantanopia developed after the patients had undergone selective amygdalohippocampectomy. In the other two patients a complete hemianopia developed, in one case after resection of a parietal astrocytoma and in the other after resection of an occipital glioblastoma multiforme. The visual hallucinations were transient and gradually disappeared between 4 days and 6 months postoperatively. The patients were aware of the fact that their hallucinations were fictitious and displayed no psychosis. Electroencephalographic recordings were obtained in only two patients and epileptic discharges were found. Deafferentiation of cortical association areas may lead to the spontaneous generation of complex visual phenomena. In the present series this phenomenon occurred in approximately 10% of patients with postoperative visual field defects. In all four cases the central optic radiation was damaged between the lateral geniculate nucleus and the primary visual cortex. The complex nature of the visual hallucination indicates that they were generated in visual association areas.
失明后出现视幻觉被称为邦纳综合征。这一现象于1760年由查尔斯·邦纳等人在观察视网膜或角膜退化的老年患者时首次描述。迄今为止，尚未有视幻觉与神经外科手术之间明确关联的报道。然而，由于大脑中的手术损伤界限清晰，为确定视幻觉的病理解剖学方面提供了独特的机会。在3年期间，对41例神经外科手术后出现视野缺损的连续患者进行了视幻觉发生情况的检查。术后，其中4例患者出现了视幻觉。其中2例在接受选择性杏仁核海马切除术后出现了上象限盲。另外2例患者出现了完全性偏盲，1例是在切除顶叶星形细胞瘤后，另1例是在切除枕叶多形性胶质母细胞瘤后。视幻觉是短暂的，在术后4天至6个月之间逐渐消失。患者意识到他们的幻觉是虚构的，且未表现出精神病症状。仅对2例患者进行了脑电图记录，发现有癫痫放电。皮质联合区的传入神经阻滞可能导致复杂视觉现象的自发产生。在本系列中，这种现象发生在约10%的术后视野缺损患者中。在所有4例病例中，外侧膝状体核与初级视觉皮层之间的中央视辐射均受损。视幻觉的复杂性表明它们是在视觉联合区产生的。
