Department of Neurosurgery, Komagome Metropolitan Hospital, Bunkyo-ku, Tokyo 113-8677, Japan.
Acta Neurochir (Wien). 2010 Apr;152(4):637-42. doi: 10.1007/s00701-009-0582-0. Epub 2010 Jan 10.
Diffusion tensor tractography provides useful information regarding the surgical strategy for brain tumors. The goal of the present study was to analyze relationships between visual field deficits and the locations of brain tumors compared with optic tracts as visualized by tractography, and compared with the calcarine fissure.
Subjects comprised 11 patients with brain tumor in the occipital lobe or atrium of the lateral ventricle who underwent surgery between October 2006 and February 2009. Tumors were categorized as Type A, with almost all the optic tract in the occipital lobe or atrium of the lateral ventricle running close to and stretched by the brain tumor; and Type B, with the optic tract running at least partially distant to the brain tumor and remaining unstretched.
Those type A optic tracts that were laterally compressed by brain tumors (Cases 1-3) displayed hemianopsia after surgery. When the brain tumor was located rostro-medial to the calcarine fissure and optic tracts were compressed caudally by the tumor, lower quadrant hemianopsia remained after surgery (Cases 4, 5). In other cases, the visual field remained or improved to normal after surgery.
The relationship between optic tracts or the calcarine fissure, and brain tumors in the occipital lobe or atrium of the lateral ventricle is related to visual field deficits after surgery. In particular, those Type A optic tracts that are compressed laterally show hemianopsia of the visual field after surgery.
弥散张量纤维束成像为脑肿瘤的手术策略提供了有价值的信息。本研究的目的是分析视野缺损与脑肿瘤位置之间的关系,将其与视束的位置进行对比,并与距状裂进行对比。
本研究纳入了 2006 年 10 月至 2009 年 2 月期间 11 例接受手术治疗的位于枕叶或侧脑室外侧角的脑肿瘤患者。肿瘤分为 A 型和 B 型:A 型肿瘤几乎全部位于视束在枕叶或侧脑室外侧角内,与脑肿瘤紧邻且被脑肿瘤牵拉;B 型肿瘤的视束至少部分远离脑肿瘤且未被牵拉。
被脑肿瘤侧向压迫的 A 型视束(病例 1-3)术后出现偏盲。当肿瘤位于距状裂和视束的前内侧,且肿瘤向尾部压迫视束时,术后出现下象限偏盲(病例 4、5)。在其他情况下,术后视野保持或恢复正常。
枕叶或侧脑室外侧角的视束或距状裂与脑肿瘤之间的关系与术后视野缺损有关。特别是那些被侧向压迫的 A 型视束术后会出现视野偏盲。