Tan Terence, Tee Jin W, Trost Nicholas, McKelvie Penny, Wang Yi Yuen
Department of Neurosurgery, St. Vincent's Hospital, Melbourne, VIC, Australia; Victorian Brain and Spine Centre, P.O. Box 2900, Fitzroy, VIC 3065, Australia.
Department of Neurosurgery, St. Vincent's Hospital, Melbourne, VIC, Australia.
J Clin Neurosci. 2015 Feb;22(2):258-67. doi: 10.1016/j.jocn.2014.07.027. Epub 2014 Nov 11.
Anterior visual pathway cavernous malformations (CM) are rare diagnoses with poorly-defined natural history and management. A systematic review of all reports of anterior visual pathway CM was performed to identify all English-language articles with histopathologically-proven anterior visual pathway CM published from 1950 to December 2013. Patient demographics, presenting symptoms, CM location, treatment modality and clinical outcome were recorded and analyzed. The case of a 60-year-old woman from our institution with acute-on-chronic visual disturbance secondary to visual pathway CM is presented. Including the current patient, 70 cases of anterior visual pathway CM have been published to our knowledge. The average patient age is 34.8 ± standard deviation of 14.2 years, with a female preponderance (n = 37, 52.9%). The majority of patients had an acute (n = 44; 62.9%; 95% confidence interval [CI] 0.51-0.73) onset of symptoms. In at least 55.6% (n = 40) of patients, the cause of visual disturbance was initially misdiagnosed. The majority (91.4%; n = 64) of patients underwent craniotomy, with complete resection and subtotal resection achieved in 53.1% (n = 34; 95%CI 0.41-0.65) and 17.2% (n = 11; 95%CI 0.10-0.28) of all surgical patients, respectively. Comparing surgically managed patients, complete resection improved visual deficits in 59.0% (n = 20; 95%CI 0.42-0.75), while subtotal resection improved visual deficits in 50.0% (n = 5; 95%CI 0.24-0.76; p = 0.62). CM is an important differential diagnosis for suprasellar lesions presenting with visual disturbance. A high index of suspicion is required in its diagnosis. Expeditious operative management is recommended to improve clinical outcomes.
前部视觉通路海绵状畸形（CM）是一种罕见的疾病，其自然病史和治疗方法尚不明确。我们对所有前部视觉通路CM的报告进行了系统回顾，以确定1950年至2013年12月间发表的所有经组织病理学证实的前部视觉通路CM的英文文章。记录并分析了患者的人口统计学特征、症状表现、CM位置、治疗方式和临床结果。本文报告了我院一名60岁女性患者，因视觉通路CM继发急性-on-慢性视觉障碍。据我们所知，包括当前患者在内，已发表了70例前部视觉通路CM病例。患者的平均年龄为34.8±标准差14.2岁，女性占优势（n = 37，52.9%）。大多数患者症状急性发作（n = 44；62.9%；95%置信区间[CI] 0.51 - 0.73）。至少55.6%（n = 40）的患者最初视觉障碍的病因被误诊。大多数患者（91.4%；n = 64）接受了开颅手术，在所有手术患者中，分别有53.1%（n = 34；95%CI 0.41 - 0.65）和17.2%（n = 11；95%CI 0.10 - 0.28）实现了完全切除和次全切除。比较手术治疗的患者，完全切除使59.0%（n = 20；95%CI 0.42 - 0.75）的患者视力缺陷得到改善，而次全切除使50.0%（n = 5；95%CI 0.24 - 0.76；p = 0.62）的患者视力缺陷得到改善。CM是伴有视觉障碍的鞍上病变的重要鉴别诊断。其诊断需要高度的怀疑指数。建议迅速进行手术治疗以改善临床结果。
