Dawkins Ross L, Hackney James R, Riley Kristen O
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Divisions of Neuropathology and Informatics, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
World Neurosurg. 2016 Mar;87:662.e7-11. doi: 10.1016/j.wneu.2015.10.077. Epub 2015 Nov 5.
Sellar/suprasellar cystic lesions can cause compression of the optic pathways and result in a decline in vision. There have been reports of optic pathways being fenestrated by intracranial aneurysms. This is the first report of a sellar/suprasellar arachnoid cyst causing fenestration of an optic nerve.
Our patient presented with an 8-month history of worsening vision. Imaging revealed a sellar/suprasellar cystic lesion with compression of the optic pathways. He was treated surgically via an endoscopic transsphenoidal approach. The left optic nerve was found to have multiple round defects during surgery. Pathology was consistent with an arachnoid cyst. The patient has had progressive improvement in vision up to 6 months after surgery.
Sellar/suprasellar arachnoid cysts likely form when a communication exists between the suprasellar arachnoid space and the sella turcica. We believe that our patient's cyst grew slowly enough to allow normal functioning of the optic nerve as it was being penetrated. Though visual symptoms may be gradual and not present until after the optic nerve has been penetrated, these symptoms and signs may still improve with removal of the cyst. Prognosis for visual improvement is difficult to predict with cases of compressive sellar/suprasellar cystic masses. Improvement in the vision examination after surgical resection is possible even when the optic nerve has been penetrated.
鞍区/鞍上囊性病变可压迫视路并导致视力下降。有颅内动脉瘤使视路形成筛孔的报道。这是首例鞍区/鞍上蛛网膜囊肿导致视神经形成筛孔的报告。
我们的患者有8个月视力恶化病史。影像学检查显示鞍区/鞍上囊性病变并压迫视路。他通过内镜经蝶窦入路接受了手术治疗。术中发现左侧视神经有多个圆形缺损。病理结果与蛛网膜囊肿一致。患者术后6个月视力逐渐改善。
鞍区/鞍上蛛网膜囊肿可能在鞍上蛛网膜下腔与蝶鞍之间存在交通时形成。我们认为我们患者的囊肿生长缓慢，以至于在视神经被穿透时仍能保持正常功能。尽管视觉症状可能是渐进性的，直到视神经被穿透后才出现，但这些症状和体征仍可能通过切除囊肿而改善。对于压迫性鞍区/鞍上囊性肿块病例，视力改善的预后难以预测。即使视神经已被穿透，手术切除后视力检查仍有可能改善。
