Loewenstern Joshua, Hernandez Christopher M, Chadwick Carolyn, Doshi Amish, Banik Rudrani, Sarkiss Christopher A, Bederson Joshua, Shrivastava Raj K
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2018 Jan;109:e546-e553. doi: 10.1016/j.wneu.2017.10.018. Epub 2017 Oct 13.
Fibrous dysplasia (FD) of the skull base can manifest with optic nerve compression. As most patients initially do not experience vision loss, controversy exists whether to proceed with prophylactic surgical decompression or elect for conservative observation. Optical coherence tomography (OCT), a physiologic imaging modality widely used to assess the condition of the retinal nerve fiber layer (RNFL), has been useful in monitoring compressive tumors on the optic nerve. This study evaluated potential use of OCT in management of patients with fibrous dysplasia and optic nerve involvement.
Six patients with suspected optic nerve compression who underwent OCT imaging as part of a neuro-ophthalmic examination were reviewed over a 2-year period. Patient records were evaluated for visual examination measures, most notably the presence of optic neuropathy, and radiographic measures on computed tomography. Measures were compared by age-adjusted RNFL thickness (above or below fifth percentile) on OCT imaging.
Two patients were found to have mild optic neuropathy in 1 eye each. Three of 12 eyes fell below the age-adjusted fifth percentile of RNFL thickness. Presence of optic neuropathy was associated with abnormal age-adjusted RNFL thickness but not with optic nerve compression (P = 0.45).
Abnormal RNFL thickness as measured by OCT better predicted the presence of optic neuropathy than computed tomography alone. OCT may be a valuable imaging modality to monitor patients with fibrous dysplasia for development of optic neuropathy during periods of conservative watchful waiting.
颅底骨纤维异常增殖症（FD）可表现为视神经受压。由于大多数患者最初并无视力丧失，对于是否进行预防性手术减压或选择保守观察存在争议。光学相干断层扫描（OCT）是一种广泛用于评估视网膜神经纤维层（RNFL）状况的生理成像方式，在监测视神经上的压迫性肿瘤方面很有用。本研究评估了OCT在骨纤维异常增殖症合并视神经受累患者管理中的潜在用途。
在两年期间，对6例疑似视神经受压且接受OCT成像作为神经眼科检查一部分的患者进行了回顾。评估患者记录中的视力检查指标，最显著的是视神经病变的存在情况，以及计算机断层扫描的影像学指标。通过OCT成像上根据年龄调整的RNFL厚度（高于或低于第五百分位数）对各项指标进行比较。
发现2例患者每只眼各有轻度视神经病变。12只眼中有3只眼的RNFL厚度低于根据年龄调整的第五百分位数。视神经病变的存在与根据年龄调整的RNFL厚度异常相关，但与视神经受压无关（P = 0.45）。
与单独的计算机断层扫描相比，OCT测量的RNFL厚度异常能更好地预测视神经病变的存在。在保守观察期间，OCT可能是监测骨纤维异常增殖症患者视神经病变发展的一种有价值的成像方式。
