Ozdemir Evin Singar, Yildirim Ali Erdem, Can Aslihan Yavas
Department of Ophthalmology, Ankara Training and Research Hospital.
Department of Neurosurgery, Yuksek Ihtisas University.
J Craniofac Surg. 2018 Jan;29(1):199-201. doi: 10.1097/SCS.0000000000004059.
Isolated primary central nervous system lymphoma arising from anterior visual pathway is very rare.
A 76-year-old immunocompetent previously healthy man presented bilateral decreased visual acuity in 1 month. Pituitary magnetic resonans imaging (MRI) showed a lobulated mass with homogeneous enhancement after gadolinium administration that arising from optic chiasm suggested that inflammatory disease or an optic glioma. The patient underwent an extended endoscopic endonasal transsphenoidal surgery. Postoperative course and outcomes were wonderful. Histopathological diagnosis was diffuse large B-cell lymphoma. The patient underwent investigations for systemic lymphomatous involvement, did not detect any evidence of systemic disease.
In this case, we claimed that differential diagnoses of anterior visual pathway lesions are difficult because of similarity of lesions on clinical and radiological examinations. Biopsy is essential for these lesions. As a biopsy technique, endoscopic endonasal transsphenoidal approach is safer and more effective than open procedures.
起源于前视觉通路的孤立性原发性中枢神经系统淋巴瘤非常罕见。
一名76岁、免疫功能正常且此前健康的男性在1个月内出现双侧视力下降。垂体磁共振成像（MRI）显示，钆剂注射后有一个分叶状肿块，呈均匀强化，起源于视交叉，提示炎症性疾病或视神经胶质瘤。该患者接受了扩大经鼻内镜经蝶窦手术。术后病程和结果良好。组织病理学诊断为弥漫性大B细胞淋巴瘤。该患者接受了全身淋巴瘤累及情况的检查，未发现任何系统性疾病的证据。
在本病例中，我们认为由于临床和放射学检查中病变的相似性，前视觉通路病变的鉴别诊断困难。对于这些病变，活检至关重要。作为一种活检技术，经鼻内镜经蝶窦入路比开放手术更安全、更有效。
