Division of Neurosurgery, Department of Neurosciences, Reproductive and Odonotostomatological Sciences, University of Naples Federico II, Naples, Italy -
Department of Public Health, University of Naples Federico II, Naples, Italy.
J Neurosurg Sci. 2022 Aug;66(4):362-370. doi: 10.23736/S0390-5616.19.04687-3. Epub 2019 Jul 23.
Tumors involving the sellar area often cause visual disorders due to optic nerves/chiasm compression, so that surgery is required. However, the likelihood of visual improvement/restoration is variable. Optical coherence tomography (OCT) is a valid diagnostic tool for defining pathological conditions of the optic apparatus. We herein investigated the role of the SD-OCT and the best corrected visual acuity in predicting postoperative visual recovery, in patients complaining of chiasm compression due to sellar-suprasellar lesions.
We retrospectively analyzed 20 patients (7 females and 13 males; mean age 50.8±17.87 years, range 11-83), with optic chiasm/nerve compression that underwent endoscopic endonasal approach at the Division of Neurosurgery of the University of Naples Federico II, Naples, Italy, between June 2014 and February 2015. Preoperative ophthalmological assessment focused on BCVA Snellen charts, standard automated perimetry test and SD-OCT. Test were repeated at two weeks, one and three months after surgery.
A significant thickness reduction in all the patients, as compared to the control group was noted: GCC thickness reduction remained mostly unchanged postoperatively: 42.9% of the patients had altered visual acuity (VA), while the Perimetry revealed 90% of altered preoperative MD values (MD>-2.00): perimetry improvement was noted in 93% of cases and visual acuity in 91.3% of cases. A direct correlation between preoperative retinal status and functional recovery was identified considering the values of pRNFL and GCC.
OCT provides valuable information regarding the entity of compression also in patients without any visual field defects. Although several factors should be taken into consideration, we retain that preoperative RNFL and GCC thickness values can be claimed as a reliable predictor of visual recovery in those patients presenting chiasm compression.
鞍区肿瘤常因视神经/视交叉受压而导致视觉障碍，因此需要手术治疗。然而，视觉改善/恢复的可能性是不同的。光学相干断层扫描（OCT）是一种有效的诊断工具，可用于定义视神经器的病理状况。我们在此研究了 SD-OCT 和最佳矫正视力在预测因鞍上-鞍旁病变而导致视交叉受压的患者术后视觉恢复中的作用。
我们回顾性分析了 2014 年 6 月至 2015 年 2 月在意大利那不勒斯费德里科二世大学神经外科分部接受内镜经鼻入路手术的 20 例（7 名女性和 13 名男性；平均年龄 50.8±17.87 岁，范围 11-83 岁）视神经/视交叉受压的患者。术前眼科评估重点是 BCVA 视力表、标准自动视野检查和 SD-OCT。术后两周、一个月和三个月重复检查。
与对照组相比，所有患者的厚度均显著减少：术后 GCC 厚度减少基本不变：42.9%的患者视力改变，而视野检查显示 90%的术前 MD 值改变（MD>-2.00）：93%的病例出现视野改善，91.3%的病例视力改善。考虑到 pRNFL 和 GCC 的值，发现术前视网膜状态与功能恢复之间存在直接相关性。
OCT 提供了有价值的信息，表明即使在没有任何视野缺损的患者中，视神经受压的程度。尽管应考虑多种因素，但我们认为术前 RNFL 和 GCC 厚度值可作为视交叉受压患者视觉恢复的可靠预测指标。
