Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA.
Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA.
World Neurosurg. 2020 Oct;142:456-459. doi: 10.1016/j.wneu.2020.07.041. Epub 2020 Jul 14.
Anatomic compression of the optic nerve secondary to a dolichoectatic cerebrovascular compression is a rare clinical entity. Because of the limited number of published cases and variable clinical presentation, the natural history remains ambiguous and no consensus exists regarding management. In addition, there is an ongoing debate regarding whether a dolichoectatic cerebral blood vessel can actually cause optic neuropathy, or it merely represents an incidental finding. As a result, it is thought that a diagnosis of compressive optic neuropathy from an adjacent dolichoectatic internal carotid artery (ICA) should be considered only after other possible etiologies are excluded. Although this might seem straightforward, the clinical scenario becomes complex if the patient is also found to have additional incidental pituitary lesions. Such coexistence has not been reported previously in the literature.
A 52-year-old left-handed man presented to us with intermittent headache and painless progressive visual deterioration in the right eye for 1 month. Screening magnetic resonance imaging (MRI) scan revealed a 9-mm eccentrically placed pituitary adenoma with right optic nerve compression because of dolichoectatic ICA. He underwent microvascular decompression of the right optic nerve. On follow-up, significant vision improvement was noticed and MRI scan revealed no change in the size of the pituitary adenoma.
The compression of the optic nerve by dolichoectatic ICA is commonly thought to be a diagnosis of exclusion. However, the presence of a coexisting pathology should not prompt the exclusion in every case and a case-based approach is highly recommended to correctly manage this rare clinical condition.
由于发表的病例数量有限且临床表现多样，因此，继发于迂曲扩张性脑血管压迫的视神经解剖性受压仍然是一种罕见的临床实体，其自然病程尚不清楚，管理方法也尚无共识。此外，关于迂曲扩张性脑血管是否确实会导致视神经病变，或者仅仅是偶然发现，目前仍存在争议。因此，人们认为只有在排除其他可能的病因后，才应考虑由相邻迂曲扩张颈内动脉（ICA）引起的压迫性视神经病变的诊断。尽管这似乎很简单，但如果患者还发现有其他偶然的垂体病变，则临床情况会变得复杂。这种共存以前在文献中没有报道过。
一名 52 岁的左撇子男性因间歇性头痛和右侧无痛性进行性视力下降 1 个月来我院就诊。筛查磁共振成像（MRI）扫描显示，垂体瘤 9mm 偏心生长，右侧视神经受压，原因是 ICA 迂曲扩张。他接受了右侧视神经微血管减压术。随访时，发现视力显著改善，MRI 扫描显示垂体瘤大小无变化。
ICA 迂曲扩张导致视神经受压通常被认为是一种排除性诊断。然而，在每种情况下共存的病理都不应该被排除，强烈建议根据具体病例来处理这种罕见的临床情况。
