Department of Neurosurgery, University Hospital Hradec Králové, Faculty of Medicine in Hradec Králové, Charles University, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
Department of Anatomy, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
Sci Rep. 2022 Feb 8;12(1):2102. doi: 10.1038/s41598-022-06097-8.
Chiasmal compression is a known cause of visual impairment, often leading to surgical decompression of the optic chiasm (OC). A prospective study was held at University Hospital in Hradec Králové to explore sensitivity of optical coherence tomography (OCT) and visual evoked potentials (VEPs) to OC compression and eventual changes after a decompression. 16 patients with OC compression, caused by different sellar pathologies, were included. The main inclusion criterion was the indication for decompressive surgery. Visual acuity (VA), visual field (VF), retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness, and peak time and amplitude of pattern-reversal (P-VEPs) and motion-onset VEPs (M-VEPs) were measured pre- and postoperatively. The degree of OC compression was determined on preoperative magnetic resonance imaging. For M-VEPs, there was a significant postoperative shortening of the peak time (N160) (p < 0.05). P100 peak time and its amplitude did not change significantly. The M-VEPs N160 amplitude showed a close relationship to the VF improvement. Thinner preoperative RNFL does not present a statistically important limiting factor for better functional outcomes. The morphological status of the sellar region should be taken into consideration when one evaluates the chiasmal syndrome. M-VEPs enable detection of functional changes in the visual pathway better than P-VEPs.
视交叉受压是视力损害的已知原因，常导致视神经交叉（OC）减压手术。在赫拉德茨-克拉洛韦大学医院进行了一项前瞻性研究，以探讨光学相干断层扫描（OCT）和视觉诱发电位（VEPs）对视交叉受压的敏感性，以及减压后的最终变化。纳入了 16 例由不同鞍区病变引起的视交叉受压患者。主要纳入标准是减压手术的适应证。术前和术后分别测量视力（VA）、视野（VF）、视网膜神经纤维层（RNFL）和节细胞层（GCL）厚度以及图形反转（P-VEPs）和运动起始 VEPs（M-VEPs）的峰值时间和振幅。术前磁共振成像确定视交叉受压程度。对于 M-VEPs，术后峰时间（N160）明显缩短（p < 0.05）。P100 峰时间及其振幅无明显变化。M-VEPs N160 振幅与 VF 改善密切相关。术前 RNFL 较薄不是功能预后更好的统计学重要限制因素。在评估视交叉综合征时，应考虑鞍区的形态学状态。M-VEPs 比 P-VEPs 能更好地检测视觉通路的功能变化。
