Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Neurosurg Rev. 2022 Dec 6;46(1):4. doi: 10.1007/s10143-022-01915-z.
Critical flicker fusion frequency (CFF) is a short but sensitive method for evaluating optic nerve function. We measured CFF in patients with pituitary neuroendocrine tumors (Pit-NETs) to assess its usefulness. Data from 184 patients with nonfunctioning Pit-NETs, who had been treated with transsphenoidal surgery and had no medical history of eye diseases, was used in this retrospective study. Visual acuity decline (VAD) was defined as > 0.10 reduction in logMAR visual acuity and CFF decline (CFD) was defined as CFF value < 35 Hz. Visual field defect (VFD) was evaluated by automated perimetry on a Humphrey visual field analyzer. Potential associations between abnormal test results and tumor height from the suprasellar were analyzed. Contact between the optic nerve or chiasma and the tumor was present and absent in 161 and 23 patients, respectively. In patients showing contact, the difference in CFF between the left and right eyes was larger (p = 0.0008), and the optimal cutoff value using the receiver operating characteristic curve was 3 Hz. Therefore, ≥ 3 Hz was considered positive for CFF laterality (CFL), the most prevalent condition. Tumor height was lower in patients with CFL positivity compared to those with VAD or VFD (p < 0.01). The prevalence of test abnormalities was the highest for small tumors compared to those of other tests. Changes in CFL permit early detection of Pit-NETs. Our results indicate that CFF laterality can be seen in the early stages of compressive optic neuropathy due to Pit-NET.
临界闪烁融合频率（CFF）是一种评估视神经功能的短但敏感的方法。我们测量了垂体神经内分泌肿瘤（Pit-NETs）患者的 CFF，以评估其有用性。这项回顾性研究使用了 184 例无功能性 Pit-NET 患者的数据，这些患者接受了经蝶窦手术治疗，且无眼部疾病史。视力下降（VAD）定义为 logMAR 视力下降>0.10，CFF 下降（CFD）定义为 CFF 值<35 Hz。通过 Humphrey 视野分析仪自动视野检查评估视野缺损（VFD）。分析了异常测试结果与鞍上肿瘤高度之间的潜在关联。视神经或视交叉与肿瘤接触和不接触的患者分别为 161 例和 23 例。在显示接触的患者中，左右眼 CFF 的差异更大（p=0.0008），使用受试者工作特征曲线的最佳截断值为 3 Hz。因此，≥3 Hz 被认为是 CFF 偏侧性（CFL）阳性，这是最常见的情况。与 VAD 或 VFD 患者相比，CFL 阳性患者的肿瘤高度较低（p<0.01）。与其他测试相比，小肿瘤的测试异常患病率最高。CFL 的变化可以早期发现 Pit-NETs。我们的结果表明，由于 Pit-NET，CFF 偏侧性可能在压迫性视神经病变的早期阶段出现。
