Demura Munehiro, Sasagawa Yasuo, Hayashi Yasuhiko, Tachibana Osamu, Nakada Mitsutoshi
Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
Department of Neurosurgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan.
Surg Neurol Int. 2024 Mar 1;15:70. doi: 10.25259/SNI_909_2023. eCollection 2024.
Pituitary adenomas show typical visual field defects that begin superiorly and progress inferiorly. The cause of atypical visual field defects that start inferiorly remains unclear. This study aimed to understand this phenomenon using magnetic resonance imaging (MRI).
A total of 220 patients with pituitary adenomas underwent a visual field assessment of both eyes. Preoperative visual fields were assessed and classified into two types: superior quadrantanopia (typical) and inferior quadrantanopia (atypical). Several parameters related to tumor characteristics and optic nerve compression were evaluated using MRI.
Of the 440 eyes examined, 174 (39.5%) had visual field defects. Of these, 28 (16.1%) had typical and 11 (6.3%) had atypical visual field defects. Patient age, tumor size, degree of cavernous sinus invasion, tumor pathology, and intratumor bleeding were similar between the two groups. The angle formed by the optic nerve in the optic canal and in the intracranial subarachnoid space at the exit of the optic canal (degree of optic nerve bending) was significantly larger in the atypical group than in the typical group (42.6° vs. 23.9°, = 0.046).
In some pituitary adenomas, visual field defects begin inferiorly. This may be caused by optic nerve compression on the superior surface by the bony margin of the optic canal exit. Therefore, pituitary adenomas should be considered in patients with atypical visual field defects.
垂体腺瘤表现出典型的视野缺损，始于上方并向下发展。始于下方的非典型视野缺损的原因尚不清楚。本研究旨在使用磁共振成像（MRI）来了解这一现象。
共有220例垂体腺瘤患者接受了双眼视野评估。术前视野被评估并分为两种类型：上象限盲（典型）和下象限盲（非典型）。使用MRI评估了与肿瘤特征和视神经受压相关的几个参数。
在检查的440只眼中，174只（39.5%）有视野缺损。其中，28只（16.1%）有典型视野缺损，11只（6.3%）有非典型视野缺损。两组患者的年龄、肿瘤大小、海绵窦侵犯程度、肿瘤病理和肿瘤内出血情况相似。非典型组视神经在视神经管内和视神经管出口处颅内蛛网膜下腔形成的角度（视神经弯曲度）明显大于典型组（42.6°对23.9°，P = 0.046）。
在一些垂体腺瘤中，视野缺损始于下方。这可能是由于视神经管出口的骨边缘对上表面的视神经压迫所致。因此，对于有非典型视野缺损的患者应考虑垂体腺瘤。
