Girkin C A, Comey C H, Lunsford L D, Goodman M L, Kline L B
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, USA.
Ophthalmology. 1997 Oct;104(10):1634-43. doi: 10.1016/s0161-6420(97)30084-0.
The purpose of the study is to report the occurrence of optic neuropathy after stereotactic radiosurgery for perichiasmal tumors.
Records of four patients with visual deterioration after stereotactic radiosurgery were reviewed, including clinical findings, neuroimaging results, and treatment methods.
Optic neuropathy developed 7 to 30 months after gamma knife radiosurgery. All patients experienced an abrupt change in visual function. Clinical findings indicated anterior visual pathway involvement. Patterns of field loss included nerve fiber bundle and homonymous hemianopic defects. Gadolinium-enhanced magnetic resonance imaging (MRI) showed swelling and enhancement of the affected portion of the visual apparatus in three patients. Systemic corticosteroids were administered in all patients and one partially recovered. One patient also received hyperbaric oxygen without improvement.
Although rare, optic neuropathy may follow radiosurgery to lesions near the visual pathways. Careful dose planning guided by MRI with restriction of the maximal dose to the visual pathways to less than 8 Gy will likely reduce the incidence of this complication.
本研究旨在报告立体定向放射外科治疗视交叉周围肿瘤后视神经病变的发生情况。
回顾了4例立体定向放射外科治疗后出现视力下降患者的记录，包括临床表现、神经影像学结果和治疗方法。
视神经病变在伽玛刀放射外科治疗后7至30个月出现。所有患者的视觉功能均突然改变。临床表现提示前视觉通路受累。视野缺损模式包括神经纤维束和同向性偏盲缺陷。钆增强磁共振成像（MRI）显示3例患者视觉器官受累部分肿胀并强化。所有患者均接受了全身皮质类固醇治疗，1例部分恢复。1例患者还接受了高压氧治疗，但无改善。
尽管罕见，但视神经病变可能发生在视觉通路附近病变的放射外科治疗后。在MRI引导下进行仔细的剂量规划，将视觉通路的最大剂量限制在8 Gy以下，可能会降低这种并发症的发生率。
