Huang W C, Lee L S
Department of Neurosurgery, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1997 Nov;60(5):245-51.
The most common objective manifestations of pituitary adenoma are visual, including impairment of a visual field and loss of acuity. The characteristic visual field defect caused by pituitary adenomas with suprasellar extension is bitemporal hemianopsia. The present study was undertaken to determine the relationship between a visual field defect and the chiasma compression caused by pituitary adenomas.
Between January 1994 and December 1996 within the Department of Neurosurgery at the Neurological Institute of Veterans General Hospital-Taipei, 70 patients with pituitary adenoma were selected. Their medical records and radiological films were reviewed. The qualified visual field scores were compared with the chiasma compression levels measured from computed tomography, sagittal and coronal magnetic resonance (MR) imaging. The relationships of pathological diagnosis as well as history of prior operations with visual field defect score were also evaluated.
patients with a pathological diagnosis of a non-functional pituitary adenoma or with a history of prior operation for the pituitary adenoma had the more severe visual field defect. The chiasma compression level, no matter measured from computed tomography, sagittal MR or coronal MR imaging, was correlated significantly with the visual field defect. The correlation coefficient was 0.764 from computed tomography, 0.688 from sagittal MR imaging, and 0.717 from coronal MR imaging. The visual field defect was present mostly when the chiasma compression exceeded a certain level when measured from computed tomography, sagittal MR and coronal MR imaging. On the other hand, variation in chiasma type had little effect on the appearance and degree of a visual field defect.
There was a linear correlation between a visual field defect and the chiasma compression no matter whether measured from computed tomography or from MR imaging. The visual field defect occurred mostly when the chiasma compression exceeded a certain level. A more severe visual field defect appeared in patients with nonfunctional pituitary adenoma or those with a prior operation history for the pituitary adenoma.
垂体腺瘤最常见的客观表现为视觉方面的，包括视野缺损和视力丧失。鞍上扩展型垂体腺瘤所致的特征性视野缺损为双颞侧偏盲。本研究旨在确定垂体腺瘤所致视野缺损与视交叉受压之间的关系。
1994年1月至1996年12月期间，在台北荣民总医院神经研究所神经外科选取70例垂体腺瘤患者。回顾他们的病历和放射学影像。将合格的视野评分与通过计算机断层扫描、矢状位和冠状位磁共振成像测量的视交叉受压程度进行比较。还评估了病理诊断以及既往手术史与视野缺损评分的关系。
病理诊断为无功能性垂体腺瘤的患者或有垂体腺瘤既往手术史的患者视野缺损更严重。视交叉受压程度，无论通过计算机断层扫描、矢状位磁共振成像还是冠状位磁共振成像测量，均与视野缺损显著相关。计算机断层扫描的相关系数为0.764，矢状位磁共振成像为0.688，冠状位磁共振成像为0.717。当通过计算机断层扫描、矢状位磁共振成像和冠状位磁共振成像测量视交叉受压超过一定程度时，大多会出现视野缺损。另一方面，视交叉类型的变化对视野缺损的出现和程度影响很小。
无论通过计算机断层扫描还是磁共振成像测量，视野缺损与视交叉受压之间均存在线性相关性。视交叉受压超过一定程度时大多会出现视野缺损。无功能性垂体腺瘤患者或有垂体腺瘤既往手术史的患者视野缺损更严重。
