Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position.
Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position.
复制标题
松果体区肿瘤患者以半坐位经小脑幕接近的神经眼功能。
作者：
J. Nazzaro;W. T. Shults;E. Neuwelt
为了优化积极切除的方向和手术暴露，作者以半坐位经小脑幕接近松果体区肿瘤。在本报告中，对 12 名连续患者进行了评估，记录与脑干有关的手术眼部发病率以及枕叶回缩继发的视力缺陷。在开颅手术前，10 名曾接受过脑室分流术的患者中，有 4 名患者出现了明显的与背侧中脑功能障碍相关的眼科发现。其他患者在术后早期出现部分或完全帕里诺综合征，有些患者还出现脑神经麻痹等额外缺陷。所有患者的这些缺陷都有不同程度的改善。尽管术前每个人都有完整的视野，但术后立即出现绝对或不完全的左侧同向偏盲。 12 名患者中，有 10 名患者的视野缺陷在不同的时间段内得到了完全解决。一名患者患有永久性左侧同向偏盲，另一名患者患有左侧同向旁中央暗点。八名患者能够恢复术前的活动。虽然与背侧中脑功能障碍相关的眼部异常很可能与手术入路无关，但在半坐位进行枕叶经小脑幕入路后的患者中，由于枕叶回缩而导致的视野缺损很常见。背侧中脑受累导致的与眼运动功能障碍相关的阅读困难是接受松果体区手术的患者的主要长期神经眼科主诉。
To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro-ophthalmological complaint of patients who have undergone pineal region surgery.
手术切除含有生殖细胞瘤和星形细胞瘤成分的松果体肿瘤。
影响因子：
4.8
作者：
Neuwelt,EA;Buchan,C;Blank,NK;Lewy,AJ
通讯作者：
Lewy,AJ