Compressive Lesions of the Optic Nerves and Chiasm

Kayan, A; Earl, Cassie

doi:10.1093/brain/98.1.13

Cited by 67 publications

(4 citation statements)

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“…Improvement in visual fields following decompression of the optic chiasm has been reported in large cohorts of patients (10–12). Consecutive measurements suggest two stages of recovery that might stem from different biological mechanisms: a fast early improvement due to the resolution of conduction block, and late improvement due to restoration of axonal transport, remyelination or remodeling within the anterior visual pathways (12).…”

Section: Discussionmentioning

confidence: 94%

Physiological Correlates and Predictors of Functional Recovery After Chiasmal Decompression

Raz

Bick

Klistorner

et al. 2015

Journal of Neuro-Ophthalmology

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Background The intrinsic abilities and limits of the nervous system to repair itself after damage may be assessed using a model of optic chiasmal compression, prior to and following a corrective surgical procedure. Methods Visual fields (VFs), multi-focal visual evoked potentials (mfVEP), retinal nerve fiber layer (RNFL) thickness and diffusion tensor imaging (DTI) were used to evaluate a patient before and after removal of a meningioma compressing the chiasm. Normally-sighted individuals served as controls. The advantage of each modality to document visual function and predict post-operative outcome (two years follow up) was evaluated. Results Post-surgery visual recovery was best explained by critical mass of normally-conducting fibers, and not associated with average conduction amplitudes. Recovered VF was observed in quadrants in which more than 50% of fibers were identified, characterized by intact mfVEP latencies but severely reduced amplitudes. Recovery was evident despite additional reduction of RNFL thickness and abnormal optic tract diffusivity. The critical mass of normally conducting fibers was also the best prognostic indicator for functional outcome two years later. Conclusion Our results highlight the ability of the remaining normally conductive axons to predict visual recovery following decompression of the optic chiasm. The redundancy in anterior visual pathways may be explained, neuro-anatomically, by overlapping receptive fields.

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Section: Discussionmentioning

confidence: 94%

Physiological Correlates and Predictors of Functional Recovery After Chiasmal Decompression

Raz

Bick

Klistorner

et al. 2015

Journal of Neuro-Ophthalmology

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“…Transsphenoidal decompression of the sella results in immediate to early reversal of the conduction block, and visual function thereafter continues to improve in a stepwise fashion through continued remyelination and restoration of axoplasmic ow. [16,19,20] The primary outcome measure chosen for this study was visual outcome at 1 year, since clinically meaningful improvements in VA and VF usually stabilize within a few months after surgery. The postoperative recovery of VA does not necessary parallel that of VF 21 , and there it has been suggested that improvements in VF tend to be more delayed than the early gains seen in the domain of VA. [19, 22,23] In a recent prospective study of a large institutional cohort, Wang et al demonstrated no signi cant improvement in LogMAR scores of VA after surgery, while also detecting slower and delayed improvements in VF at 6 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Optico-chiasmatic distortions in pituitary adenomas: correlation between postoperative morphological reversal and follow-up functional visual recovery

Sarkar,

Thakar,

Sunil

et al. 2024

Preprint

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Purpose: To objectively correlate distortions of optic apparatus morphology in patients with visual outcomes in patients with pituitary adenomas undergoing transsphenoidal surgery. Methods: In this retrospective analysis, visual acuity (VA), visual field (VF) and total visual (TV) function was objectively scored in patients selected from an institutional cohort of pituitary adenomas. The following imaging measures of optico-chiasmatic morphology were recorded preoperatively, and at 3 months after surgery: chiasm area (CA), mid-chiasm height (CH), optic nerve-canal bending angle (BA), and optic nerve kinking angle (ONKA). Results: Seventy-one eyes were individually studied. VA, VF and TV scores significantly improved after surgery, both at the 3-month and at the 1-year follow-up visits (p<0.001). Craniocaudal tumor dimension was significantly associated with VA, VF and TV scores, both pre- and post-operatively. There were significant changes in CH (p<0.001), BA (p<0.001) and ONKA (p<0.001) at 3 months after surgery, but not in CA (p=0.061). Baseline VA, VF and TVS scores were positively correlated with preoperative CH and ONKA, while VF and TV scores also demonstrated significant negative correlations with preoperative BA. VF scores at 1-year follow-up were significantly correlated with preoperative and change in BA values, as well as with preoperative and change in ONKA values. Chiasm sag was noted in 45.8% of patients at one year follow-up, but was not associated with delayed visual deterioration in any case. Conclusions: Anatomic realignment of the optic apparatus at 3 months following transsphenoidal surgery month predicts VF scores at 1 year follow-up, but not VA or TV scores.

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“…As VFDs in patients with pituitary tumors develop gradually and are associated with a long period of compression of the optic nerve or optic chiasm, the severity or duration of the axonal injury may also affect the recovery of visual dysfunction. 20,33…”

Section: Discussionmentioning

confidence: 99%

Predictive value of OCT and MRI for postoperative visual recovery in patients with chiasmal compressive lesions

Jeon

Suh

Kim

et al. 2022

European Journal of Ophthalmology

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Purpose We aimed to investigate the predictive value of retinal thickness measured by optical coherence tomography (OCT) and mass biometrics measured using magnetic resonance image (MRI) for visual recovery after surgery for removal of a mass compressing the optic chiasm. Methods Consecutive patients who showed typical temporal visual field defect (VFD) with respect to the vertical meridian due to a chiasmal compressive mass and who underwent mass removal surgery were recruited. Ophthalmic examination was performed preoperatively and postoperatively. Retinal thickness was measured by the Cirrus OCT. The height and size of the mass and suprasellar extension (SSE) in both the sagittal and coronal planes were evaluated. Patients were divided into two groups based on the improvement in VFD (mean deviation [MD] change ≥ 5 dB: group R; others: group NR) and clinical characteristics were compared. Results Fifteen patients were included in the study. Eight (53.3%) patients were allocated into group R and others (7 patients, 46.7%) into group NR. Age, sex, initial visual acuity, initial MD was not different between the two groups. The retinal thicknesses were not different while tumor height, volume, and both sagittal and coronal SSE were significantly different between the two groups. (p = 0.029, 0.014, <0.001, and <0.001, respectively) All MRI parameters showed significant predictive value for the degree of MD recovery. Conclusion MRI showed better predictive value than OCT in predicting postoperative VFD recovery in patients with temporal VFDs due to chiasmal compressive disorder.

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Compressive Lesions of the Optic Nerves and Chiasm

Cited by 67 publications

References 0 publications

Physiological Correlates and Predictors of Functional Recovery After Chiasmal Decompression

Physiological Correlates and Predictors of Functional Recovery After Chiasmal Decompression

Optico-chiasmatic distortions in pituitary adenomas: correlation between postoperative morphological reversal and follow-up functional visual recovery

Predictive value of OCT and MRI for postoperative visual recovery in patients with chiasmal compressive lesions

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