Microsurgical Resection of a Chiasmatic Cavernoma: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Alvaro Campero ◽  
Ignacio Casas-Parera ◽  
Juan F Villalonga ◽  
Matías Baldoncini
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Visual Loss ◽  
Brain Mri ◽  
Optic Tract ◽  
Nerve Fibers ◽  
Visual Field Defects ◽  
Cavernous Malformations ◽  
Transsylvian Approach ◽  
The Right

Abstract According to reports from the literature,1,2 depending on the location where cavernomas appear, range from the very common locations to unusual. Cavernous malformations arising from the optic nerve and chiasm are rare, with only few cases reported to date.3-5  We present a case of a 28-yr-old man who suddenly started with sever visual loss in the right eye and homonymous lateral hemianopia in the left eye. Because of the acute symptomatology, a brain MRI was immediately performed in order to diagnose the etiology. The MRI showed a chiasmatic mass with right extension, heterogeneous on T1 and T2 sequences, without enhancement after gadolinium. The surgery was carried out a week after the diagnosis. A right pterional transsylvian approach was performed and the cavernoma was resected with microsurgical maneuvers, preserving the optic nerve fibers, chiasm, and optic tract.  The patient evolved favorably, improving the visual deficit in the postoperative period as can be observed in the postoperative visual field study 7 mo after the surgery.  The patient signed an informed consent for the procedure and agreed with the use of his images and surgical video for research and academic purposes.  Our surgical case emphasizes the importance of a prompt diagnosis and surgery for chiasmatic cavernomas3 associated to visual loss, providing early decompression of the optic apparatus and improvement of the visual field defects after surgery.

scholarly journals Different IOP, different diseases?

2016 ◽  
Vol 1 (2) ◽  
pp. 97-102
Author(s):  
Michele Iester ◽  
Elisa D’Alessandro
Keyword(s):  
Intraocular Pressure ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Progressive Disease ◽  
Clinical Findings ◽  
Nerve Fibers ◽  
Visual Field Defects ◽  
Chronic Progressive Disease ◽  
Field Defects

Glaucoma is a chronic, progressive disease characterized by typical optic nerve head changes and visual field defects. These alterations are caused by an intraocular pressure (IOP) being too high for the wellbeing of the specific optic disc. Typical clinical findings in glaucoma patients include thinning of the optic disc rim (Fig. 1), loss of retinal nerve fibers in the inferior sector with subsequent visual field defects in the superior sector.

Anatomic Basis and Differential Diagnosis of Field Defects

Visual Fields ◽  
2010 ◽  
Author(s):  
Jonathan D. Wirtschafter ◽  
Thomas J. Walsh
Keyword(s):  
Differential Diagnosis ◽  
Optic Nerve ◽  
Visual Field ◽  
Vision System ◽  
Optic Tract ◽  
Optic Chiasm ◽  
Visual Field Defects ◽  
Medical Test ◽  
Ct Angiogram ◽  
Field Defects

The purpose of any medical test is to confirm or rule out a diagnosis based on the clinical facts. In performing perimetry, the printout of the defect is not the end of the test. For even the most experienced reader, the test results at best tell the location of the defect. The next step is to consider the causes of such a defect in that part of the vision system. The experienced perimetrist will look at the results and suggest a differential list of causes. The primary diagnostic list is frequently aided by adding to the perimetry the medical history and other physical signs. The results of both then lead to the next step: ordering tests to confirm the cause of the field defect. It may require the ordering of a magnetic resonance (MR) image, but that may not be the proper test if the original differential diagnosis is faulty. Sedimentation rate and C-reactive protein may be more appropriate tests if the clinical facts suggest cranial arteritis. If carotid disease is suspected, a computed tomography (CT) angiogram may be more appropriate. In the following discussion of these defects, there has been a melding of a discussion explaining anatomically why these defects occur in certain areas. Because the course and relations of the primary visual sensory pathway have been frequently and well described (including in other chapters of this monograph), this chapter concentrates on the multiple anatomic substrates that may explain each particular pattern of visual field abnormality. Visual field abnormalities are represented by three categories: monocular, binocular, and junctional. Monocular field defects include those that can be caused by lesions of one eye or optic nerve. Binocular field defects include those that may result from single or multiple lesions at one or more points along the visual pathway. Junctional field defects include three types of visual field defects resulting from a lesion at the junction of the optic nerve and optic chiasm or of the optic tract and optic chiasm.

scholarly journals Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

2017 ◽  
Vol 8 (1) ◽  
pp. 157-162
Author(s):  
Yurie Fukiyama ◽  
Hidehiro Oku ◽  
Yusuke Hashimoto ◽  
Yuko Nishikawa ◽  
Masahiro Tonari ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Neuropathy ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Complete Recovery ◽  
Visual Field Defects ◽  
Anterior Cerebral Artery Aneurysm ◽  
The Right ◽  
Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss.

Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

2021 ◽  
pp. 1-11
Author(s):  
Visish M. Srinivasan ◽  
Phiroz E. Tarapore ◽  
Stefan W. Koester ◽  
Joshua S. Catapano ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Visual Fields ◽  
Optic Tract ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Subtotal Resection

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

[3H]nicotine binding sites are associated with mammalian optic nerve terminals

1988 ◽  
Vol 1 (2) ◽  
pp. 245-248 ◽  
Author(s):  
Glen T. Prusky ◽  
Max S. Cynader
Keyword(s):  
Optic Nerve ◽  
Visual System ◽  
Nicotinic Acetylcholine Receptors ◽  
Binding Sites ◽  
Acetylcholine Receptors ◽  
Optic Tract ◽  
Nerve Fibers ◽  
Nerve Terminals ◽  
Nicotinic Acetylcholine ◽  
Retinotectal Transmission

AbstractThe autoradiographic distribution of [3H]nicotine binding sites was examined in the superior colliculus in normal rats and cats, and in animals in which one or both eyes were removed. [3H]Nicotine binding sites in normal animals were densely concentrated in the superficial layers of the colliculus corresponding to the zone of termination of optic nerve fibers. Following bilateral enucleation, [3H]nicotine binding in the superficial collicular layers was drastically reduced. Unilateral enucleation markedly reduced [3H]nicotine binding sites in the colliculus contralateral to the removed eye, with little effect on the ipsilateral colliculus. These results provide further evidence that nicotinic acetylcholine receptors have a presynaptic location on optic tract terminals and may therefore modulate retinotectal transmission in both the rat and cat visual system.

Automated Perimetry in Glaucoma

Visual Fields ◽  
2010 ◽  
Author(s):  
Hylton R. Mayer ◽  
Marc L. Weitzman
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Structural Damage ◽  
Visual Field Defects ◽  
Fiber Layer ◽  
Glaucomatous Damage ◽  
Retinal Fibers ◽  
Field Defects

Clinical experience and multiple prospective studies, such as the Collaborative Normal Tension Glaucoma Study and the Los Angeles Latino Eye Study, have demonstrated that the diagnosis of glaucoma is more complex than identifying elevated intraocular pressure. As a result, increased emphasis has been placed on measurements of the structural and functional abnormalities caused by glaucoma. The refinement and adoption of imaging technologies assist the clinician in the detection of glaucomatous damage and, increasingly, in identifying the progression of structural damage. Because visual field defects in glaucoma patients occur in patterns that correspond to the anatomy of the nerve fiber layer of the retina and its projections to the optic nerve, visual functional tests become a link between structural damage and functional vision loss. The identification of glaucomatous damage and management of glaucoma require appropriate, sequential measurements and interpretation of the visual field. Glaucomatous visual field defects usually are of the nerve fiber bundle type, corresponding to the anatomic arrangement of the retinal nerve fiber layer. It is helpful to consider the division of the nasal and temporal retina as the fovea, not the optic nerve head, because this is the location that determines the center of the visual field. The ganglion cell axon bundles that emanate from the nasal side of the retina generally approach the optic nerve head in a radial fashion. The majority of these fibers enter the nasal half of the optic disc, but fibers that represent the nasal half of the macula form the papillomacular bundle to enter the temporal-most aspect of the optic nerve. In contrast, the temporal retinal fibers, with respect to fixation, arc around the macula to enter the superotemporal and inferotemporal portions of the optic disc. The origin of these arcuate temporal retinal fibers strictly respects the horizontal retinal raphe, temporal to the fovea. As a consequence of this superior-inferior segregation of the temporal retinal fibers, lesions that affect the superotemporal and inferotemporal poles of the optic disc, such as glaucoma, tend to cause arcuateshaped visual field defects extending from the blind spot toward the nasal horizontal meridian.

Neuro-ophthalmology: Disorders of Visual Perception, Pupils, and Eyelids

2021 ◽  
pp. 821-833
Author(s):  
Shivram Kumar ◽  
Kelly D. Flemming
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Perception ◽  
Visual Loss ◽  
Visual Field Defects ◽  
Clinical Disorders ◽  
Physical Findings ◽  
Abnormal Visual ◽  
Visual Changes ◽  
Field Defects

Visual loss may develop acutely, subacutely, or insidiously. The course may be transient, static, or progressive. This chapter reviews the causes, diagnosis, and treatment of various disorders resulting in visual loss or abnormal visual perception. In addition, it reviews clinical disorders of the eyelids and pupils. Disorders of visual perception involve visual acuity, color perception, visual field defects, and other visual changes. Historical information and physical findings on examination can help to localize the problem and define the cause.

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