垂体腺瘤对视功能损害的临床观察

目的：探讨垂体腺瘤对眼视功能损害的临床表现。方法：对126例（252只眼）垂体腺瘤患者进行视力、视野、荧光眼底血管造影（Fundusfluoresceinangiography，FFA）、图形视诱发电位（Patternvisualevokedpotential，PVEP）及眼底检查。结果：视力下降186只眼，占73．8％。眼底原发性视神经萎缩130只眼，占51．6％。视野缺损156只眼，占69．6％。PVEP异常160只眼，占88．9％。26．2％的患者以眼部异常为首诊症状．其中16．7％曾被诊断为眼科疾病。结论：垂体腺瘤可引起视功能的损害，充分认识垂体腺瘤在眼部的临床特点，有助于早期诊断及时治疗。     

垂体腺瘤的眼部改变和误诊分析

目的 :探讨首诊于眼科的垂体腺瘤视功能损害及误诊原因 ,以提高对肿瘤的早期认识和促进诊断。方法 :对5 5例经手术病理证实的垂体腺瘤进行临床分析。结果 :视功能损害者 36例 ,视野缺损者 4 0例 ,以视力减退为首发症状就诊于眼科的 32例 ,误诊 14例。结论 :眼科医师在临床诊断过程中对视力、视野异常的患者需要综合分析 ,以避免或减少垂体肿瘤的误诊     

视神经萎缩的闪光视觉诱发电位检查所见

视神经萎缩是眼科临床常见病变,可由多种原因所致。在对视神经萎缩患者的视功能进行判断时,除了传统的视力,视野检查等手段外,近年来逐渐将视觉电生理检查技术应用于其中,视觉诱发电位检查则是最常用的一种视     

青光眼相关检查在慢性闭角型青光眼中的临床应用

目的：：评价图形视觉诱发电位( P-VEP )、视野、眼底照相和光学相干断层扫描( OCT)对慢性闭角型青光眼患者检查的可靠性。方法：对96例109眼慢性闭角型青光眼患者应用眼科电生理仪、视野、眼底照相和OCT,根据P-VEP、视野、眼底照相和OCT检查结果的阳性率进行相关性分析。结果：选取96例109眼获得 P-VEP 阳性病例72眼(66.1%),未见明显异常37眼(33.9%);视野检查显示阳性病例84眼(77.1%),未见明显异常25眼(22.9%);眼底照相成功获取阳性病例图像87眼(79.8%),未见明显异常22眼(20.2%);成功获取OCT阳性病例图像94眼(86.2%),未见明显异常 OCT 图像15眼(13.8%)。OCT阳性检出率高于视野检查、眼底照相、P-VEP检查( P<0.05)。 OCT在获取前房角图像与三面镜检查相比无统计学差异(P>0.05)。结论：视觉电生理检查、视野、眼底照相和光学相干断层图像结果对慢性闭角型青光眼患者的视功能状况进行综合评估。     

首诊眼科的儿童颅内肿瘤三例

很多颅脑肿瘤患者发病初期可表现为神经眼科症状,患者常首诊于眼科,典型的初期症状是进行性视力下降,伴或不伴视神经萎缩、视野缺损和眼外肌麻痹等[1]。当肿瘤未累及视路或累及初期,视功能损害常不明显,患者也可同时伴有眼部疾病,遮掩了肿瘤引起的视功能损害;儿童患者往往因主诉表达不清,视野检查难以配合等更容易误诊、漏诊[2]。笔者回顾近期3例首诊于我院眼科而最终被诊断为颅脑肿瘤患儿临床资料,现报告如下。     

垂体腺瘤的中心视野与误诊分析

目的 分析垂体腺瘤患者双眼的中心视野及其后极部的眼底改变。 方法 应用Humphrey instruments 750型电脑视野分析仪和TopconTRC-50x眼底照相机，对手术前70例垂体腺瘤患者行全阈值静态中心视野及眼底检查。 结果 视力损害者占64.3%，视野损害者占80.7%，眼底改变者占46.4%。而以视力减退为首诊症状者占45.7%，其中28.6%曾被误诊为眼科疾病。 结论 误诊因素主要是患者以视力减退为首诊症状，且多无视野缺 损主诉及同时伴有眼科疾病症状。因此，在眼科临床诊断过程中，对于原因不明的视力下降和解释不清的视神经萎缩，均应把视野作为常规检查，避免漏诊、误诊。 （中华眼底病杂志，2003，19：18-19）     

视神经损害疾病的对比敏感度（CSF）检查

视神经损害疾病的对比敏感度（ＣＳＦ）检查空军沈阳医院眼科邱远东青光眼和视神经炎是临床上较为常见的神经损害性疾病．在患者有自觉症状，而客观检查无明显改变时，做早期诊断有一定的困难．依据中心视力和视野的改变判断视功能是否受损，具有一定的局限性，且对于早期...     

296例垂体腺瘤的视器症状和疗效分析

垂体腺瘤是颅内肿瘤中常见的一种,其发生率仅次于神经胶质细胞瘤和脑膜瘤,占第三位。由于视交叉和视神经常可遭受突出鞍隔的肿瘤的压迫,或因肿瘤引起视交叉腹面中央区供血障碍,出现视力减退和视野缺损,故病人多首次就诊于眼科。由于视器症状常能给本病的诊断、治疗和预后提     

白内障术前行相关检查对视功能评估及视网膜疾病检出的有效性探索

目的:评价闪光视觉诱发电位(FVEP)、闪光视网膜电图(FERG)或图形视网膜电图(PERG)、眼底照相、眼部B超和光学相干断层扫描(OCT)应用于白内障术前对视功能的评估及对视网膜疾病检出的有效性观察。方法:对148例196眼白内障患者术前应用眼科电生理仪、眼底照相、眼部B超和OCT,根据FVEP和FERG(或PERG)、眼底照相、OCT、眼部B超检查结果的阳性率进行分析。结果:患者148例196眼中,B超检查显示玻璃体混浊165眼(84.2%),无法获取B超图像31眼(15.8%);成功获取眼底照相图像161眼(80.6%),无法获取图像35眼(19.4%);获得有价值VEP、ERG 58眼(29.6%),VEP、ERG未见明显异常138眼(70.4%);成功获取OCT图像167眼(85.2%),无法获取OCT图像29眼(14.8%)。结论:视觉电生理检查、眼底照相、眼部B超和光学相干断层图像结果可对白内障患者术前的视功能状况进行综合评估,多种检查方法相互配合,可进一步提高白内障手术前对视网膜疾病以及其他眼科疾病的检出率。     

垂体腺瘤200例眼部表现与MRI特点的相关性分析

目的:分析垂体腺瘤患者200例的眼部表现,并探讨MRI特点及与眼部表现的关系.方法:回顾性分析垂体腺瘤患者200例的眼部表现,89例MRI特点及与眼部表现的相关性.结果:有眼部表现者135例(67.5%),首诊于眼科者74例(37.0%),视力下降128例(64.0%),视野缺损132例(66.0%),视乳头水肿5例(2.5%),视神经萎缩31例(15.5%),颅神经麻痹14例(7.0%),眼球突出3例(1.5%).MRI明确诊断者84例(94.4%),肿瘤向鞍上生长者67例(75.3%),其中引起视力下降53例,视野缺损55例,视神经萎缩12例,视乳头水肿3例.向鞍旁生长者44例(49.4%),其中引起动眼神经麻痹4例,外展神经麻痹1例,三叉神经麻痹1例.向下侵入蝶窦者24例(27.0%),向后累及斜坡或压迫大脑脚者4例(4.5%),向前累及鼻咽部者3例(3.4%),累及额叶、颞叶、胼胝体、侧脑室任一者5例(5.6%).结论:垂体腺瘤可引起视力下降、视野缺损等多种眼部表现,很多患者首诊于眼科.     

Compression of the prechiasmatic optic nerve produces a junctional scotoma.

PURPOSE: To demonstrate the clinical-radiologic correlation between a junctional scotoma and a focal lesion compressing the prechiasmatic segment of the distal optic nerve. METHODS: Case report involving a man with a pituitary adenoma. Clinical correlation was determined by reviewing visual field evaluations and magnetic resonance images. RESULTS: The tumor compressed the prechiasmatic segment of the distal optic nerve but not the optic chiasm, producing a junctional scotoma documented by Goldmann and automated perimetry. The visual field defect resolved after neurosurgical decompression of the anterior visual pathway. CONCLUSIONS: A junctional scotoma can be caused by focal as well as large and diffuse lesions injuring the anterior visual pathway, specifically at the junction of the optic nerve and chiasm. This finding supports the existence of Wilbrand fibers.     

The role of optical coherence tomography in the detection of pituitary adenoma

Purpose: To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high‐pass resolution perimetry (HRP). Methods: Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans‐sphenoidal and one trans‐cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. Results: In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino‐cortical neural channels in HRP. Conclusion: RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression.     

Ocular Symptoms of Tumors at Sella Turcica Region

Background: The sella tumors were found in 15% of intracranial tumors. The sella turcica region locates in the base of skull, so the carcinoma patients in early stage often showed no intracranial hypertension and other positive signs of neural system. However, the patients presented visual field defect and hypopsia, and often went to see the doctor of ophthalmology, which resulted from that the tumor often compressed optic nerve and chiasm. We analysed the symptomatic changes of the visual organs in order to provide a diagnositic basis for sellar tumor in oph-thalmological department.Clinical materials: Of the 407 cases of sellar tumors, 296 were pituitary adenoma, 52 were craniopharyngioma, 43 were meningioma, and the rest 16 were other kinds of sellar tumors. We analysed their ocular changes of the sellar tumors and the characteristics of the tumors.Results: The sellar tumor in its early stage is mainly symptomized as visual field changes. Visual field defect was found in 92. 9% of pituitary adenoma,     

Criteria for early detection of temporal hemianopia in asymptomatic pituitary tumor

PURPOSE: To determine new criteria for early detection of temporal hemianopia in patients with asymptomatic pituitary tumor. METHODS: Fifteen patients without visual symptoms had pituitary tumor and subtle defects or normal visual fields by Goldmann perimetry. Twelve patients with visual symptoms had pituitary adenoma and visual field defects detected by Goldmann perimetry. All were examined by automated perimetry. The relationship between the tumor and the optic chiasm was graded by magnetic resonance imaging (MRI) on a scale of 0-4. Grade number increased with extent of compression. Temporal hemianopia observed by automated perimetry was estimated from normal data (52 normal fields). Vertical step was determined from the number of adjacent pairs along the midline; sensitivity was lower in the temporal field than in the nasal field. Temporal depression was calculated by the quadrant sum of sensitivity. RESULTS: All patients with symptomatic pituitary adenoma had vertical step and temporal depression in the upper field. Nine of 15 patients without visual symptoms had vertical step or temporal depression. Of nine patients with temporal hemianopia, two of four patients had grade 1 compression, three of five had grade 2, and four of four had grade 3. CONCLUSIONS: New criteria by automated perimetry could detect temporal hemianopia in patients with asymptomatic pituitary tumor.     

The clinical value of the multi-channel PVEP and PERG in the diagnosis and management of the patient with pituitary adenoma: a case report

Purpose

To present a patient with a diagnosis of pituitary adenoma and progressive visual pathway dysfunction detected in the electrophysiological tests in one-year follow-up. Patient is a 59-year-old male with a non-secreting pituitary macroadenoma.

Methods

Routine ophthalmological evaluation, standard automatic perimetry (SAP), retinal nerve fibers layer and the ganglion cell complex thickness in optical coherent tomography (OCT), as well as electrophysiological examinations (pattern electroretinogram—PERG, multi-channel pattern visual evoked potentials—multi-channel PVEPs record according to ISCEV standards) were performed. The examination and additional tests were conducted 3 times (in 0, 6 and 12 months) and 6 months after neurosurgery.

Results

Visual acuity, funduscopic examinations, SAP, OCT and electrophysiological test results at the first visit were all normal. In both eyes, the abnormalities were observed only in the multi-channel PVEP and PERG despite the absence of the changes in the routine ophthalmological examination and additional tests after 6- and 12-month follow-up. The tumor growth but without chiasmal compression was confirmed by magnetic resonance imaging. The progression of the optic pathway dysfunction in the electrophysiological tests was a cause of surgical removal of the pituitary tumor.

Conclusion

This case highlights novel observations that in patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

     

垂体腺瘤视野表现的特征

目的　探讨垂体腺瘤视野表现特征。方法　收集于神经外科经病理确诊为垂体腺瘤的３７１例患者的视野及光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）资料。将垂体腺瘤患者根据视野缺损改变分为颞侧象限性视野缺损组、颞侧垂直性偏盲组和管状视野组。分析视野缺损形态特征,通过线性相关分析及方差分析对视野缺损形态、视野平均光敏感度（ｍｅａｎｓｅｎｓｉｔｉｖｉｔｙ,ＭＳ）等指标与ＯＣＴ测量视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度、肿瘤体积之间的关系进行分析。结果　颞侧象限性视野缺损组、颞侧垂直性偏盲组和管状视野组三组间ＲＮＦＬ厚度、ＭＳ值差异均具有统计学意义（均为Ｐ＝０．００）,垂体腺瘤体积差异无统计学意义（χ２ ＝０．５８,Ｐ＝０．７５）。颞侧垂直性偏盲组与管状视野组中,ＭＳ和对应眼鼻侧ＲＮＦＬ厚度有直线关系（Ｒ２ ＝０．１８６,ｔ＝４．７６,Ｐ＝０．００;Ｒ２＝０．１４６,ｔ＝２．６５,Ｐ＝０．０１）,ＲＮＦＬ厚度、ＭＳ与肿瘤体积均无直线关系（均为Ｐ＞０．０５）。结论　视野缺损类型与垂体腺瘤侵犯视交叉的位置有关。相应受累眼视野缺损程度与视网膜ＲＮＦＬ厚度、ＭＳ值有一致性。受累眼的ＭＳ值变化与ＲＮＦＬ厚度有一致性。视野缺损改变、ＲＮＦＬ厚度、ＭＳ与肿瘤体积单一因素无关。     

原发性青光眼合并早期垂体腺瘤的临床分析

目的:通过分析青光眼的中心视野、周边视野以及头颅影像学检查结果,诊断早期垂体腺瘤。方法:回顾分析7例原发性青光眼合并早期垂体腺瘤的临床资料。原发性青光眼中,2例为急性闭角型,1例为慢性闭角型,4例为开角型。患者均行中心及周边视野、头颅X射线平片、电子计算机X射线断层扫描(CT)或者核磁共振成像(MRI)检查。结果:除了青光眼性视野改变,所有患者均有颞上象限不同程度的视野缺损,进而做头颅影像学检查,发现了垂体腺瘤。结论:青光眼与垂体腺瘤均可有视野的损害,前者的改变早期位于中心,而后者可以位于周边。建议对青光眼患者的视野检查范围应包括中心及周边,如果周边视野有象限性缺损,须行头颅X射线平片、CT或者MRI检查,以防漏诊、误诊垂体腺瘤。     

Giant Chondroma of the Saddle Area: Case Report and Literature Review*

Abstract

A 63-year-old man presented with sexual dysfunction of 6-year duration, 5-year history of bilateral vision loss, and left nasal obstruction for 3 years. Brain computed tomography and magnetic resonance imaging showed a large mass lesion in the saddle area and extending upward to the dorsum sellae, bilateral cavernous sinus, and suprasellar region, and down into the sphenoid sinus and nasal cavity; the optic nerves and optic chiasm were elevated upward and compressed. Endocrine tests indicated that all serum level of anterior pituitary hormones decreased. The preoperative diagnosis included invasive pituitary adenoma, chordoma, osteosarcoma, chondrosarcoma, and craniopharyngioma. The tumour was subtotally removed through transsphenoidal approach. Histopathology examination revealed a chondroma. Postoperatively, the patient was stable and his visual acuity and visual field defect improved and his pituitary function return to normal except for hypothyroidism.