Gliomas of the anterior optic tract (AOT) (optic nerves, chiasms, and visual tracts) are benign slowly growing tumors usually detectable in childhood. These are a rather heterogenic group of tumors. The pattern and course of the disease are frequently affected by the presence of type 1 neurofibromatosis (NF-1) in the patient. The ophthalmological symptoms of AOT lesion in the presence of NF-1 were analyzed in 80 patients aged 1 to 24 years (median 5 years). According to the ophthalmological symptoms and the pattern and extent of lesions to AOT structures, the authors identified 4 groups by the data of neurovisualization techniques (magnetic resonance imaging, computed tomography) and revealed that the ophthalmological pattern reflected the site and degree of lesion to AOT structures. At the same time it is shown that there is a group of silent tumors attending without visual disorders. These tumors have the similar neurovisualization pattern, such as a moderate thickening of AOT structures and they occur in 13.8% of cases, as shown by the authors.
The aim of study was to optimize evaluation and surgery of cranioorbital injuries in different periods after trauma. Material and methods. We analyzed 374 patients with cranioorbital injuries treated in Burdenko Neurosurgery Institute in different periods after trauma from January 1998 till April 2010. 288 (77%) underwent skull and facial skeleton reconstructive surgery within 24 hours - 7 years after trauma. Clinical and CT examination data were used for preoperative planning and assessment of surgery results. Stereolithographic models (STLM) were applied for preoperative planning in 89 cases. The follow-up period ranged from 4 months up to 10 years. Results. In 254 (88%) of 288 patients reconstruction of anterior skull base, upper and/or midface with restoration of different parts of orbit was performed. Anterior skull base CSF leaks repair, calvarial vault reconstruction, maxillar and mandibular osteosynthesis were done in 34 (12%) cases. 242 (84%) of 288 patients underwent one reconstructive operation, while 46 (16%)--two and more (totally 105 operations). The patients with extended frontoorbital and midface fractures commonly needed more than one operation--in 27 (62.8%) cases. Different plastic materials were used for reconstruction in 233 (80.9%) patients, of those in 147 (51%) cases split calvarial bone grafts were preferred. Good functional and cosmetic results were achieved in 261 (90.6%) of 288 patients while acceptable were observed in 27 (9.4%). Conclusion. Active single-stage surgical management for repair of combined cranioorbital injury in acute period with primary reconstruction optimizes functional and cosmetic outcomes and prevents the problems of delayed or secondary reconstruction. Severe extended anterior skull base, upper and midface injuries when intracranial surgery is needed produced the most challenging difficulties for adequate reconstruction. Randomized trial is required to define the extent and optimal timing of reconstructive surgery in patients with severe traumatic brain injury and craniofacial injury in acute period of trauma.
Hemodynamics of the fundus oculi was studied in 41 patients with arteriovenous aneurysms and arteriosinus anastomoses by fluorescent angiography. Fifty-eight fluorescent angiographic examinations of the fundus oculi were performed. The findings were compared with the clinical course of the disease and the degree of the development of the arteriovenous shunt. Analysis of the fluorescent angiograms in patients with a normal fundus oculi showed that the disorders of its hemodynamics reflect the degree of changes in the cerebral circulation in the brain vascular disease that is studied. Prolongation of the venous phase of the retinal hemodynamics is the first sign and prolongation of the arterial phase too, a later sign of changes in cerebral circulation.
Primary intraocular lymphoma (PIOL) is a primary central nervous system lymphoma subtype. The article presents a case of bilateral vitreoretinal lymphoma in a functionally monocular 68-year-old woman, whose ocular manifestations developed prior to multiple primary lymphoma of the brain, thus, impeding the diagnosis. Stereotactic radiotherapy enabled stabilization of the process and did not affect visual functions.
Clinical symptoms of craniopharyngioma, a benign tumor, are determined by its effects on the adjacent structures, the optic route being one of them. Ophthalmologic symptoms of craniopharyngiomas reflect the tumor localization and predominant growth and depend on patient's age. Visual disturbances are among the first symptoms of the disease, particularly so in adult patients. The pathogenesis of visual disturbances in craniopharyngiomas is determined by several components: vascular factor, mechanic influence of a volumic formation and brain base major vessels on the optic route structures, toxic effects, and the presence of an optic route nervous tissue edema. It should be noted that visual disturbances may not manifest up to a certain moment because of a high resistance of the optic route nervous tissue.
Emphasis is laid on how important to use clinical perimetry in the diagnosis of visual disturbances that are common in neurosurgical pathology. The authors compare kinetic perimetry with automatic static one. They consider the advantages of computerized perimetry used in patients with chiasmocellular diseases in visual analyzerlesion in the cerebral hemispheres, in congestive optic disks, anterior optic ischemic neuropathy, and visual dysfunctions.
Methods of diagnostics of primary intraocular lymphomas associated with primary CNS lymphomas are described. This article demonstrates the value of neurophtalmological assessment before surgery in patients with intracranial space occupying lesions. Three cases with bilateral primary intraocular lymphomas are presented. Authors analyzed initial results of intraocular lymphomas treatment with intravitreal methotrexate injections.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
