RESUMO
We describe a clinical case of successful treatment of a female patient with a giant paraclinoid aneurysm of the right ICA. The aneurysm had a pseudotumoral course and manifested as pronounced progressive visual impairments. The patient underwent microsurgery including trapping/clipping of the right ICA aneurysm after creation of an EICMA and a high-flow anastomosis between the ECA and the M2 segment of the MCA. The surgery enabled decompression of the optic nerves, avoiding their injury. Postoperatively, the patient underwent transcutaneous electrical stimulation of the optic nerves. The case feature was that the patient developed gradual restoration of the blind eye vision.
Assuntos
Revascularização Cerebral , Descompressão Cirúrgica , Aneurisma Intracraniano , Doenças do Nervo Óptico , Estimulação Elétrica Nervosa Transcutânea , Disparidade Visual , Idoso , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/terapiaRESUMO
Transcutaneous electrostimulation of optic nerves after Ye. B. Kompaneyets et al. (1985) was used in the treatment of 203 neurosurgical patients aged 5 to 65 years with vision disorders. Improvement of visual functions (vision acuity and/or visual field) was attained in 112 (55.2%) patients. No changes were observed in 91 (44.8%) patients. The authors investigated the relationship between the efficacy of transcutaneous electrostimulation of optic nerves and neurosurgical disease, status of visual function, history of vision disorders, ophthalmoscopic picture, and electrophysiological parameters. The best results were achieved in patients with traumatic injuries of the optic route at the base of the brain, with cerebrovascular aneurysms, and the hypertensive hydrocephalic syndrome. The results depended on the history and stage of vision disorders.
Assuntos
Encefalopatias/complicações , Nervo Óptico , Estimulação Elétrica Nervosa Transcutânea , Transtornos da Visão/terapia , Adolescente , Adulto , Idoso , Encefalopatias/cirurgia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/cirurgia , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Transtornos da Visão/etiologia , Acuidade Visual , Campos VisuaisRESUMO
Craniocerebral injuries are known to involve the visual tract in 2-5% of cases. Fifty-nine patients aged 5 to 68 with visual tract involvement in craniocerebral injury were examined in N. N. Burdenko Institute of Neurosurgery of the Russian Academy of Medical Sciences. Unilateral optic nerve involvement was found in 48 patients, involvement of the chiasm and/or both optic nerves in 11. Involvement of a single optic nerve was associated with vision acuity reduction, 30 patients becoming blind or virtually blind, and with various defects of the visual field. Traumatic injury to the chiasm manifested as a rule by the asymmetric chiasmal syndrome. Follow-up of the patients in the acute period of craniocerebral injury showed that paling of the optic disc manifested in various periods after the moment of the injury, from 3-4 days to 1 month, this depending on the localization of the injury and its distance from the posterior pole of the eye. Besides visual disturbances and ophthalmoscopic changes, oculomotor disorders were found which were caused by traumatic impairment of the oculomotor nerves (in the orbit or skull) and muscles. Transcutaneous electrostimulation of the injured optic nerves was sufficiently effective, its efficacy directly depending on the period elapsed since the injury, excepting blind or virtually blind patients.
Assuntos
Lesões Encefálicas/complicações , Traumatismos do Nervo Oculomotor , Traumatismos do Nervo Óptico , Transtornos da Visão/etiologia , Adolescente , Adulto , Idoso , Cegueira/etiologia , Criança , Pré-Escolar , Terapia por Estimulação Elétrica , Humanos , Pessoa de Meia-Idade , Quiasma Óptico/lesões , Transtornos da Visão/terapiaRESUMO
The author analyzes the time course of neuro-ophthalmologic symptoms in patients with craniopharyngiomas in the immediate and late periods after tumor removal by microsurgical techniques. The early stage of visual disturbances was found the most favorable as regarded vision recovery. In patients with later stages of visual disturbances vision recovery is possible and more likely in the late period after surgery. Conservative therapy is advisable in the postoperative period, transcutaneous electrostimulation of optic nerves may be recommended as well. Repeated interventions for progressive tumor growth may not only prevent further deterioration of vision, but may even contribute to its improvement.
Assuntos
Craniofaringioma/fisiopatologia , Neoplasias Hipofisárias/fisiopatologia , Visão Ocular/fisiologia , Adulto , Envelhecimento/fisiologia , Criança , Craniofaringioma/epidemiologia , Craniofaringioma/cirurgia , Seguimentos , Humanos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/fisiopatologia , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Prognóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/fisiopatologiaRESUMO
The article analyzes the clinical data of 48 patients with arteriovenous malformations of the thalamus, who were examined at the Burdenko Institute of Neurosurgery, AMS USSR, from 1970 to 1989. The experience in surgical treatment is based on 25 cases. The authors describe in detail the indications for surgical treatment, adequate surgical approaches, and the method for removal of the malformations. Neuropsychological and electrophysiological methods of examination of patients in dynamics were applied to evaluate the results of surgery.