PMC3363304_01
Enhanced magnetic resonance imaging and operative views. (A-C) At the onset, a 9 mm heterogeneous intracranial lesion attached to the tuberculum sellae can be seen. The mass was close to the left optic nerve anterior to the chiasm. (D-F) Preoperatively, thin sliced enhanced magnetic resonance imaging showed the lesion had extended into the left optic canal (red arrow). (G-I) The tumor was successfully removed including the intracranial lesion by opening the optic canal.
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However, enhanced magnetic resonance imaging (MRI) showed a 9 mm heterogeneous intracranial lesion attached to the TS around the left optic nerve anterior to the chiasm (Figure 1A-C). Thin sliced enhanced MRI revealed that the intracranial lesion had extended into her left optic canal, even though the size of the main mass was almost the same as earlier (Figure 1D-F). A hemi-interhemispheric approach was used, and the tumor was successfully removed (Simpson grade 2) including the intracranial lesion by opening the optic canal (Figure 1G-I).
Fundus photograph and results of Humphrey static perimetry. (A and B) At the onset, fundus photograph showed that the retina and disc were normal. (C and D) At the onset, Humphrey static perimetry showed inferior temporal field defect in the left eye (30-2 strategy MD -17.57 dB), and normal field in the right eye. (E) One year after the onset, Humphrey static perimetry showed the visual field was almost normal (30-2 strategy MD -2.35 dB). (F) One month after surgery, Humphrey static perimetry showed a mild temporal hemianopia (30-2 strategy MD -3.19 dB).
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The results of ophthalmoscopic examinations were normal (Figure 2A and B). Static perimetry 30-2 with the Humphrey field analyzer (HFAII 745; Carl Zeiss AG, Oberkochen, Germany) showed an inferior temporal field defect in the left eye (Figure 2C and D). At the 1-year follow-up examination, her BCVA remained in 1.2, and the visual field was almost normal in the left eye without any treatment (Figure 2E). One month after surgery, her BCVA improved to 1.2, and a mild temporal hemianopia was detected in the left eye (Figure 2F).
Pattern visual evoked potentials.. Notes: At the onset, the pattern visual evoked potentials elicited by transient and steady-state stimuli to the left eye were undetectable. One month after surgery, pattern visual evoked potentials were present but had a prolonged P100 latency of 170 ms in the left eye (mean: 105.2 +- 6.4 ms; normal range: 92.4 to 118.0 ms).. Abbreviation: VEP, visual evoked potentials.
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The pattern VEPs elicited by transient and steadystate stimuli to the left eye were undetectable (Figure 3). The pattern VEPs were present but had a prolonged P100 latency of 170 ms (Figure 3).
Optical coherence tomography.. Notes: Preoperatively, a thinning of the ganglion cell complex was detected by optical coherence tomography even while her visual function was stable. After surgery, the ganglion cell complex area was thinner than the preoperative thickness, but became stable during the 3 months of follow-up.. Abbreviations: GCC, ganglion cell complex; FLV, focal loss volume; GLV, global loss volume.
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A thinning of the ganglion cell complex (GCC) was detected by a spectral domain OCT (Figure 4). OCT showed that the GCC was thinner than the preoperative thickness (Figure 4).