Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position

J. M. Nazzaro, W. T. Shults, Edward Neuwelt

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro- ophthalmological complaint of patients who have undergone pineal region surgery.

Original languageEnglish (US)
Pages (from-to)746-751
Number of pages6
JournalJournal of Neurosurgery
Volume76
Issue number5
StatePublished - 1992

Fingerprint

Pinealoma
Mesencephalon
Visual Fields
Hemianopsia
Occipital Lobe
Postoperative Period
Eye Abnormalities
Ocular Motility Disorders
Scotoma
Cranial Nerve Diseases
Craniotomy
Brain Stem
Reading

Keywords

  • neuro-ophthalmology
  • occipital transtentorial approach
  • Parinaud's syndrome
  • pineal tumor

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. / Nazzaro, J. M.; Shults, W. T.; Neuwelt, Edward.

In: Journal of Neurosurgery, Vol. 76, No. 5, 1992, p. 746-751.

Research output: Contribution to journalArticle

@article{36c398d221e0414a96e05cdd7ba8ec47,
title = "Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position",
abstract = "To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro- ophthalmological complaint of patients who have undergone pineal region surgery.",
keywords = "neuro-ophthalmology, occipital transtentorial approach, Parinaud's syndrome, pineal tumor",
author = "Nazzaro, {J. M.} and Shults, {W. T.} and Edward Neuwelt",
year = "1992",
language = "English (US)",
volume = "76",
pages = "746--751",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position

AU - Nazzaro, J. M.

AU - Shults, W. T.

AU - Neuwelt, Edward

PY - 1992

Y1 - 1992

N2 - To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro- ophthalmological complaint of patients who have undergone pineal region surgery.

AB - To optimize orientation and operative exposure for aggressive resection, the authors approached pineal region tumors transtentorially with the patient in a semisitting position. In the current report, 12 consecutive patients were evaluated to document operative ocular morbidity referable to the brain stem as well as visual deficits secondary to occipital lobe retraction. Before craniotomy, ophthalmological findings related to dorsal midbrain dysfunction were evident in four of the 10 patients who had previously undergone ventricular shunting. The other patients developed a partial or complete Parinaud's syndrome in the early postoperative period and some suffered additional deficits such as cranial nerve palsies. These deficits improved to varying degrees in all patients. Although each had full visual fields preoperatively, an absolute or incomplete left homonymous hemianopsia developed in the immediate postoperative period. Such visual field deficits fully resolved over a variable period of time in 10 of the 12 patients. One patient has a permanent left homonymous hemianopsia, while another has a left homonymous paracentral scotoma. Eight patients were able to return to preoperative pursuits. While ocular abnormalities related to dorsal midbrain dysfunction are most probably independent of operative approach, visual field deficits attributable to occipital lobe retraction were common in patients after a occipital transtentorial approach performed in the semisitting position. Reading difficulties associated with ocular motor dysfunction due to dorsal midbrain involvement represent the principal long-term neuro- ophthalmological complaint of patients who have undergone pineal region surgery.

KW - neuro-ophthalmology

KW - occipital transtentorial approach

KW - Parinaud's syndrome

KW - pineal tumor

UR - http://www.scopus.com/inward/record.url?scp=0026587634&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026587634&partnerID=8YFLogxK

M3 - Article

VL - 76

SP - 746

EP - 751

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 5

ER -