domagoj jugović peter spazzapan andrej porčnik borut prestor
DESCRIPTION
Partial recover of blindness after e ndoscopic treatment of suprasellar cystic craniopharyngioma: case report. Domagoj Jugović Peter Spazzapan Andrej Porčnik Borut Prestor University M edical C enter Ljubljana. 2007 Right sided temporal hemianopsia - PowerPoint PPT PresentationTRANSCRIPT
Partial recover of Partial recover of blindness after blindness after
eendoscopic treatment of ndoscopic treatment of suprasellar cystic suprasellar cystic
craniopharyngioma: case craniopharyngioma: case reportreport
Domagoj Jugović Domagoj Jugović Peter SpazzapanPeter SpazzapanAndrej PorčnikAndrej PorčnikBorut PrestorBorut Prestor
University University MMedical edical CCenter Ljubljanaenter Ljubljana
CASE REPORTCASE REPORT
20072007
• Right sided temporal Right sided temporal hemianopsia hemianopsia
• MRIMRI: : 1100 mmm m cystic cystic lesion in the suprasellar lesion in the suprasellar space with no space with no compression of optic compression of optic nerves and chiasmnerves and chiasm
• No endocrinological No endocrinological abnormalitiesabnormalities
20102010
• Worsening of right Worsening of right sided temporal sided temporal hemianopsiahemianopsia
• MRI: increase in cyst’s MRI: increase in cyst’s size (20 mm) with size (20 mm) with upward compression upward compression of optical cof optical chhiasmaiasma
• Refusal of surgeryRefusal of surgery
Visual evoked potentials in 2011Visual evoked potentials in 2011
RIGHT EYERIGHT EYE LEFT EYELEFT EYE
Latency (ms)Latency (ms) Amplitude (Amplitude (V)V) Latency Latency (ms)(ms)
Amplitude Amplitude ((V)V)
VEP CPVEP CP val val P100P100 120120 (110)(110) 2.82.8 (5.3)(5.3) 141141 (110)(110) 1.21.2 (5.3)(5.3)
DPPDPP val val P100P100 -- (108)(108) 00 (3.2)(3.2) -- (108)(108) 00 (3.2)(3.2)
LPPLPP val val P100P100 101101 (108)(108) 4.44.4 (3.2)(3.2) 115115ww (108)(108) 2.62.6ww (3.2)(3.2)
CASE REPORTCASE REPORT
20122012
• Acute onset of blindnessAcute onset of blindness
• Pupils fixed and dilatedPupils fixed and dilated
• Optic disc bilaterally paleOptic disc bilaterally pale
• MRIMRI:: further increase in size to 30x40 mm further increase in size to 30x40 mm
2007 2008
2010 20122012
Transventricular Transventricular endoscopic approachendoscopic approach
Transventricular Transventricular endoscopic approachendoscopic approach
• Cysto-cisterno-ventriculostomyCysto-cisterno-ventriculostomy
• Decompression of optic nerves and Decompression of optic nerves and chiasmchiasm
• Fast procedureFast procedure
• Low morbidity and mortality reported Low morbidity and mortality reported in literaturein literature
Superior part of the cyst through the right foramen of Monroe Cystoventriculostomy
Cystocisternostomy Ventriculostomy
POSTOPERATIVE MRIPOSTOPERATIVE MRI
Postoperative visual evoked Postoperative visual evoked potentialspotentials
RIGHT EYERIGHT EYE LEFT EYELEFT EYE
Latency (ms)Latency (ms) Amplitude (Amplitude (V)V) Latency Latency (ms)(ms)
Amplitude Amplitude ((V)V)
VEP CPVEP CP val val P100P100
122 (110)(110) 2.5 (5.3)(5.3) 105105 (110)(110) 5.35.3 (5.3)(5.3)
DPPDPP val val P100P100 -- (108)(108) 00 (3.2)(3.2) 104104 (108)(108) 4.04.0 (3.2)(3.2)
LPPLPP val val P100P100 105105 (108)(108) 3.03.0 (3.2)(3.2) 110110 (108)(108) 2.32.3 (3.2)(3.2)
OCTOPUSOCTOPUS
Right eye 2012 Left eye 2012
Right eye 2013
Left eye 2013
CONCLUSIONSCONCLUSIONS
• Blindness due to COMPRESSION of optic Blindness due to COMPRESSION of optic nerves and chiasm can be reverseblenerves and chiasm can be reverseble
• Importance of early decompressionImportance of early decompression
• Surgical decision depends on location, Surgical decision depends on location, structure and clinical picturestructure and clinical picture