Radiation optic neuropathy after stereotactic radiosurgery.
OBJECTIVE
The purpose of the study is to report the occurrence of optic neuropathy after stereotactic radiosurgery for perichiasmal tumors.


METHODS
Records of four patients with visual deterioration after stereotactic radiosurgery were reviewed, including clinical findings, neuroimaging results, and treatment methods.


RESULTS
Optic neuropathy developed 7 to 30 months after gamma knife radiosurgery. All patients experienced an abrupt change in visual function. Clinical findings indicated anterior visual pathway involvement. Patterns of field loss included nerve fiber bundle and homonymous hemianopic defects. Gadolinium-enhanced magnetic resonance imaging (MRI) showed swelling and enhancement of the affected portion of the visual apparatus in three patients. Systemic corticosteroids were administered in all patients and one partially recovered. One patient also received hyperbaric oxygen without improvement.


CONCLUSIONS
Although rare, optic neuropathy may follow radiosurgery to lesions near the visual pathways. Careful dose planning guided by MRI with restriction of the maximal dose to the visual pathways to less than 8 Gy will likely reduce the incidence of this complication.
Girkin
C A
CA
Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, USA.
Comey
C H
CH
Lunsford
L D
LD
Goodman
M L
ML
Kline
L B
LB
D000236:Adenoma / Q000601:surgery; D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009900:Optic Nerve / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000601:surgery; D011241:Prednisone / Q000627:therapeutic use; D016634:Radiosurgery / Q000009:adverse effects*; D014786:Vision Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014794:Visual Fields
D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone