title: Direct visualization of improved optic nerve pial vascular supply following tuberculum meningioma resection: case report.
abstract: Tuberculum sellae meningiomas frequently produce visual loss by direct compression from tumor, constriction of the optic nerve (ON) under the falciform ligament, and/or ON ischemia. The authors hypothesized that changes in visual function after tumor removal may be related to changes in blood supply to the ON that might be seen in the pial circulation at surgery. Indocyanine green (ICG) angiography was used to attempt to document these changes at surgery. The first patient in whom the technique was used had a left-sided, 1.4-cm, tuberculum meningioma. Time-lapse comparison of images was done postsurgery, and the comparison of video images revealed both faster initial filling and earlier complete filling of the ON pial circulation, suggesting improved pial blood flow after surgical decompression. In follow-up the patient had significant improvements in both visual acuity and visual fields function. Intraoperative ICG angiography of the ON can demonstrate measurable changes in pial vascular flow that may be predictive of postoperative visual outcome. The predictive value of this technique during neurosurgical procedures around the optic apparatus warrants further investigation in a larger cohort.
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Magill
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Phiroz E
authors.initials: PE
authors.lastname: Tarapore
authors.affiliation: Ophthalmology, University of California, San Francisco, California.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Horton
authors.affiliation: Departments of 1 Neurological Surgery and.
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
mesh_terms: D019299:Decompression, Surgical; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009900:Optic Nerve / Q000098:blood supply*; D012658:Sella Turcica
keywords: ICA = internal carotid artery; ICG = indocyanine green; ON = optic nerve; PCON = pial circulation of the optic nerve; cPCON = complete filling of the pial circulation of the optic nerve; iPCON = initial filling of the pial circulation of the optic nerve; indocyanine green; meningioma; oncology; optic nerve; pial circulation; pial supply; tuberculum sellae