Objective To observe the results of function MRI and perimetry in patients with visual pathway diseases.Methods Three patients (6 eyes) with pituitary adenoma and craniopharyngioma diagnosed via pathological examination and three healthy volunteers aged from 24 to 30 were collected. The best corrected visual acuity was nonlight perception1.0 in the 6 sick eyes and 1.0 in the healthy eyes; all the involved individuals had no other ocular diseases except myopia and without any contraindications of MRI. Common tests including the best visual acuity, fundus test by direct or indirect ophthalmoscope, center static visual field tested by Octopus 101 perimeter, program 32, tendency oriented perimetry were performed. The visual stimulation subtended a field of view of about 12 degrees，consisted of high contrast and drifting checkerboards. MRI parameters: GE signa VH/i 30T scanner. Functional data: GRE-EPI sequence，20 slices lying perpendicular to the calcarine sulcus. Anatomical data was obtained using 3DSPGR sequence to acquire high resolution. The cortical surface was unfolded and then cut and inflated. Functional data was presented to the inflated surface and subsequently analyzed by AFNI software.Results In six eyes, three had temporal defects, two had upper temporal visual field defects, and the other one did not finish the visual field test. The retinotopic representations of health adults were obtained by using the phaseencoded visual stimulation. The Eccentricity coordinate maps showed that foveal representations lay in the occipital poles and the representations appeared further anterior as eccentricity increased. The polar angle coordinate maps showed that early retinotopically organized areas had a representation of visual field. The visual cortex beneath the calcarine sulcus matched with the upper visual field of the opposite side and which upon the calcarine sulcus matched with the under visual field of the opposite side. Less or no visual cortex response was revealed in the patients′ function MRI or the response in injury side was vanished. The visual cortex response related with the visual field defects could not be induced in function MRI.Conclusion There is a good correlation between function MRI data and the results of perimetric evaluation. The function MRI can show the visual cortex response correlated with the visual field defects of the patients with visual pathway diseases.
【摘要】 目的 分析颅咽管瘤术前泌乳素（PRL）、促甲状腺激素（TSH）和促肾上腺皮质激素（ACTH）的变化，探讨术前激素变化与术后尿崩症的关系，为术后并发症的防治及预后的评估提供参考依据。 方法 对2003年3月-2007年6月收治的96例颅咽管瘤患者进行回顾性分析。对患者术前的激素（PRL、TSH及ACTH）检测结果与术后尿崩症的关系进行分析；按照术前有异常的激素种类将患者分为Ⅰ组（术前无激素的改变）、Ⅱ组（术前有任意1种激素发生改变）、Ⅲ组（术前有任意2种激素发生改变）及Ⅳ组（术前3种激素都发生改变）组。分析不同组别与术后尿崩症的关系。 结果 术前PRL、TSH及ACTH有改变的患者术后尿崩症发生率高于术前上述激素无改变的患者，PRL、TSH及ACTH发生改变的种类越多，术后尿崩症发生率越高。 结论 术前PRL、TSH及ACTH的改变和改变的种类多少可以作为判定术后并发症和评估预后的参考指标之一。【Abstract】 Objective To observe the changes of prolactin (PRL), thyroid stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH) in patients with craniopharyngiomas before surgery; and to analyze the relationship between their changes and incipidus after the surgery to get the basis for postoperative complications and prognosis. Methods Ninety-six patients with craniopharyngiomas from March 2003 to July 2007 were seleted. The relationship between endocrine changes before surgery and diabetes insipidus after surgery was analyzed. The patients were divided into four groups:no endocrine changed in group Ⅰ, one hormone changed in group Ⅱ, two hormones changed in group Ⅲ, and all the three hormones changed in group Ⅳ. The relationship between different groups and diabetes insipidus was analyzed. Results The pre-operative endocrine abnormalities was the sign of hypothalamus injury. There were significantly higher incidences of diabetes insipidus after the surgery in patients with endocrine abnormalities than that in the patients without any endocrine changes. There were significantly different incidence of diabetes insipidus after the surgery in different groups. Conclusion The pre-operative endocrine changes can be the guideline to predict the postoperative diabetes insipidus and to evaluate the prognosis.
探讨立体定向囊内放射治疗囊性和囊实性颅咽管瘤的方法和疗效。方法:对12例囊性和囊实性颅咽管瘤的囊性部分行CT、MRI 引导立体定向吸除囊液、注入胶体磷酸铬,待瘤囊缩小远离视神经等重要结构后,施行伽玛刀治疗。结果:全部病例经手术排出囊液后临床症状迅速改善。经囊内放疗后2-36个月随访12例患者,CT、MRI扫描显示5例患者瘤囊持续消失,临床症状消失,恢复正常的生活和学习;5例患者肿瘤显著缩小,症状持续改善;2例肿瘤无明显改变;无死亡病例。结论:CT、MRI引导立体定向放射治疗囊性颅咽管瘤安全、有效。