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

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  • 1 Departments of Surgery and Neurology, Division of Neurosurgery, and Departments of Molecular Biology and Biochemistry, Oregon Health Sciences University, and Devers Eye Institute, Good Samaritan Hospital, Portland, Oregon
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✓ 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.

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Contributor Notes

Address for Dr. Nazzaro: Division of Neurosurgery, C771 Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York.Address reprint requests to: Edward A. NeuweJt, M.D., Mail Stop - L603, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201–3098.
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