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Measurement of optic nerve blood flow during dissection of parasellar tumors

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Abstract

The authors describe direct measurement of optic nerve blood flow (ONBF) and examine the application of such monitoring to detecting optic nerve ischemia during parasellar tumor surgery. Prospective evaluation was performed for 26 patients requiring surgery for parasellar tumors. Ophthalmologic examination was performed pre- and postoperatively. ONBF was measured using laser Doppler flowmetry before tumor dissection (initial ONBF) and after tumor removal (final ONBF). The waveform was analyzed using a data acquisition system. Initial ONBF could be measured in 16 patients (22 nerves; 8.9 ± 0.9 ml/100 g/min). Final ONBF could be determined in all 26 patients (42 nerves; 10.8 ± 0.7 ml/100 g/min). In the 22 nerves with initial measurements, final ONBF (11.3 ± 0.6 ml/100 g/min) was significantly increased (p < 0.01). In six patients whose optic canal was unroofed, ONBF did not change immediately; nonetheless, an increase was prominent in the final phase (p < 0.05). In another six patients, a small vessel adjacent to the optic nerve was temporarily occluded. ONBF was demonstrably reduced in three patients and recovered quickly after reperfusion. Intraoperative ONBF measurement may be useful as real-time monitoring for prediction and prevention of intraoperative optic nerve ischemia.

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Authors and Affiliations

  1. Department of Neurosurgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan

    Yuri Aimi

  2. Department of Neurosurgery, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8550, Japan

    Kiyoshi Saito, Tetsuya Nagatani, Eiji Ito & Toshihiko Wakabayashi

  3. Department of Neurosurgery, Nagoya Central Hospital, Nagoya, Japan

    Tadashi Watanabe

Authors
  1. Yuri Aimi
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  2. Kiyoshi Saito
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  3. Tetsuya Nagatani
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  4. Eiji Ito
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  5. Tadashi Watanabe
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  6. Toshihiko Wakabayashi
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Correspondence to Kiyoshi Saito.

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Comments

Kiyohiro Houkin, Sapporo, Japan

The risk management of the predictable adverse events in neurosurgery is highlighted in these days. Among them, postoperative visual disturbance due to the parasellar tumors are well known and serious complication for patients even if the high risk of visual deficit is informed before the surgery.

As is reported in many papers, the main cause of the postoperative visual disturbance in parasellar tumor is the physical damage to optic nerve and ischemic damage to the nerve. The ischemic damage to optic nerve is empirically well known. However, its scientific evidence has not well demonstrated. Moreover, its prediction by reliable monitoring has not been shown so far.

In this charming paper by Aimi et al. using Doppler flowmeter, it is firstly revealed that the ischemic damage to optic nerve is considered to be the cause of visual disturbance. This paper informs neurosurgeons that are committed to paresellar tumor and also paraclinoid aneurysm of novel alarm bell to the microcirculation to the optic nerve.

I am pretty confident that the ONBF monitoring may be the practical weapon to prevent the avoidable and predictable damage to the microcirculation to the optic nerve. However, the experience is quite limited in this paper. More common experience by many neurosurgeons (retest by other neurosurgeons) is indispensable to establish this attractive tool as a clinical routine. In addition, I hope that the authors accumulate more experience and show more quantitative date to be useful for other colleagues.

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Aimi, Y., Saito, K., Nagatani, T. et al. Measurement of optic nerve blood flow during dissection of parasellar tumors. Neurosurg Rev 32, 199–205 (2009). https://doi.org/10.1007/s10143-008-0176-y

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  • DOI: https://doi.org/10.1007/s10143-008-0176-y

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