Abstract
Ischemia of the optic nerve (ON) is an important cause of visual field deficit provoked by tuberculum sellae (TS) meningiomas. Indocyanine green (ICG) videoangiography could provide prognostic information. Moreover, it allows new insight into the pathophysiology of visual disturbance. The authors present the case of a 48-year-old woman with visual field impairment. Magnetic resonance imaging (MRI) depicted a lesion highly suggestive of a TS meningioma. Following microsurgical resection, ICG videoangiography demonstrated improvement of right ON pial blood supply. In this case, there was one lesion causing visual impairment through both direct compression over the left ON and ischemia to the right nerve.The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21155
Highlights
This video demonstrates the improvement of optic nerve pial blood supply visualized through indocyanine green videoangiography after resection of a tuberculum sellae meningioma
Here the displacement of the left optic nerve, with the right nerve just touched by the tumor, which is interesting considering that the visual field examination of the right nerve was slightly worse regarding the left
Here a superior hypophyseal artery running inside this arachnoid is demonstrated, vessels that must be preserved when dissecting around optic apparatus, as they are an important source of blood supply to optic nerves.[3,4,5,6]
Summary
This video demonstrates the improvement of optic nerve pial blood supply visualized through indocyanine green videoangiography after resection of a tuberculum sellae meningioma. Following Sylvian fissure dissection, the tumor, right optic nerve, internal carotid artery, and olfactory tract were exposed. It is possible to demonstrate a branch of a superior hypophyseal artery running toward right optic nerve compressed by the tumor.
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