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Neurological Surgery No Shinkei Geka Volume 27, Issue 2 （February 1999）

Neurological Surgery 脳神経外科 27巻2号（1999年2月発行）

Japanese English

症例

内頸動脈による視神経圧迫—Decompressionにて視野障害改善の得られた1症例 Unilateral Visual Field Defect due to Optic Nerve Compression by Sclerotic Internal Carotid Artery : a case report 内野正文 ¹ , 根本匡章 ¹ , 大塚隆嗣 ¹ , 倉光徹 ¹ , 磯部裕 ² Masafumi UCHINO ¹ , Masaaki NEMOTO ¹ , Takashi OHTSUKA ¹ , Tohru KURAMITSU ¹ , Yutaka ISOBE ² ¹済生会横浜市南部病院脳神経外科 ²済生会横浜市南部病院眼科 ¹Departments of Neurosurgery, Saiseikai-Yokohamashi Nanbu Hospital ²Departments of Ophthalmology, Saiseikai-Yokohamashi Nanbu Hospital キーワード： visual field defect , optic nerve compression , carotid artery , arteriosclerosis , vascular compression neuropathy Keyword: visual field defect , optic nerve compression , carotid artery , arteriosclerosis , vascular compression neuropathy pp.189-194

発行日 1999年2月10日 Published Date 1999/2/10

DOI https://doi.org/10.11477/mf.1436901684

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Abstract 文献概要
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I．はじめに

　視力低下や視野欠損を主症状とする視神経障害の原因としては，下垂体腫瘍を初めとする視交叉近傍の腫瘍，動脈瘤などが代表的である．その中に稀ではあるが動脈硬化により蛇行拡張した内頸動脈が視神経を直接圧迫し視神経障害を来たすことも知られている．しかし，従来この診断は容易ではない上，治療法も未だに確立したものがなく，したがって手術成績も良好ではなかった．われわれはMRIや脳血管写に工夫を加えこれを診断し，視神経管開放術を施行，視野障害改善の得られた1症例を経験したので報告する．

A case of unilateral visual field defect due to optic nerve compression by a sclerotic internal carotid ar-tery was reported. A 71-year-old woman was admitted to our department because of constricted visual fieldof the right eye. MRI showed elevation of the right optic nerve compressed by an internal carotid artery.The right carotid angiography revealed elevation and distortion of the C1-2 portion. Frontal craniotomywas carried out and the optic nerve was visualized on this side. The right optic nerve was found to havebeen compressed by the sclerotic internal carotid artery. The optic canal was then unroofed. The post-operative course was uneventful. The visual field was improved. When last seen 6 months after surgery,her visual field remained in the improved condition. Nasal field abnormalities are most frequently encoun-tered in retinal and anterior optic nerve pathology. Our success in improving the visual field disturbancemay be accounted for by the fact that the preoperative period was short and the operation was performedbefore atrophy of ocular funcli occurred. Nasal field loss caused by intracranial lesions of the optic pathwayis rare. It is probably impossible to determine degree of the symptomatology caused by direct-pressurecompression as opposed to that caused by ischemia secondary to occlusion of small arterial supply bran-ches. Vascular compressive neuropathy of optic nerve should not be diagnosed simply by the radiological finding of the optic nerve dislocation. However, optic nerve compression by surrounding arteries should beremembered as one of the possible causes of visual field defect which needs to be treated surgically.