A Prospective Study On Neuro-ophthalmic Clinical Features For Neurosurgical Inpatients

【Objects】To analysis the clinical features and spectrums of neuro-ophthalmicdiseases in neurosurgical inpatients. To provide scientific data for preventionalstrategies of neuro-ophthmic diseases.【Methods】. All the inpatients in Neurosurgery Department of PLA GeneralHospital from Jan1,2012to July30,2012were assessed in this continuousprospective case serials study. The patients who had ocular complaints or showedneuro-ophthalmic signs were enrolled.【Results】1. General infomations: A total of1213patients were collected, among ofthem213(17.6%) associated with neuro-ophthalmic manifestations.101weremale and112were female. The age of patients was from4-73years old, with amedian of46years old,and was non-normal distribution. The shortest durationwas5days, while the longest was17years.2. Diseases infomations: There were a total of94patients(44.1%) with earlyocular symptoms，and65（30.5%）visited oculists first。3. Lesion location: Ac78.4%of the lesions occur in the optic chiasm. Lesionsin sellar region was the most common involvement area, followed by thepituitary (61.1%), sphenoid (18.6%), cavernous sinus (7.2%) and tuberculumsellae (3.0%).4. Diseases constitute: Including intracranial tumors (86.4%) and intracranialvascular disease(13.1%). Pituitary tumor, meningioma, craniopharyngioma are themost common kinds of tumor. Aneurysm, angiocavernoma, pituitary apoplexyvasogenic lesions are also popular.5. Clinical manifestations: persistent vision loss(84.5%), defect of visual field（88.1%）, RAPD（29.6%）, and optic atrophy（12.2%）. Various visual field canbe seen,51.1%are affect temporal area.6. Ophthalmic misdiagnosis condition:30%patients have visitedOphthmology,46.5%were misdiagnosed as ocular disease.Pituitary tumor and meningioma often misdiagnosed as optic neuritis, ischemic optic neuropathy or optic atrophy.7. Treatment effect：6.5%cured,34.3%improved，4.3%unchanged.24.9%of the patients with postoperative neuro-ophthalmic complications,including vision loss, ptosis, ocular movement disorders.【Conclusions】1.17.6%of total neurosurgicalinpatients have neuro-ophthalmic clinicalmanifestations.2. Neuro-ophthalmic clinical features are help to guide the diagnosis andtreatment of neurosurgical diseases.Persistent vision loss, visual field loss, RAPDand optic atrophy are the common symptoms3. The leading cause of neuro-ophthalmic diseases were intracranial tumorsand intracranial vascular disease. The most common affected area is sellar region.4. For intracranial tumor of patients who see ophthalmologists first, earlydiagnosis is very important. Patients with unknown cause of vision loss, defect ofvisual field and optic atrophy should be complete examinations of visual field,optic fund, CT and MRI in order to make the correct diagnosis.5. Neuro-ophthalmic clinical features are contributive to determine locationsof neurosurgical diseases. The diagnosis, treatments and possible interventionstrategies of neuro-ophthalmic diseases should be explored in the future.