• Mohamadreza Hajiabadi, Maysam Alimohamadi, and Rudolf Fahlbusch.
• International Neuroscience Institute, Hannover, Germany; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Iranian International Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address: dr.m.haji55@gmail.com.
• World Neurosurg. 2015 Jul 1;84(1):147-53.

BackgroundCoexisting complex visual field defects and serious ophthalmologic comorbidities make the management of the pituitary macroadenomas more challenging. Diffusion tensor imaging (DTI) magnetic resonance imaging that tracks neural fibers in the white matter has been used recently to visualize the impact of different pathologies on cranial nerves. This study explains application of anterior optic pathway tractography for patients with ophthalmologic comorbidities and pituitary adenoma.MethodsTwo patients with atypical visual field defects caused by nonfunctional pituitary macroadenoma and simultaneous ophthalmologic morbidities (one glaucoma and the other giant cell arteritis) were selected for surgical decompression of the anterior optic apparatus. Standard perimetry and optic pathway DTI were done preoperatively, intraoperatively, and 3 months after surgery.ResultsThe nontypical pattern of visual field defect could not differentiate between the ophthalmologic disease and the chiasmatic compression attributable to pituitary macroadenoma as the main cause. Preoperative visual pathway DTI tractography showed lack of decussating chiasmatic fibers in both of the patients. DTI tractography revealed the reappearance of these fibers intraoperatively in one and postoperatively in the other one. Three months after surgery, the visual field and acuity improved and DTI tractography confirmed presence of crossing chiasmatic fibers.ConclusionVisual pathway DTI tractography is a promising adjunct to the standard perimetry in preoperative assessment of pituitary macroadenoma with serious ophthalmologic comorbidities. It also may be useful in the intraoperative determination of the optic pathway decompression and for following the visual outcome of these patients after surgery.Copyright © 2015 Elsevier Inc. All rights reserved.

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