A neurosurgical assessment of the blood supply in the optochiasmatic system: a cadaveric-anatomic study

Baykal, Duygu; Yılmazlar, Selçuk; Fedakar, Recep

doi:10.1007/s12565-020-00595-3

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…31 Cisternal and intracanalicular vascularization seemed more precarious than for its orbital segment, making these segments sensitive to mechanical tension. 32,33 Francois et al 32 showed that proximal segments lacked both a central axial artery and a dense peripheral capillary network vs the orbital segment. Baykal et al 33 counted fewer perforators along the ON anteriorly than are associated with the chiasm posteriorly.…”

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

“…32,33 Francois et al 32 showed that proximal segments lacked both a central axial artery and a dense peripheral capillary network vs the orbital segment. Baykal et al 33 counted fewer perforators along the ON anteriorly than are associated with the chiasm posteriorly. Thus, the cisternal and canalicular parts of the ON seemed to be the most sensitive to vascular injury.…”

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study

Basma

Dacus

Kumar

et al. 2022

Operative Neurosurgery

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BACKGROUND:Questions remain regarding optic nerve (ON) physiology, mechanical compliance, and microvasculature, particularly surgical outcomes and atypical visual field defects associated with sellar/parasellar pathology (eg, tumors and aneurysms).OBJECTIVE:To study the microsurgical/histological anatomy of each ON segment and corresponding microvasculature, calculate area of optic-carotid space at each decompression stage, and measure ON tension before/after compression.METHODS:Five cadaveric heads (10 sides) underwent sequential dissection: (1) intradural (arachnoidal) ON dissection; (2) falciform ligament opening; (3) anterior clinoidectomy, optic canal decompression, and ON sheath release. At each step, we pulled the nerve superiorly/laterally with a force meter and measured maximal mobility/mechanical tension in each position.RESULTS:Cisternal ON microvasculature was more superficial and less dense vs the orbital segment. ON tension was significantly lower with higher mobility when manipulated superiorly vs lateromedially. Optic-carotid space significantly increased in size at each decompression stage and with ON mobilization both superiorly and laterally, but the increase was statistically significant in favor of upward mobilization. At decompression step, upward pull provided more space with less tension vs side pull. For upward pull, each step of decompression provided added space as did side pull.CONCLUSION:Opening the optic canal, falciform ligament, and arachnoid membrane decompresses the ON for safer manipulation and provided a wider optic-carotid surgical corridor to access sellar/parasellar pathology. When tailoring decompression, the ON should be manipulated superiorly rather than lateromedially, which may guide surgical technique, help prevent intraoperative visual deterioration, facilitate postoperative visual improvement, and help understand preoperative visual field deficits based on mechanical factors.

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