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Objective Optical coherence tomography (OCT) is a noninvasive, high-resolution imaging technique that was suggested to be a powerful biomarker of neurodegeneration. The objective of our study is to assess the pattern of retinal OCT changes in patients with visual pathway tumors. Methods A prospective clinical study was conducted and patients with single cerebral tumors with potential of compression on the visual pathway were included. Patients with multiple and/or metastatic tumors were excluded. Each patient underwent a neurosurgical and ophthalmologic evaluation, cranial-cerebral magnetic resonance imaging, and ocular OCT in both eyes. The OCT parameters included circumpapillary retinal nerve fiber layer thickness (average and sector thickness) and retinal thickness in the macular area (average and sector thickness). Results Fifty patients were investigated clinically and by magnetic resonance imaging, and 18 patients were excluded. Thirty-two patients were eligible for the study and completed the retinal OCT. Eighteen patients had tumors with compressive potential on the optic chiasm, 11 patients had tumors close to the optic radiations, and 3 patients had tumors in the occipital lobe. A specific pattern of OCT changes was found for each site. Regional parameters of both optic nerve and macula were altered. Conclusions Retinal OCT is a promising tool for the in vivo assessment of the neurodegeneration pattern in patients with intracranial tumors. The evaluation of single intracranial tumors with compressive potential on the visual pathway is a good candidate for the study of neurodegeneration.

Objective To present a hitherto unreported modification of the classic Torkildsen procedure: passing a catheter intracranially, between the third ventricle and cisterna magna. Methods We applied our technique to a 56-year-old man who presented to our department for treatment of a pineal region mass. Results The patient was placed in sitting position and the mass was gross totally removed through a supracerebellar infratentorial approach. After the completion of the tumor resection, the patency of the cerebral aqueduct was checked, but the permeability was doubtful. During the same procedure, a shunt was inserted, under direct microsurgical control, into the third ventricle and passed over the cerebellar surface into the cisterna magna. The postoperative course was uneventful, and the patient was discharged from our unit with no neurological deficits and able to carry on with his day-to-day life. Conclusions Our case illustrates that ventriculocisternal shunting can successfully be used in selected cases. The variation we describe can be a valuable surgical strategy in patients with pineal region masses, in whom a supracerebellar infratentorial route is used and in whom uncertainty exists regarding the patency of the sylvian aqueduct.

Background Retinal optical coherence tomography (OCT) is a noninvasive high-resolution imaging technique, which is considered a biomarker of neurodegeneration. Several intracranial lesions can induce retrograde neurodegeneration which can be assessed using OCT. The cysts of the pineal region are usually asymptomatic and most often are an incidental radiologic finding. Case Description We describe the case of a 50-year-old woman with an arachnoid cyst of the pineal region who complained of visual symptoms for 3 months. Bilateral macular thinning was demonstrated by OCT both on the preoperative and postoperative examinations, without any other clinical findings that could explain the results. Conclusions We suggest that the retinal alteration is caused by retrograde neurodegeneration secondary to the pineal region mass.

Background In cerebral aneurysm surgery, various tools are used to evaluate blood flow, including Doppler ultrasonography, conventional cerebral angiography, and electrophysiological monitoring. Fluorescein and indocyanine green are widely used in vascular and central nervous system tumor neurosurgery; however, their routine utilization in aneurysmal surgery is uncommon, despite the fact that they allow direct visualization of blood flow after aneurysmal sac occlusion, enabling the observation of vessel permeability and the effectiveness of aneurysmal obliteration. We report our initial experience using fluorescein video angiography as a control measure for proper clip placement and control of blood flow in aneurysm surgery, and review the relevant literature. Methods This pilot study presents an initial experience, with enrollment of 10 patients harboring a total of 12 cerebral aneurysms who underwent surgery via clipping and subsequent fluorescence videoangiography control. The intravenous injection was performed to demonstrate the patency of the arteries adjacent to the aneurysm. Results Following intravenous injection, fluorescein sodium remains in the cerebral vasculature for approximately 3 minutes, providing ample time to evaluate vessel patency and determine whether clip repositioning is needed. None of the patients experienced complications during intravenous injection of fluorescein sodium, and the patency of surrounding vessels was demonstrated in all cases. Conclusions Fluorescein injection in itself does not present a risk of complications, is simple to use, and offers a clear image of the cerebral vasculature. Thus, this technique is useful for determining vessel patency and the degree of aneurysmal occlusion.