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目的 应用核磁共振弥散张量成像(DTI)和视觉诱发电位检查(fVEPs)来评估儿童鞍区肿瘤的视力受损情况,以及手术对视力恢复的作用程度.方法 纳入了2016年3月至2018年3月清华大学玉泉医院收治的20例鞍区肿瘤的患儿.术前及术后均进行DTI和视觉诱发电位检查,计算出双侧视神经的部分各向异性(FA)值、表观扩散系数(ADC值)和视觉诱发电位波幅,并对其进行统计学分析.结果 根据DTI显示的术前术后病变与视交叉之间的空间关系,20例患儿可被分为视交叉破坏性病变及视交叉压迫性病变两组.手术切除肿瘤后,患儿两侧视神经的FA值升高、ADC值减低、双眼的视觉诱发电位波幅均值升高(53.5％比55.9％),差异有统计学意义(P＜0.05).结论 DTI检查可提示手术方案,其参数FA值、ADC值可判断鞍区肿瘤术后视力水平的早期恢复情况.视觉诱发电位检查证实,鞍区肿瘤患儿术后视力可以得到大幅度提高.

Objiective To evaluate the prognosis of visual function and the impact of surgery in pediatric patients with sellar mass lesions,as evidenced by diffusion tensor imaging (DTI) and visual evoked potentials.Methods Twenty patients with sellar mass lesions were included in the study.DTI and visual evoked potentials were obtained before and after surgery.Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated for both optic nerves.DTI parameters and visual evoked potential amplitudes were compared for all patients to assess the correlation between DTI parameters and visual function.Results The 20 patients were divided into two groups according the relationship between the lesions and the optic chiasm.The FA values increased significantly after operation,while the ADC values decreased (P＜0.05).And the average amplitude of visual evoked potentials after operation was significantly higher than before operation (P＜0.05).Conclusions DTI assessments of the affected sides,with the resulting FA and ADC values,may help to estimate the visual improvement produced by surgical therapy in the early postoperative period.Surgical removal can improve visual function dramatically.