1
|
Furui Y, Araya M, Masaki H, Koiwai K, Sato R, Miyairi Y, Chiba A, Komori K, Kurata T, Sakashita K. Nasal cavity tumor successfully treated with urgent combined proton and photon therapy to preserve visual function: A case study. Pediatr Blood Cancer 2023; 70:e30570. [PMID: 37440325 DOI: 10.1002/pbc.30570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Yu Furui
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Masayuki Araya
- Department of Radiology, Center of Proton Therapy, Aizawa Hospital, Nagano, Japan
| | - Hidekazu Masaki
- Department of Radiology, Center of Proton Therapy, Aizawa Hospital, Nagano, Japan
| | - Keiichiro Koiwai
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ririko Sato
- Department of Otorhinolaryngology, Nagano Children's Hospital, Azumino, Japan
| | - Yosuke Miyairi
- Department of Neurosurgery, Nagano Children's Hospital, Azumino, Japan
| | - Akihiro Chiba
- Department of Neurosurgery, Nagano Children's Hospital, Azumino, Japan
| | - Kazutoshi Komori
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Takashi Kurata
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| | - Kazuo Sakashita
- Department of Hematology and Oncology, Nagano Children's Hospital, Azumino, Japan
| |
Collapse
|
2
|
Cutler C, Azab MA, Lucke-Wold B, Khan M, Henson JC, Gill AS, Alt JA, Karsy M. Systematic Review of Treatment Options and Therapeutic Responses for Lesions of the Sella and Orbit: Evidence-Based Recommendations. World Neurosurg 2023; 173:136-145.e30. [PMID: 36639102 DOI: 10.1016/j.wneu.2022.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Inflammatory pathologies of the sella and orbit are rare but require prompt diagnosis to initiate effective treatment. Because uniform recommendations for treatment are currently lacking, we performed an evidence-based review to identify recommendations. METHODS We performed a literature search of the PubMed, Embase, and Web of Science databases to identify papers evaluating treatment of inflammatory pathologies of the sella and orbit. We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to define recommendations, specifically examining aggregated sample sizes, disease-specific patient follow-up, and clinical trials focused on inflammatory diseases of the sella and orbit. RESULTS A total of 169 studies were included and organized by disease pathology. Treatments for various pathologies were recorded. Treatment options included surgery, radiation, steroids, targeted treatments, immunomodulators, intravenous immune globulin, and plasmapheresis. Steroids were the most often employed treatment, second-line management options and timing varied. Pathological diagnosis was highly associated with treatment used. Most evidence were level 3 without available control groups, except for 13 trials in neuromyelitis optica with level 1 or 2 evidence. CONCLUSIONS This is the first evidence-based review to provide recommendations on specific treatments for pathologies of the orbit and sella. The reported data may be useful to help guide randomized clinical trials and provide resource for clinical management decisions based on the available evidence.
Collapse
Affiliation(s)
- Christopher Cutler
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Mohammed A Azab
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Majid Khan
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - J Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amarbir S Gill
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jeremiah A Alt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
3
|
Kachhara R, Nigam P, Nair S. Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome. J Neurosci Rural Pract 2022; 13:431-440. [PMID: 35945998 PMCID: PMC9357473 DOI: 10.1055/s-0042-1745817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background
Tuberculum sella meningioma form a distinct surgical entity with significant morbidity for the patient due to early and profound visual involvement. Surgical treatment of tuberculum sella meningioma is challenging in view of the proximity of vital neuro-vasculature. These lesions may be approached via a high-route (trans-cranial) or a low-route (trans-sphenoidal).
Materials and Methods
The authors present a consecutive series of 36 patients, operated by the first author from 1996 onward, with an analysis of clinical presentation (emphasizing visual deterioration), imaging features, operative approaches, and outcome with postoperative visual status.
Results
There were 36 patients (72 eyes) in the series, 75% females and 25% males. The mean age of patients was 48.05 ± 10.02 years. In all, 88.89% had visual diminution, 50% had headache, 5.56% had behavioral changes, and 2.78% had seizures. The mean tumor size was 4.01 ± 1.01 cm. The frontotemporal approach was employed in 66.67% of patients, and all patients underwent a right-sided approach. There was no significant difference between improvement in the vision between the right eye and left eye, despite the fact that right-sided approach was employed in nearly cases.
Conclusion
While tuberculum sella meningioma have profound morbidity in terms of visual deterioration, timely surgical intervention may help patients gain serviceable vision postoperatively. We advocate the trans-cranial approach and find no difference in visual outcomes on employing right-sided approach, regardless of the side with worse vision.
Collapse
Affiliation(s)
- Rajneesh Kachhara
- Department of Neurosurgery, Institute of Neurosciences, Medanta Multi-Speciality Hospital, Indore, Madhya Pradesh, India
| | - Pulak Nigam
- Department of Neurosurgery, Institute of Neurosciences, Medanta Multi-Speciality Hospital, Indore, Madhya Pradesh, India
| | - Suresh Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| |
Collapse
|
4
|
Liu A, Craver EC, Bhatti MT, Chen JJ. Population-Based Incidence and Outcomes of Compressive Optic Neuropathy. Am J Ophthalmol 2022; 236:130-135. [PMID: 34695397 DOI: 10.1016/j.ajo.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Prior studies on compressive optic neuropathy (CON) have come from large tertiary centers, which may contain referral bias toward more severe or atypical disease. To our knowledge, there are no studies to determine the population-based etiologies and clinical outcomes of compressive optic neuropathy (CON). This study aims to bridge that gap using the Rochester Epidemiology Project database. DESIGN Retrospective, population-based cohort. METHODS Medical records of all residents living in Olmsted County, Minnesota, from January 1, 2000, through December 31, 2018, were screened for CON. Demographic and clinical information were collected before and after treatment. RESULTS Twenty-three patients had a confirmed diagnosis of CON during our study period, which provided an overall incidence of 1.14 per 100 000 per year. Average age at onset of CON was 51 years (SD 24), and 39% were male. The most common etiologies were pituitary adenoma and meningioma. There was significant improvement in visual fields (P < .003) but not in visual acuity (P = .08) after patients underwent treatment for CON. There was also a significant relationship between the time until treatment and the degree of visual field improvement at follow-up (Pearson correlation rho = -0.58, P < .047). CONCLUSION To our knowledge, this study provides the first population-based incidence of CON. The finding that earlier treatment leads to better visual outcomes stresses the importance of having CON on the differential diagnosis of patients with optic neuropathy.
Collapse
Affiliation(s)
- Alice Liu
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota
| | - Emily C Craver
- and the Department of Biostatistics (E.C.C.), Mayo Clinic, Jacksonville, Florida, USA
| | - M Tariq Bhatti
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota
| | - John J Chen
- From the Mayo Clinic Alix School of Medicine (A.L.), Department of Ophthalmology (M.T.B., J.C.C.), and Department of Neurology (M.T.B., J.C.C.), Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
5
|
Qiao N, Ma Y, Chen X, Ye Z, Ye H, Zhang Z, Wang Y, Lu Z, Wang Z, Xiao Y, Zhao Y. Machine Learning Prediction of Visual Outcome after Surgical Decompression of Sellar Region Tumors. J Pers Med 2022; 12:jpm12020152. [PMID: 35207641 PMCID: PMC8879436 DOI: 10.3390/jpm12020152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction: This study aims to develop a machine learning-based model integrating clinical and ophthalmic features to predict visual outcomes after transsphenoidal resection of sellar region tumors. Methods: Adult patients with optic chiasm compression by a sellar region tumor were examined to develop a model, and an independent retrospective cohort and a prospective cohort were used to validate our model. Predictors included demographic information, and ophthalmic and laboratory test results. We defined “recovery” as more than 5% for a p-value in mean deviation compared with the general population in the follow-up. Seven machine learning classifiers were employed, and the best-performing algorithm was selected. A decision curve analysis was used to assess the clinical usefulness of our model by estimating net benefit. We developed a nomogram based on essential features ranked by the SHAP score. Results: We included 159 patients (57.2% male), and the mean age was 42.3 years old. Among them, 96 patients were craniopharyngiomas and 63 patients were pituitary adenomas. Larger tumors (3.3 cm vs. 2.8 cm in tumor height) and craniopharyngiomas (73.6%) were associated with a worse prognosis (p < 0.001). Eyes with better outcomes were those with better visual field and thicker ganglion cell layer before operation. The ensemble model yielded the highest AUC of 0.911 [95% CI, 0.885–0.938], and the corresponding accuracy was 84.3%, with 0.863 in sensitivity and 0.820 in specificity. The model yielded AUCs of 0.861 and 0.843 in the two validation cohorts. Our model provided greater net benefit than the competing extremes of intervening in all or no patients in the decision curve analysis. A model explanation using SHAP score demonstrated that visual field, ganglion cell layer, tumor height, total thyroxine, and diagnosis were the most important features in predicting visual outcome. Conclusion: SHAP score can be a valuable resource for healthcare professionals in identifying patients with a higher risk of persistent visual deficit. The large-scale and prospective application of the proposed model would strengthen its clinical utility and universal applicability in practice.
Collapse
Affiliation(s)
- Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
| | - Yichen Ma
- Fudan University Graduate School, Fudan University, Shanghai 200043, China;
| | - Xiaochen Chen
- Surgical Theatre, Huashan Hospital Hongqiao Campus, Shanghai 201107, China;
| | - Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Shanghai 200040, China; (H.Y.); (Z.Z.)
| | - Zhaoyun Zhang
- Department of Endocrinology, Huashan Hospital, Shanghai 200040, China; (H.Y.); (Z.Z.)
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
| | - Zhaozeng Lu
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
| | - Yiqin Xiao
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
- Correspondence: (Y.X.); (Y.Z.)
| | - Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
- Correspondence: (Y.X.); (Y.Z.)
| |
Collapse
|
6
|
Kelly PD, Fernando SJ, Malenke JA, Chandra RK, Turner JH, Chambless LB. The Effect of Timing of Surgery in Pituitary Apoplexy on Continuously Valued Visual Acuity. J Neurol Surg B Skull Base 2020; 82:e70-e78. [PMID: 34306919 DOI: 10.1055/s-0040-1701217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022] Open
Abstract
Background Pituitary apoplexy is often treated urgently, but this is based on studies which assess vision categorically and dichotomizes the time interval between symptom onset and surgery which may introduce bias in measuring an association between the two. Objective This study was aimed to assess for a relationship between continuously valued surgery delay and visual acuity recovery after pituitary apoplexy. Methods In this retrospective study, all patients presenting with symptomatic pituitary apoplexy between 2004 and 2016 were identified from an institutional database. The primary endpoint was visual acuity improvement, measured as the difference in acuity from the pre- to postoperative period, and measured in Logarithm of the Minimal Angle of Resolution (LogMAR) units. Analysis was performed using continuous values of time delay and visual acuity to assess for an underlying association. Results Thirty-two pituitary apoplexy patients were identified. Visual acuity deficits were reported in 81%. The median visual acuity was 0.35 LogMAR (Snellen's fraction 20/40) preoperatively, and 0.1 (20/25) postoperatively ( p < 0.01). The time between symptom onset and surgery was not associated with improvement in visual acuity ( p = 0.46). When the time delay and visual outcome were intentionally dichotomized, patients undergoing surgery within 2 days of symptom onset had 0.21 times the odds of a good visual outcome (95% confidence interval [CI]: 0.04-1.05). Conclusion When assessed as continuously valued measures, the time from symptom onset to surgical intervention and the improvement in visual acuity are not associated, although intentional dichotomization of data produced conflicting results.
Collapse
Affiliation(s)
- Patrick D Kelly
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Shanik J Fernando
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Jordan A Malenke
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rakesh K Chandra
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Justin H Turner
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| |
Collapse
|
7
|
Technical Description of Minimally Invasive Extradural Anterior Clinoidectomy and Optic Nerve Decompression. Study of Feasibility and Proof of Concept. World Neurosurg 2019; 129:e502-e513. [PMID: 31152882 DOI: 10.1016/j.wneu.2019.05.196] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several diseases that involve the optic canal or its contained structures may cause visual impairment. Several techniques have been developed to decompress the optic nerve. OBJECTIVE To describe minimally invasive extradural anterior clinoidectomy (MiniEx) for optic nerve decompression, detail its surgical anatomy, present clinical cases, and established a proof of concept. METHODS Anatomic dissections were performed in cadaver heads to show the surgical anatomy and to show stepwise the MiniEx approach. In addition, these surgical concepts were applied to decompress the optic nerve in 6 clinical cases. RESULTS The MiniEx approach allowed the extradural anterior clinoidectomy and a nearly 270° optic nerve decompression using the no-drill technique. In the MiniEx approach, the skin incision, dissection of the temporal muscle, and craniotomy were smaller and provided the same extent of exposure of the optic nerve, anterior clinoid process, and superior orbital fissure as that usually provided by standard techniques. All patients who underwent operation with this technique had improved visual status. CONCLUSIONS The MiniEx approach is an excellent alternative to traditional approaches for extradural anterior clinoidectomy and optic nerve decompression. It may be used as a part of more complex surgery or as a single surgical procedure.
Collapse
|
8
|
Maza G, Subramaniam S, Yanez-Siller JC, Otto BA, Prevedello DM, Carrau RL. The Role of Endonasal Endoscopic Optic Nerve Decompression as the Initial Management of Primary Optic Nerve Sheath Meningiomas. J Neurol Surg B Skull Base 2019; 80:568-576. [PMID: 31750042 DOI: 10.1055/s-0039-1677689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022] Open
Abstract
Background The management of optic nerve sheath meningiomas (ONSMs) remains controversial. Surgical decompression through traditional resective techniques has been associated with significant morbidity. While radiation therapy, the current modality of choice is not exempt of risks. Transnasal endoscopic optic nerve decompression (EOND) offers a direct route to the orbit, optic canal, and orbital apex, providing a minimally invasive alternative. Objective The main objective of this article is to assess EOND as the initial management of symptomatic patients with primary ONSM. Methods Patients with ONSMs without a history of radiotherapy who underwent EOND were retrospectively reviewed. Postoperative imaging, duration of follow-up, and visual outcomes at the last ophthalmology visit were assessed. Results Four women (age range 25-63 years) with primary ONSMs that underwent EOND were identified. All patients displayed subjective and objective baseline signs of vision loss. Additionally, baseline proptosis, diplopia, optic nerve atrophy, and ocular pain were identified. In none of the cases, the optic nerve sheath was breached. Following EOND, all patients deferred treatment with adjuvant radiotherapy. At a mean postoperative follow-up of 14 months, all patients were clinically stable without evidence of disease progression on imaging or physical examination. At last ophthalmologic evaluation, three out of four showed objective improvements from baseline visual acuity and visual field (remaining patient had baseline optic nerve atrophy). Conclusion These results suggest that EOND could be a viable initial treatment modality of selected primary ONSM cases. Further studies are warranted to determine long-term efficacy and its role in a stepwise progression of management, preceding radiotherapy.
Collapse
Affiliation(s)
- Guillermo Maza
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
| | - Somasundaram Subramaniam
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
| | - Juan C Yanez-Siller
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
| | - Bradley A Otto
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Prevedello
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States.,Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| | - Ricardo L Carrau
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, United States.,Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| |
Collapse
|
9
|
Navigation-assisted, endonasal, endoscopic optic nerve decompression for the treatment of nontraumatic optic neuropathy. J Craniomaxillofac Surg 2018; 47:328-333. [PMID: 30600198 DOI: 10.1016/j.jcms.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many authors have reported on therapeutic strategies for traumatic optic neuropathy and their experience with endonasal endoscopic optic nerve decompression for traumatic optic neuropathy. However, to our knowledge, few have described the therapeutic strategies for nontraumatic optic neuropathy and navigation-assisted endoscopic optic nerve decompression as a treatment for nontraumatic, compressive optic neuropathy. The aim of this study was to examine the advantages in treating nontraumatic optic neuropathy with the minimally invasive, image-guided, navigation-assisted, endonasal endoscopic optic nerve decompression. METHODS This was a retrospective study of 20 patients (21 eyes) diagnosed with nontraumatic optic neuropathy, undergoing an endonasal endoscopic approach to relieve space-occupying lesions and decompress the optic nerve under image-guided navigation. This article describes our research on the therapeutic strategies for nontraumatic optic neuropathy patients, with special focus on the advantages of navigation-assisted, endonasal, endoscopic optic nerve decompression for the treatment of nontraumatic optic neuropathy. Medical photographs were used to estimate the status of the patients. RESULTS In 18 of the 20 cases, space-occupying lesions were completely resected. In two cases, they were partially resected. All 20 cases (21 eyes) underwent image-guided, navigation-assisted, endonasal endoscopic optic nerve decompression. Visual acuity improved in 20 eyes (95.2%) and remained stable in one eye. There were no intraoperative or postoperative complications. CONCLUSIONS Optic nerve decompression is the main treatment strategy for nontraumatic optic neuropathy, to relieve space-occupying lesions and decompress the optic nerve, and to retain and/or improve visual acuity. Image-guided navigation can help doctors pinpoint the optic nerve when facing anatomical deformation caused by a space-occupying lesion. Navigation-assisted, endonasal endoscopic optic nerve decompression is a feasible, safe, practical, and minimally invasive approach.
Collapse
|
10
|
Tsutsumi S, Ono H, Yasumoto Y. Vascular Compression of the Anterior Optic Pathway: A Rare Occurrence? Can Assoc Radiol J 2017; 68:409-413. [PMID: 28720412 DOI: 10.1016/j.carj.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Vascular compression of the anterior optic pathway has been documented as an infrequent cause of visual impairments. Here we characterize such vascular compression using magnetic resonance imaging. METHODS A total of 183 patients without pathologies affecting the optic pathways underwent T2-weighted or constructive interference steady-state sequence magnetic resonance imaging. Imaging data from coronal sections were analyzed. RESULTS A vascular compression of the anterior optic pathway was identified in 20 patients (11%). They comprised 13 men and 7 women with a mean age of 60.8 years. The vascular compressions were observed at 22 sites, 15 on the optic nerve (ON) and 7 on the optic chiasm (OC). Twelve of them were on the right and 10 were on the left side. The offending vessels were the supraclinoid portion of the internal carotid artery in 86.4% and the A1 segment of the anterior cerebral artery in 13.6%. Compression sites at the ON and OC were variable, with the inferolateral surface being the most frequent (77.3% occurrences). In 2 patients (9.1%), the ON was compressed in a sandwich manner. CONCLUSIONS Vascular compression of the ON and OC may not be an infrequent occurrence in the cranial cavity. Progressive and unexplainable visual impairment might possibly be caused by vascular-compressive neuropathy.
Collapse
Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| |
Collapse
|
11
|
Sundaram ANE, Abhayambika A, Kumar S. Bilateral Compressive Optic Neuropathy from Renal Osteodystrophy Caused by Branchio-oto-renal Syndrome Stabilised After Parathyroidectomy. Neuroophthalmology 2017; 41:321-325. [PMID: 29344072 DOI: 10.1080/01658107.2017.1315145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 01/13/2023] Open
Abstract
Renal osteodystrophy can cause calvarial hypertrophy and narrowing of the neural canals and foramina. Compressive optic neuropathy is extremely rare in renal osteodystrophy and was reported once only. The authors report bilateral, simultaneous compressive optic neuropathy secondary to renal osteodystrophy with features of uremic leontiasis ossea in chronic renal failure caused by branchio-oto-renal syndrome. Because of the extensive calvarial hypertrophy and the surgical difficulties envisaged with optic canal decompression, conservative approach was pursued. The patient's visual acuity and fields improved after partial parathyroidectomy. Visual improvement may be explained by the arrest of renal osteodystrophy and reduced optic nerve compression after parathyroidectomy.
Collapse
Affiliation(s)
- Arun N E Sundaram
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Archana Abhayambika
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sunil Kumar
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Meeker AR, Ko MW, Carruth BP, Strumpf KB, Bersani TA. Diagnosis of optic nerve sheath meningioma during optic nerve sheath decompression. Orbit 2017; 36:35-38. [PMID: 28156180 DOI: 10.1080/01676830.2017.1279648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Optic nerve sheath meningioma (ONSM) is typically diagnosed based on clinical suspicion and imaging characteristics and is most often treated with radiation. Historically, biopsy, optic nerve sheath decompression, and debulking surgeries have been avoided for fear of optic nerve vascular disruption and tumor spread into the orbit. This is a case of a 48-year-old man who presented with unilateral optic disc edema, declining visual acuity, and a visual field defect. Despite an initial improvement with acetazolamide, his vision subsequently worsened. With an elevated lumbar puncture opening pressure and imaging showing right optic nerve sheath enhancement, the differential diagnosis included ONSM, perineuritis and idiopathic intracranial hypertension (IIH). Optic nerve sheath decompression (ONSD) with biopsy was performed, simultaneously decompressing the nerve and yielding a sample for pathologic analysis. A pathologic diagnosis of ONSM was made and treatment with radiation was subsequently initiated, but vision began to improve after the surgical decompression alone.
Collapse
Affiliation(s)
- Austin R Meeker
- a Department of Ophthalmology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Melissa W Ko
- a Department of Ophthalmology , SUNY Upstate Medical University , Syracuse , New York , USA.,b Department of Neurology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Bryant P Carruth
- a Department of Ophthalmology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Kenneth B Strumpf
- c Department of Pathology , SUNY Upstate Medical University , Syracuse , New York , USA
| | - Thomas A Bersani
- a Department of Ophthalmology , SUNY Upstate Medical University , Syracuse , New York , USA
| |
Collapse
|
13
|
DeKlotz TR, Stefko ST, Fernandez-Miranda JC, Gardner PA, Snyderman CH, Wang EW. Endoscopic Endonasal Optic Nerve Decompression for Fibrous Dysplasia. J Neurol Surg B Skull Base 2016; 78:24-29. [PMID: 28180039 DOI: 10.1055/s-0036-1584078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objective To evaluate visual outcomes and potential complications for optic nerve decompression using an endoscopic endonasal approach (EEA) for fibrous dysplasia. Design Retrospective chart review of patients with fibrous dysplasia causing extrinsic compression of the canalicular segment of the optic nerve that underwent an endoscopic endonasal optic nerve decompression at the University of Pittsburgh Medical Center from 2010 to 2013. Main Outcome Measures The primary outcome measure assessed was best-corrected visual acuity (BCVA) with secondary outcomes, including visual field testing, color vision, and complications associated with the intervention. Results A total of four patients and five optic nerves were decompressed via an EEA. All patients were symptomatic preoperatively and had objective findings compatible with compressive optic neuropathy: decreased visual acuity was noted preoperatively in three patients while the remaining patient demonstrated an afferent pupillary defect. BCVA improved in all patients postoperatively. No major complications were identified. Conclusion EEA for optic nerve decompression appears to be a safe and effective treatment for patients with compressive optic neuropathy secondary to fibrous dysplasia. Further studies are required to identify selection criteria for an open versus an endoscopic approach.
Collapse
Affiliation(s)
- Timothy R DeKlotz
- Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
14
|
Petramfar P, Hosseinzadeh F, Mohammadi SS. Pseudo-Foster Kennedy Syndrome as a Rare Presentation of Vitamin B12 Deficiency. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24610. [PMID: 27621919 PMCID: PMC5002969 DOI: 10.5812/ircmj.24610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 12/01/2022]
Abstract
Introduction Pseudo-Foster Kennedy syndrome is a triad consisting of ipsilateral optic atrophy, contralateral optic disc edema, and ipsilateral anosmia in the absence of an intracranial mass. Vitamin B12 plays an important role in DNA synthesis, and its deficiency causes peripheral neuropathy, myeloneuropathy, and, very rarely, optic neuropathy. Case Presentation In this study, we describe a 34-year-old male who presented with progressive loss of visual acuity and field. Fundoscopy showed optic disc edema with telangiectasia in the right eye, while the left eye had optic disc atrophy. We ruled out nearly all possible and common causes of optic neuropathy, and vitamin B12 deficiency was finally diagnosed. After treatment with vitamin B12, the patient improved. Conclusions Demyelinating disease, anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, autoimmune disease, and hereditary optic neuropathy could cause optic neuropathy. Normal CBC parameters and the absence of clinical manifestations of vitamin B12 deficiency could not rule out its diagnosis. Careful physical examinations and history-taking with a classical approach led us to the diagnosis of vitamin B12 deficiency and its treatment.
Collapse
Affiliation(s)
- Peyman Petramfar
- Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farideh Hosseinzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - S. Saeed Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: S. Saeed Mohammadi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9364402630, Fax: +98-7733444844, E-mail:
| |
Collapse
|
15
|
Berkmann S, Schlaffer S, Nimsky C, Fahlbusch R, Buchfelder M. Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging. Acta Neurochir (Wien) 2014; 156:2233-43; discussion 2243. [PMID: 25174805 DOI: 10.1007/s00701-014-2210-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/15/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Intraoperative MRI (iMRI) increases gross total resection (GTR) rates in transsphenoidal surgery; however, long-term follow-up data is lacking. The objective is to assess the outcome of patients with nonfunctioning pituitary adenomas (NFA) at a mean follow-up of > 5 years. METHODS Patients with NFA operated in a single institution with resection control by a 1.5 T intraoperative magnetic resonance imaging (iMRI) scanner and no previous pituitary surgery were included. Microscopical transsphenoidal approaches with optional endoscopy were used. The iMRI was chosen for spacious suprasellar or retrosellar and/or invasive tumours. IMRI-scans were made if GTR or if nonresectable remnants were presumed. The patients had a full neuroradiological, endocrinological and ophthalmological follow-up at the institution. RESULTS Eighty-five patients (67 % male;55 ± 14 years) with a follow-up of 5.6 ± 1.9 years were included. The initial GTR rate on iMRI was 44 %. In 83 %, further resections were possible, resulting in a final GTR rate of 66 %. In invasive tumours, the GTR rate was increased by 29 %. The detection of remnants by iMRI had high sensitivity and specificity (100 %), as opposed to endoscopy (21 %;78 %). During follow-up, four (7 %) tumours recurred and 14 (64 %) remnants grew. The recurrence and regrowth rate were 0.013 and 0.114 patients/years, respectively. Seventy-nine percent of the growing remnants were seen < 5 years postoperatively. CONCLUSIONS The use of iMRI for transsphenoidal resection leads to low recurrence rates. Even in case of invasive tumours, distinctly more patients show long tumour-free follow-ups. Tumour remnants detected by iMRI are at high risk to grow within 5 years after surgery.
Collapse
Affiliation(s)
- Sven Berkmann
- Department of Neurosurgery, University Hospital of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany,
| | | | | | | | | |
Collapse
|
16
|
Santarius T, Jian BJ, Englot D, McDermott MW. Delayed neurological deficit following resection of tuberculum sellae meningioma: report of two cases, one with permanent and one with reversible visual impairment. Acta Neurochir (Wien) 2014; 156:1099-102. [PMID: 24639145 DOI: 10.1007/s00701-014-2046-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
The most common presentation of patients with tuberculum sellae meningiomas is visual loss, and surgical resection is the main mode of treatment. Preservation of vision is not only the main objective of the surgery; loss of vision is also its main risk. Visual deterioration following surgery is usually apparent immediately post-operatively. Here we present two cases of patients who underwent resection of tuberculum sellae meningioma and whose vision following surgery was initially unchanged until the postoperative day two when dramatic visual deterioration occurred. In the first case this resulted in blindness, whereas in the second case vision recovered back to the preoperative state. The possible mechanisms of visual deterioration and modes of treatment are discussed.
Collapse
|
17
|
Bhullar SS, Gray MJ, Kay CN. Role for rapid surgical intervention in uveal effusion syndrome with associated optic neuropathy. Ophthalmic Surg Lasers Imaging Retina 2014; 45 Online:e11-3. [PMID: 24695046 DOI: 10.3928/23258160-20140331-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/07/2013] [Indexed: 11/20/2022]
Abstract
Uveal effusion syndrome (UES) can be associated with nanophthalmos and rarely can present with concomitant optic neuropathy. This case report describes nanophthalmic UES and optic neuropathy treated with early sclerectomies. One month postoperatively, the patient experienced significant improvement in choroidal effusions and optic neuropathy, with increases in visual acuity and visual fields. Early scleral windows surgery for UES with associated optic neuropathy can provide prompt improvement of choroidal swelling, optic nerve edema, and vision, although the relapsing course of this disease presents a challenge to long-term visual prognosis.
Collapse
|
18
|
Shao EH, Gallagher K, Malik N. A 44-year-old woman with a 3-month history of bilateral, painless visual loss in the absence of other symptoms. Digit J Ophthalmol 2012; 18:12-14. [PMID: 23847450 PMCID: PMC3687101 DOI: 10.5693/djo.03.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 44-year-old woman presented at the Western Eye Hospital, London, with a 3-month history of gradual, painless, bilateral deterioration of her vision. She had no other ocular symptoms and no previous ocular history. Review of systems was unrevealing, and her medical history was unremarkable: she did not complain of headaches or anosmia, nor was she taking any regular medication. She was of normal body habitus. Family history was noncontributory.
Collapse
Affiliation(s)
| | | | - Nabeel Malik
- Correspondence: Nabeel Malik MBBS, FRCOPHTH, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH ()
| |
Collapse
|
19
|
|
20
|
Carlson AP, Stippler M, Myers O. Predictive factors for vision recovery after optic nerve decompression for chronic compressive neuropathy: systematic review and meta-analysis. J Neurol Surg B Skull Base 2012; 74:20-38. [PMID: 24436885 DOI: 10.1055/s-0032-1329624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/08/2012] [Indexed: 10/27/2022] Open
Abstract
Objectives Surgical optic nerve decompression for chronic compressive neuropathy results in variable success of vision improvement. We sought to determine the effects of various factors using meta-analysis of available literature. Design Systematic review of MEDLINE databases for the period 1990 to 2010. Setting Academic research center. Participants Studies reporting patients with vision loss from chronic compressive neuropathy undergoing surgery. Main outcome measures Vision outcome reported by each study. Odds ratios (ORs) and 95% confidence intervals (CIs) for predictor variables were calculated. Overall odds ratios were then calculated for each factor, adjusting for inter study heterogeneity. Results Seventy-six studies were identified. Factors with a significant odds of improvement were: less severe vision loss (OR 2.31[95% CI = 1.76 to 3.04]), no disc atrophy (OR 2.60 [95% CI = 1.17 to 5.81]), smaller size (OR 1.82 [95% CI = 1.22 to 2.73]), primary tumor resection (not recurrent) (OR 3.08 [95% CI = 1.84 to 5.14]), no cavernous sinus extension (OR 1.88 [95% CI = 1.03 to 3.43]), soft consistency (OR 4.91 [95% CI = 2.27 to 10.63]), presence of arachnoid plane (OR 5.60 [95% CI = 2.08 to 15.07]), and more extensive resection (OR 0.61 [95% CI = 0.4 to 0.93]). Conclusions Ophthalmologic factors and factors directly related to the lesion are most important in determining vision outcome. The decision to perform optic nerve decompression for vision loss should be made based on careful examination of the patient and realistic discussion regarding the probability of improvement.
Collapse
Affiliation(s)
- Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - Martina Stippler
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - Orrin Myers
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| |
Collapse
|
21
|
Kim YS, Kim K, Lee JG, Yoon JH, Kim CH. Paranasal sinus mucoceles with ophthalmologic manifestations: a 17-year review of 96 cases. Am J Rhinol Allergy 2011; 25:272-5. [PMID: 21819766 DOI: 10.2500/ajra.2011.25.3624] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to assess the characteristics of paranasal sinus mucoceles with ophthalmologic manifestations with a focus on optic neuropathy. METHODS From January 1993 to May 2010, 96 consecutive patients diagnosed with paranasal sinus mucoceles with ophthalmologic manifestations were investigated. Clinical and therapeutic factors and demographics were reviewed from medical records. Statistical associations between clinical and therapeutic factors and visual outcomes after surgery were also analyzed. RESULTS A total of 352 patients were diagnosed with paranasal sinus mucoceles and underwent surgical treatment. Ninety-six of them presented with ophthalmologic symptoms, and periorbital swelling and pain were the most common symptoms (36.4%) in those patients. Among the 96 patients with ophthalmologic manifestations, 18 (18.8%) were diagnosed with optic neuropathy based on the deterioration of their visual acuity and unilateral relative afferent papillary defect. Ten of these 18 patients showed improvements in their vision after surgical intervention. The statistical analysis of the association between clinical and therapeutic factors and visual outcomes showed that the presence of infection was the only significant factor (p = 0.023). CONCLUSION Paranasal sinus mucoceles present various ophthalmologic manifestations. Among them, optic neuropathy may be one of the most devastating conditions. In treating optic neuropathy caused by mucoceles, the presence of infection was the only factor that had any influence on postoperative visual outcomes. Therefore, we conclude that not only surgical drainage and ventilation of the sinus are necessary, but infection control is also a vital factor in treating mucoceles with optic neuropathy.
Collapse
Affiliation(s)
- Yoo-Suk Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
22
|
Berkmann S, Fandino J, Zosso S, Killer HE, Remonda L, Landolt H. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg 2011; 115:518-27. [DOI: 10.3171/2011.4.jns101568] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Sellar lesions with suprasellar extension may cause loss of visual acuity and visual field damage due to compression of the optic chiasm. Using intraoperative MR (iMR) imaging to detect symptomatic lesion remnants adjacent to the optic chiasm (that may be resected in the same procedure) may positively affect the functional outcome of patients with these lesions. The aim of this study was to evaluate the correlation between visual improvement and optic nerve decompression detected by iMR imaging in patients undergoing transsphenoidal resection of pituitary lesions.
Methods
A total of 32 patients (23 men and 9 women) who underwent transsphenoidal resection of sellar lesions causing visual impairment were included in this study. Tumor volume ranged from 0.9 cm3 to 55.7 cm3 (mean 9.8 ± 11.7 cm3). Preoperative assessment showed visual field damage in 31 patients (97%) and loss of visual acuity in 28 patients (88%). The latency period between the appearance of symptoms and transsphenoidal decompression was 14.9 ± 19.5 weeks.
Results
Intraoperative MR imaging was performed after the resection was believed to be complete, or if further tumor removal was not safely possible due to changed conditions in the surgical field. Complete resection was detected on these initial scans in 17 patients (53%). Partial resection was achieved in 9 patients (28%) and tumor debulking in 6 (19%). Additional resection was possible in 8 (53%) of these 15 patients. Four (50%) of these 8 cases had suprasellar remnants and the optic chiasm was subsequently decompressed. In 5 cases optimal decompression of the optic chiasm was not possible. On early follow-up within 1 month after surgery, overall improvement of visual field damage was observed in 27 patients (87%). In 23 patients (74%), the Goldmann perimetry demonstrated complete recovery. Improvement of visual acuity was noted in 24 patients (86%). Eighteen patients (64%) regained full visual acuity. Identification of a decompressed optic chiasm on iMR imaging was significantly correlated with visual field improvement (p = 0.0007; positive predictive value 0.96, 95% CI 0.81–0.99) and relief of visual acuity deficits (p = 0.0002; positive predictive value 0.96, 95% CI 0.79–0.99). Two patients needed transcranial procedures for symptomatic tumor remnants detected on iMR imaging.
Conclusions
Intraoperative MR imaging findings correlate with prognosis of visual deficits after transsphenoidal decompression of the anterior optic pathways. The use of iMR imaging may prevent revision surgery for unexpected symptomatic remnants.
Collapse
Affiliation(s)
| | | | | | | | - Luca Remonda
- 3Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Switzerland
| | | |
Collapse
|
23
|
Nakaya K, Oshima T, Kudo T, Ikeda R, Hidaka H, Kobayashi T. Outcomes of surgically treated rhinogenic optic neuropathy. Acta Otolaryngol 2011; 131:833-9. [PMID: 21466260 DOI: 10.3109/00016489.2011.557837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONCLUSION The visual outcomes of endoscopic treatment of optic neuropathy are favorable. However, no specific prognostic factor was associated with good outcome. OBJECTIVE To investigate visual outcomes of patients with optic neuropathy caused by paranasal mucocele or sinusitis. METHODS The clinical course in 38 patients with rhinogenic optic neuropathy was investigated retrospectively. All patients underwent endoscopic sinus surgery and ophthalmologists measured preoperative and postoperative visual acuities. RESULTS Visual acuity completely recovered in 31 patients and partially in 2 patients, and did not recover in 5 patients. Age, sex, sinus involved (ethmoid or sphenoid), preoperative visual acuity, abnormal fundus findings, duration of symptoms, steroid use, and coexistence of diabetes mellitus showed no significant correlation with full recovery.
Collapse
Affiliation(s)
- Kazuhiro Nakaya
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Sendai, Miyagi, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Predicting visual recovery following optic nerve decompression for chronic optic neuropathy. Acta Neurochir (Wien) 2009; 151:1729. [PMID: 19479189 DOI: 10.1007/s00701-009-0404-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
|