1
|
Kemchoknatee P, Singhakul C, Arjkongharn N, Vongsa N, Tangon D, Srisombut T. Insights into Visual Outcomes and Determinants in Pituitary Adenoma Surgery: A 5-Year Retrospective Cohort Study. Clin Ophthalmol 2024; 18:1779-1788. [PMID: 38919405 PMCID: PMC11198008 DOI: 10.2147/opth.s463303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose To investigate the long-term visual outcome and their determinants after an operation in Thai pituitary adenoma (PA). Patients and Methods A retrospective cohort study was conducted on PA patients who underwent surgery at Rajavithi Hospital. Baseline characteristics and visual parameters, including visual acuity (VA) and visual field (VF), were analyzed in relation to the visual prognosis outcome. The outcome was defined as VA improvement at 1-year postoperatively. Visual parameters were measured at each follow-up visit and compared. Factors for improved visual prognosis were evaluated using logistic regression analysis. Results A total cohort of 87 patients (64.37% female), 62.07% showed improvement in visual outcome. Most improvement occurred immediately after surgery, evident at the 1-month visit. The mean follow-up time was 47.45 months (±28.49 SD), mean difference in VA improvement at 1-year was -0.56 logMAR (95% CI -0.73, -0.47). In multivariable logistic regression model, prolonged onset duration was associated with a reduced odds of improved visual outcome, with an odds ratio (OR) of 0.946 (95% CI 0.899-0.996, p = 0.034). Baseline characteristics, tumor volume, Hardy and Knops classification, and surgical approaches were not identified as significant predictors. Conclusion Both TSS and transcranial approaches are effective for pituitary adenoma. A prompt operation is recommended for patients with prolonged onset duration, with thorough discussion on poor postoperative visual outcomes.
Collapse
Affiliation(s)
- Parinee Kemchoknatee
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Chotika Singhakul
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Niracha Arjkongharn
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Nattaporn Vongsa
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Duanghathai Tangon
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Thansit Srisombut
- Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| |
Collapse
|
2
|
Zhang Y, Zheng J, Huang Z, Teng Y, Chen C, Xu J. Predicting visual recovery in pituitary adenoma patients post-endoscopic endonasal transsphenoidal surgery: Harnessing delta-radiomics of the optic chiasm from MRI. Eur Radiol 2023; 33:7482-7493. [PMID: 37488296 PMCID: PMC10598191 DOI: 10.1007/s00330-023-09963-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To investigate whether morphological changes after surgery and delta-radiomics of the optic chiasm obtained from routine MRI could help predict postoperative visual recovery of pituitary adenoma patients. METHODS A total of 130 pituitary adenoma patients were retrospectively enrolled and divided into the recovery group (n = 87) and non-recovery group (n = 43) according to visual outcome 1 year after endoscopic endonasal transsphenoidal surgery. Morphological parameters of the optic chiasm were measured preoperatively and postoperatively, including chiasmal thickness, deformed angle, and suprasellar extension. Delta-radiomics of the optic chiasm were calculated based on features extracted from preoperative and postoperative coronal T2-weighted images, followed by machine learning modeling using least absolute shrinkage and selection operator wrapped with support vector machine through fivefold cross-validation in the development set. The delta-radiomic model was independently evaluated in the test set, and compared with the combined model that incorporated delta-radiomics, significant clinical and morphological parameters. RESULTS Postoperative morphological changes of the optic chiasm could not significantly be used as predictors for the visual outcome. In contrast, the delta-radiomics model represented good performances in predicting visual recovery, with an AUC of 0.821 in the development set and 0.811 in the independent test set. Moreover, the combined model that incorporated age and delta-radiomics features of the optic chiasm achieved the highest AUC of 0.841 and 0.840 in the development set and independent test set, respectively. CONCLUSIONS Our proposed machine learning models based on delta-radiomics of the optic chiasm can be used to predict postoperative visual recovery of pituitary adenoma patients. CLINICAL RELEVANCE STATEMENT Our delta-radiomics-based models from MRI enable accurate visual recovery predictions in pituitary adenoma patients who underwent endoscopic endonasal transsphenoidal surgery, facilitating better clinical decision-making and ultimately improving patient outcomes. KEY POINTS • Prediction of the postoperative visual outcome for pituitary adenoma patients is important but challenging. • Delta-radiomics of the optic chiasm after surgical decompression represented better prognostic performances compared with its morphological changes. • The proposed machine learning models can serve as novel approaches to predict visual recovery for pituitary adenoma patients in clinical practice.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Junkai Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Zhouyang Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Yuen Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
| |
Collapse
|
3
|
Lin TM, Chen CY, Chung HW. Compressive optic neuropathy by pituitary adenoma: may making radiomics delta provide prognostic value after surgery? Eur Radiol 2023; 33:7479-7481. [PMID: 37782339 DOI: 10.1007/s00330-023-10274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chieh-Yi Chen
- Department of Neurosurgery, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Hsiao-Wen Chung
- Graduate Institute of Biomedical Electronics and Bioinformatics, Department of Electrical Engineering, National Taiwan University, Taipei, 10617, Taiwan.
| |
Collapse
|
4
|
Kawajiri S, Isozaki M, Komori O, Yamada S, Higashino Y, Yamauchi T, Akazawa A, Kidoguchi M, Yomo M, Kodera T, Arishma H, Awara K, Inatani M, Kikuta K. Visual Evoked Potential Can Predict Deterioration of Visual Function After Direct Clipping of Paraclinoid Aneurysm With Anterior Clinoidectomy. Neurosurgery 2023; 92:1276-1286. [PMID: 36757317 DOI: 10.1227/neu.0000000000002363] [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: 05/24/2022] [Accepted: 11/14/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The role of visual evoked potential (VEP) in direct clipping of the paraclinoid internal carotid artery (ICA) aneurysm remains uncertain. OBJECTIVE To examine whether intraoperative neuromonitoring with VEP can predict deterioration of visual function after direct clipping of the paraclinoid ICA aneurysm with anterior clinoidectomy. METHODS Among consecutive 274 patients with unruptured cerebral aneurysm, we enrolled 25 patients with paraclinoid ICA aneurysm treated by direct clipping after anterior clinoidectomy with intraoperative neuromonitoring with VEP in this study. We evaluated the visual acuity loss (VAL) and visual field loss (VFL) before surgery, 1 month after surgery, and at the final follow-up. RESULTS The VAL at 1 month after surgery (VAL1M) and VAL at the final follow-up (Final VAL) were significantly related to the reduction rate of VEP amplitude at the end of surgery (RedEnd%), more than 76.5%, and the maximal reduction rate of VEP amplitude during surgery (MaxRed%), more than 66.7% to 70%. The VFL at 1 month after surgery (VFL1M) and the VFL at the final follow-up (Final VFL) were significantly related to MaxRed% more than 60.7%. CONCLUSION VAL1M, Final VAL, VFL1M, and Final VFL could be significantly predicted by the value of RedEnd% and MaxRed% in direct clipping of Al-Rodhan group Ia, Ib, and II paraclinoid ICA aneurysms with anterior clinoidectomy.
Collapse
Affiliation(s)
- Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Tokyo, Japan
| | - Shinsuke Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yorhifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Munetaka Yomo
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidetaka Arishma
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kousuke Awara
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| |
Collapse
|
5
|
Zhang Y, Chen C, Huang W, Teng Y, Shu X, Zhao F, Xu J, Zhang L. Preoperative volume of the optic chiasm is an easily obtained predictor for visual recovery of pituitary adenoma patients following endoscopic endonasal transsphenoidal surgery: a cohort study. Int J Surg 2023; 109:896-904. [PMID: 36999782 PMCID: PMC10389445 DOI: 10.1097/js9.0000000000000357] [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: 12/28/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Predicting the postoperative visual outcome of pituitary adenoma patients is important but remains challenging. This study aimed to identify a novel prognostic predictor which can be automatically obtained from routine MRI using a deep learning approach. MATERIALS AND METHODS A total of 220 pituitary adenoma patients were prospectively enrolled and stratified into the recovery and nonrecovery groups according to the visual outcome at 6 months after endoscopic endonasal transsphenoidal surgery. The optic chiasm was manually segmented on preoperative coronal T2WI, and its morphometric parameters were measured, including suprasellar extension distance, chiasmal thickness, and chiasmal volume. Univariate and multivariate analyses were conducted on clinical and morphometric parameters to identify predictors for visual recovery. Additionally, a deep learning model for automated segmentation and volumetric measurement of optic chiasm was developed with nnU-Net architecture and evaluated in a multicenter data set covering 1026 pituitary adenoma patients from four institutions. RESULTS Larger preoperative chiasmal volume was significantly associated with better visual outcomes ( P =0.001). Multivariate logistic regression suggested it could be taken as the independent predictor for visual recovery (odds ratio=2.838, P <0.001). The auto-segmentation model represented good performances and generalizability in internal (Dice=0.813) and three independent external test sets (Dice=0.786, 0.818, and 0.808, respectively). Moreover, the model achieved accurate volumetric evaluation of the optic chiasm with an intraclass correlation coefficient of more than 0.83 in both internal and external test sets. CONCLUSION The preoperative volume of the optic chiasm could be utilized as the prognostic predictor for visual recovery of pituitary adenoma patients after surgery. Moreover, the proposed deep learning-based model allowed for automated segmentation and volumetric measurement of the optic chiasm on routine MRI.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Radiology, West China Hospital, Sichuan University
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Radiology, West China Hospital, Sichuan University
| | - Wei Huang
- College of Computer Science, Sichuan University
| | - Yuen Teng
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Radiology, West China Hospital, Sichuan University
| | - Xin Shu
- College of Computer Science, Sichuan University
| | - Fumin Zhao
- Department of Radiology, West China Second University Hospital, Sichuan University
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Radiology, West China Hospital, Sichuan University
| | - Lei Zhang
- College of Computer Science, Sichuan University
| |
Collapse
|
6
|
Mohamadzadeh O, Sadrehosseini SM, Tabari A, Ghanaati H, Zeinalizadeh M. Can Preoperative Diffusion Tensor Imaging Tractography Predict the Visual Outcomes of Patients with Pituitary Macroadenomas? A Prospective Pilot Study. World Neurosurg 2023; 172:e326-e334. [PMID: 36640834 DOI: 10.1016/j.wneu.2023.01.022] [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: 11/04/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Visual impairment has been reported as the most common clinical manifestation of pituitary adenoma (PA) due to the compressive effect of the tumor. This prospective study aimed to evaluate the predictive role of diffusion tensor imaging (DTI) in the visual improvement of patients with PA, who were candidates for endoscopic endonasal surgery. METHODS A total of 13 patients (male, 8; female, 5) with visual impairment due to pituitary macroadenoma were enrolled in this study. The DTI findings and visual parameters, including visual acuity (VA), visual field (VF), and visual evoked potential (VEP), were recorded for all participants before and 3 months after surgery. RESULTS Significant recovery was reported in both VA and VF following PA surgery (P < 0.001). The results of perimetry indicated recovery in all quadrants, except for the lower nasal quadrant of the right eye. The tumor volume showed no significant association with the preoperative optic nerve, optic tract, and chiasm fractional anisotropy (FA) or mean diffusivity (MD). The VA and VF recoveries were more likely in patients with a lower preoperative optic nerve MD. Besides, increased preoperative FA of the optic nerve was associated with a higher probability of VA recovery. No significant correlation was found between the optic tract MD and FA values and visual improvement. Overall, MD values below 0.0021 and FA values above 0.1689 could predict a good prognosis of VA recovery after surgery. CONCLUSIONS DTI may have a predictive value in estimating visual improvement in patients with PA preoperatively.
Collapse
Affiliation(s)
- Omid Mohamadzadeh
- Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mousa Sadrehosseini
- Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Tabari
- Department of Otolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Zeinalizadeh
- Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
7
|
Hernández-Echevarría O, Cuétara-Lugo EB, Pérez-Benítez MJ, González-Gómez JC, González-Diez HR, Mendoza-Santiesteban CE. Bi-nasal sectors of ganglion cells complex and visual evoked potential amplitudes as biomarkers in pituitary macroadenoma management. Front Integr Neurosci 2022; 16:1034705. [PMID: 36506477 PMCID: PMC9730037 DOI: 10.3389/fnint.2022.1034705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
The study aimed to evaluate the retinal ganglion cell structure using optical coherence tomography and the visual pathway function employing visual evoked potentials in the diagnosis and monitoring of patients with pituitary macroadenoma. A descriptive, cross-sectional, and longitudinal study (3 and 12 months follow-up) was conducted on forty-two patients. Thirty-five age-matched healthy controls were used in the cross-sectional one. Full neuro-ophthalmological evaluation (structural and functional) was carried out including global and segmented retinal nerve fiber layer/ganglion cell complex analysis and amplitude and latency of P100 component in the electrophysiology. Statistical data analysis was conducted with R version 3.6.3 and Python version 3.8. Associations were evaluated using Spearman's correlations. Amplitude sensitivities were 0.999, and bi-nasal sectors of ganglion cell complex thickness specificities were 0.999. This structural parameter had the highest diagnostic value (area under curve = 0.923). Significant associations were found between bi-nasal sectors with amplitude at 12' (rho > 0.7, p < 0.01) and median deviation of the visual field (rho > 0.5, p < 0.01) at 3 months. Pre-surgical values of bi-nasal sectors and amplitude can predict post-surgically median deviation and amplitude (Oz, 12') at 3 months with r 2 > 0.5. Bi-nasal sectors of ganglion cell complex and visual evoked potentials P100 amplitude are efficient biomarkers of visual pathway damage for pituitary macroadenoma patients' management. Pre-surgical values of the bi-nasal sector and visual evoked potentials' amplitude could help to predict the restoration of parvocellular pathway traffic after decompression.
Collapse
Affiliation(s)
- Odelaisys Hernández-Echevarría
- Department of Neuro-ophthalmology, Cuban Institute of Ophthalmology “Ramón Pando Ferrer”, University of Medical Sciences of Havana, Havana, Cuba,*Correspondence: Odelaisys Hernández-Echevarría,
| | - Elizabeth Bárbara Cuétara-Lugo
- Department of Research and Academic, National Institute of Oncology and Radiobiology, University of Medical Sciences of Havana, Havana, Cuba
| | - Mario Jesús Pérez-Benítez
- Department of Research and Academic, National Institute of Oncology and Radiobiology, University of Medical Sciences of Havana, Havana, Cuba
| | - Julio César González-Gómez
- Department of Neuro-ophthalmology, Cuban Institute of Ophthalmology “Ramón Pando Ferrer”, University of Medical Sciences of Havana, Havana, Cuba
| | | | - Carlos E. Mendoza-Santiesteban
- Department of Neuro-ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
| |
Collapse
|
8
|
Nakagawa I, Park H, Kotsugi M, Yokoyama S, Omoto K, Myochin K, Takeshima Y, Matsuda R, Nishimura F, Yamada S, Takatani T, Nakase H. Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm. Front Neurol 2022; 13:761263. [PMID: 35280302 PMCID: PMC8904750 DOI: 10.3389/fneur.2022.761263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function. Methods This study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed. Results Treated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case. Conclusion Although significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.
Collapse
Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
- *Correspondence: Ichiro Nakagawa
| | - HunSoo Park
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kouji Omoto
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kaoru Myochin
- Departments of Radiology, Nara Medical University, Kashihara, Japan
| | | | - Ryosuke Matsuda
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| |
Collapse
|
9
|
Dotto PDF, Berezovsky A, Sacai PY, Rocha DM, Fernandes AG, Salomão SR. Visual function assessed by visually evoked potentials in adults with orbital and other primary intracranial tumors. Eur J Ophthalmol 2020; 31:1351-1360. [PMID: 32468859 DOI: 10.1177/1120672120925643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess visual function by visually evoked potentials in adults with orbital and other primary brain tumors affecting the optic pathway. METHODS In this retrospective case-control series, patients with orbital (intraconal and extraconal) or midline/chiasmatic tumors were included. Visually evoked potentials using pattern-reversal visually evoked potential and flash visually evoked potential stimuli were performed according to the international standards. Outcome measures were visually evoked potential parameters of amplitude (µV) and peak times (ms) measured both for the P100 component (pattern-reversal visually evoked potentials) and the N2P2 complex (flash visually evoked potential). Individual results were also compared with gender-based normative values. RESULTS A group of 21 adult patients (17 females) and age- and sex-matched controls were evaluated. Tumor location was intraconal (6 meningiomas, 3 hemangiomas, 1 glioma), extraconal (6 meningiomas), and midline (3 pituitary adenomas, 2 hypothalamic/chiasmatic low-grade gliomas). Abnormal fundus (76%), abnormal pupillary reflexes (71%), reduced visual acuity (62%), strabismus (48%), and proptosis (38%) were present. Visually evoked potential abnormalities were found in at least one eye of all cases. Affected eyes had significantly reduced amplitudes and prolonged peak times for pattern-reversal visually evoked potentials (p < .001) and significantly reduced amplitudes for flash visually evoked potential (p < .001). In unilateral orbital tumors, abnormally prolonged pattern-reversal visually evoked potential peak times were also detected in some contralateral eyes (n = 6/16). CONCLUSION Visually evoked potential abnormalities were found in all adult patients with orbital and other intracranial primary tumors, even in eyes with normal exam and good visual acuity. Visually evoked potential can be used as a non-invasive ancillary test to characterize and monitor visual function in subjects with these neoplastic lesions.
Collapse
Affiliation(s)
- Patrícia de Freitas Dotto
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Adriana Berezovsky
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Paula Yuri Sacai
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Daniel Martins Rocha
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Arthur Gustavo Fernandes
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| | - Solange Rios Salomão
- Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brasil
| |
Collapse
|