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Han KE, Choi H, Kim SJ, Lee SM, Lee JE. Clinical efficacy of optical coherence tomography parameters to predict the visual field outcome following pituitary adenoma surgery. PLoS One 2024; 19:e0313521. [PMID: 39531448 PMCID: PMC11556729 DOI: 10.1371/journal.pone.0313521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024] Open
Abstract
PURPOSE To investigate the factors affecting visual field recovery in patients with pituitary adenoma following surgical removal, both eyes of 35 patients with pituitary adenoma who had been followed up for > six months post-surgery were retrospectively analyzed. MATERIAL AND METHODS Pre- and post-operative visual acuity, visual field test, retinal nerve fiber layer (RNFL), and ganglion cell inner plexiform layer (GCIPL) thickness were investigated. The average age of the 35 patients was 58.3 ± 11.5 years. Preoperatively, 30 eyes (mean average RNFL thickness, 99.73 ± 5.89 μm) and 40 eyes (mean average RNFL thickness, 77.55 ± 8.35 μm) were included in the thick (≥ 90 μm) and thin RNFL group (< 90 μm), respectively. RESULTS In the thick RNFL group, pre- and post-operative mean deviation (MD) and pattern standard deviation (PSD) were favorable (all p < 0.001), and the proportion of eyes of postoperative MD change which were stable or improved was greater than in the thin RNFL group (p = 0.042). Preoperative MD, RNFL (except nasal quadrant) and GCIPL thickness were positively correlated to postoperative MD values (all, p < 0.05). Preoperative MD and temporal RNFL thickness were significantly correlated with postoperative MD change rate (p = 0.03 and 0.04, respectively). Preoperative GC IPL thickness and postoperative MD change rate were not significantly correlated (p = 0.61). Using univariate regression analysis, preoperative best corrected visual acuity (Odds ratio [OR], 0.050; p < 0.001), tumor volume (OR, 1.110, p = 0.002), higher preoperative MD values (OR, 0.858; p < 0.001), lower preoperative PSD values (OR, 1.169, p = 0.002), thick RNFL (OR, 0.215; p = 0.003) and thick GCIPL (OR, 0.305, p = 0.018) were significantly associated with a good visual field outcome following surgery. According to multivariate analysis, any other parameters were not significant. In patients with thick RNFL, postoperative MD values were better than in the thin RNFL group. CONCLUSIONS Eyes with preoperative higher MD and thick temporal RNFL showed more improvement in their visual fields postoperative. Preoperative thick RNFL could be a potential predictor of visual field recovery following TSA-TR, while macular GCIPL thickness does not appear to be a reliable predictor.
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Affiliation(s)
- Kwang Eon Han
- Department of Ophthalmology, Research Institute for Convergence of Biomediocal Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Heeyoung Choi
- Department of Ophthalmology, Biomedical Research Institute, School of Medicine, Pusan National University, Pusan National University Hospital, Busan, Korea
| | - Su-Jin Kim
- Department of Ophthalmology, Research Institute for Convergence of Biomediocal Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Min Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomediocal Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Eun Lee
- Department of Ophthalmology, Research Institute for Convergence of Biomediocal Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Shafiq I, Williams ZR, Vates GE. Advancement in perioperative management of pituitary adenomas-Current concepts and best practices. J Neuroendocrinol 2024; 36:e13427. [PMID: 38964869 DOI: 10.1111/jne.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/30/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
Pituitary adenomas are very common representing 18.1% of all brain tumors and are the second most common brain pathology. Transsphenoidal surgery is the mainstay of treatment for all pituitary adenomas except for prolactinomas which are primarily treated medically with dopamine agonists. A thorough endocrine evaluation of pituitary adenoma preoperatively is crucial to identify hormonal compromise caused by the large sellar mass, identifying prolactin-producing tumors and comorbidities associated with Cushing and acromegaly to improve patient care and outcome. Transsphenoidal surgery is relatively safe in the hands of experienced surgeons, but still carries a substantial risk of causing hypopituitarism that required close follow-up in the immediate postoperative period to decrease mortality. A multidisciplinary team approach with endocrinologists, ophthalmologists, and neurosurgeons is the cornerstone in the perioperative management of pituitary adenomas.
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Affiliation(s)
- Ismat Shafiq
- Division of Endocrinology, Diabetes, and Metabolism, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Zoë R Williams
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Nair SS, Varsha AS, Hegde A, Raju B, Nayak R, Menon G, Menon S. Correlation of pre-operative and post-operative retinal nerve fibre layer thickness with visual outcome following decompression of pituitary macroadenoma. Clin Neurol Neurosurg 2024; 244:108446. [PMID: 39018992 DOI: 10.1016/j.clineuro.2024.108446] [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: 05/18/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To (i) correlate preoperative retinal nerve fibre layer (RNFL) thickness with visual parameters in patients with pituitary macroadenomas. (ii) study the predictive role of preoperative RNFL in visual outcome following surgery for pituitary macroadenomas (iii) correlate change in postoperative RNFL thickness (RNFLT) with visual outcome. METHODS Preoperative and post-operative RNFL thickness of thirty-three consecutive patients operated for pituitary macro adenoma between June 2022 and May 2023 were measured using Optical Coherence Tomography (OCT) and compared with standard visual examination findings and Magnetic Resonance Imaging (MRI) measurements. RESULTS A total of 66 eyes of 33 patients who underwent surgical excision of pituitary macro adenoma between June 2022 and May 2023 were studied. The mean age in years of the study group was 44.36 ± 13.77 and both sexes were equally represented (Male: Female = 16:17). RNFL thinning predominantly involved the temporal (51.21+/-15.19 μm) followed by nasal quadrants (62.67+/- 17.03 μm) and correlated well with the visual field (VF) deficit (p <0.001). Patients with severe disc pallor had extremely thin RNFL (less than 67 +/- 8.68 μm). Patients with moderate to severe visual acuity (VA) deficits had significantly thinner RNFLs (65.08±7.09) compared to patients with normal to mild impairment in vision. (83.185±1.2) (p<0.05). RNFL values were significantly thinner for patients with Wilson Grade C, D and E tumours (66.13 ±12.19 μm) compared to those in Grade A and B (77.67±22.12 μm). The mean preop RNFL of patients who showed post-operative improvement in vision was 87.025± 15.02 μm, of patients in whom vision remained static was 74.58 ±18.31 μm. The mean VA (Decimal) increased from a minimum of 0.60 at the pre-operative timepoint to a maximum of 0.68 at the post-operative timepoint. (Wilcoxon Test: V = 42.5, p = <0.001). The mean RNFLT (µm) increased from 77.14 μm at the pre-operative timepoint to 83.77 μm at the post-operative timepoint. (Wilcoxon Test: V = 218.0, p = <0.001). The mean change of RNFL in patients in whom vision improved was 3.6 μm and the mean change of RNFL in patients in whom vision remained static was 9.51 μm. Absence of postoperative visual improvement was noted despite postoperative RNFL thickness improvement in eyes which showed significant preoperative thinning of the nasal (<65 μm) and temporal (<52μm) quadrants. CONCLUSION RNFL thinning corelates directly with visual acuity, visual field, and optic disc pallor. Patients with pituitary adenoma have preferential thinning of temporal and nasal quadrants. Visual outcome is better in patients with preserved RNFLT of values more than 82 +/- 5 μm. Reversal of RNFL thinning postoperatively need not necessarily correlate with visual improvement especially in patients who showed significant preoperative thinning of nasal and temporal quadrants.
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Affiliation(s)
- Soumya S Nair
- Department of Ophthalmology, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Aral Sai Varsha
- Department of Neurosurgery, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Bharath Raju
- Department of Neurosurgery, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, MAHE, Manipal, India
| | - Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal, MAHE, Manipal, India.
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Demura M, Sasagawa Y, Hayashi Y, Tachibana O, Nakada M. Inferior temporal quadrantanopia associated with pituitary adenomas and a potential mechanism of excessive optic nerve bending. Surg Neurol Int 2024; 15:70. [PMID: 38468671 PMCID: PMC10927194 DOI: 10.25259/sni_909_2023] [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: 11/12/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Pituitary adenomas show typical visual field defects that begin superiorly and progress inferiorly. The cause of atypical visual field defects that start inferiorly remains unclear. This study aimed to understand this phenomenon using magnetic resonance imaging (MRI). Methods A total of 220 patients with pituitary adenomas underwent a visual field assessment of both eyes. Preoperative visual fields were assessed and classified into two types: superior quadrantanopia (typical) and inferior quadrantanopia (atypical). Several parameters related to tumor characteristics and optic nerve compression were evaluated using MRI. Results Of the 440 eyes examined, 174 (39.5%) had visual field defects. Of these, 28 (16.1%) had typical and 11 (6.3%) had atypical visual field defects. Patient age, tumor size, degree of cavernous sinus invasion, tumor pathology, and intratumor bleeding were similar between the two groups. The angle formed by the optic nerve in the optic canal and in the intracranial subarachnoid space at the exit of the optic canal (degree of optic nerve bending) was significantly larger in the atypical group than in the typical group (42.6° vs. 23.9°, P = 0.046). Conclusion In some pituitary adenomas, visual field defects begin inferiorly. This may be caused by optic nerve compression on the superior surface by the bony margin of the optic canal exit. Therefore, pituitary adenomas should be considered in patients with atypical visual field defects.
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Affiliation(s)
- Munehiro Demura
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasuo Sasagawa
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Marques P, Sagarribay A, Tortosa F, Neto L, Tavares Ferreira J, Subtil J, Palha A, Dias D, Sapinho I. Multidisciplinary Team Care in Pituitary Tumours. Cancers (Basel) 2024; 16:950. [PMID: 38473312 DOI: 10.3390/cancers16050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The optimal care for patients with pituitary tumours is best provided in a multidisciplinary and collaborative environment, which requires the contribution of multiple medical specialties working together. The benefits and advantages of the pituitary multidisciplinary team (MDT) are broad, and all relevant international consensus and guidelines in the field recommend that patients with pituitary tumours should always be managed in a MDT. Endocrinologists and neurosurgeons are normally the leading specialties within the pituitary MDT, supported by many other specialties with significant contributions to the diagnosis and management of pituitary tumours, including neuropathology, neuroradiology, neuro-ophthalmology, and otorhinolaryngology, among others. Here, we review the literature concerning the concepts of Pituitary MDT/Pituitary Tumour Centre of Excellence (PTCOE) in terms of their mission, goals, benefits, structure, proposed models of function, and barriers, and we also provide the views of different specialists involved in our Pituitary MDT.
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Affiliation(s)
- Pedro Marques
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
- Faculty of Medicine, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Amets Sagarribay
- Pituitary Tumor Unit, Neurosurgery Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Francisco Tortosa
- Pituitary Tumor Unit, Pathology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Lia Neto
- Pituitary Tumor Unit, Radiology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Joana Tavares Ferreira
- Pituitary Tumor Unit, Ophthalmology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - João Subtil
- Pituitary Tumor Unit, Otorhinolaryngology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Ana Palha
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Daniela Dias
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Inês Sapinho
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
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Lei K, Tang Y, Pang R, Zhou H, Yang L, Wang N. Comparison of the retinal microvasculature between compressive and glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3589-3597. [PMID: 37347246 DOI: 10.1007/s00417-023-06137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE To compare the patterns of retinal microvasculature change in the peripapillary and macular region between compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON), and to assess the ability of optical coherence tomography angiography (OCTA) in differentiating the two conditions. METHODS This cross-sectional study included 108 participants (108 eyes), 36 with CON, 36 with GON, and 36 healthy controls. The CON and GON eyes were matched by the average peripapillary retinal nerve fiber layer (pRNFL) thickness (1:1). Optical coherence tomography (OCT) and OCTA were performed to compare the structural and vascular change of the peripapillary and macular region between groups. RESULTS Both CON and GON eyes showed more severe structural and vascular damage than the control eyes. The CON eyes had lower pRNFL thickness than the GON eyes in the temporal and nasal quadrants, and thicker pRNFL thickness in the inferior quadrant. The average GCC thickness did not differ between the two groups. The peripapillary vessel density of the CON group was significantly higher in the inferior sectors than that of the GON group. In the macular region, the CON group had significantly higher vessel density in the whole image, the temporal sector in parafovea region, and the temporal, superior, and inferior sectors in perifovea region. CONCLUSION To a similar degree of structural damage, CON had less retinal vascular impairment than GON, especially in the macular region, and the significance of the finding needs further evaluation.
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Affiliation(s)
- Kun Lei
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yang Tang
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruiqi Pang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Huiying Zhou
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Ergen A, Kaya Ergen S, Gunduz B, Subasi S, Caklili M, Cabuk B, Anik I, Ceylan S. Retinal vascular and structural recovery analysis by optical coherence tomography angiography after endoscopic decompression in sellar/parasellar tumors. Sci Rep 2023; 13:14371. [PMID: 37658097 PMCID: PMC10474160 DOI: 10.1038/s41598-023-40956-2] [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: 04/04/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023] Open
Abstract
We assessed the potential retinal microcirculation alterations for postoperative visual recovery in sellar/paraseller tumor patients with Optical Coherence Tomography Angiography (OCT-A). Two hundred ten eyes with sellar/parasellar tumor for which preoperative and postoperative (3 months) MRI Scans, Visual Acuity Test, Optical Coherence Tomography (OCT), OCT-A and, Visual Field Test data were available, besides 92 healthy eyes were evaluated. In the preoperative phase, significant reductions were observed in retinal vascular densities in various regions, including the Superficial Retinal Capillary Plexus (SRCP) (whole: p < 0.001, fovea: p = 0.025, parafovea: p < 0.001), Deep Retinal Capillary Plexus (DRCP) (whole: p < 0.001, fovea: p = 0.003, parafovea: p < 0.001), Peripapillary Vascular Density (PVD) (whole: p = 0.045, peripapillary: p < 0.001, nasal: p < 0.001, inferior: p < 0.001, temporal: p < 0.001), and Retinal Nerve Fiber Layer (RNFL) (nasal: p = 0.024, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001) compared to the healthy control group. After surgery, the postoperative data of patients without chiasmal distortion were compared to their preoperative data. In the postoperative evaluation, significant increases were observed in vascular densities in patients without chiasmal distortion in the SRCP (whole: p < 0.001, parafovea: p = 0.045), DRCP (whole: p = 0.007, fovea: p = 0.006, parafovea: p = 0.040), PVD (peripapillary: p = 0.010, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001), and RNFL (nasal: p = 0.011, inferior: p = 0.034, temporal: p = 0.046, superior: p = 0.011). Furthermore, significant associations were observed in the ROC analysis between the postoperative Visual Field Mean Deviation (VFMD) and SRCP (whole AUC = 0.793, p < 0.001, cut-off = 51.45, parafovea AUC = 0.820, p < 0.001, cut-off = 53.95), DRCP (whole AUC = 0.818, p < 0.001, cut-off = 55.95, parafovea AUC = 0.820, p < 0.001, cut-off = 59.05), PVD (temporal AUC = 0.692, p < 0.001, cut-off = 55.10), and RNFL (whole AUC = 0.690, p = 0.001, cut-off = 119.5, inferior AUC = 0.712, p < 0.001, cut-off = 144.75). These findings indicate a potential role of pre and post-operative OCT-A measurements in the assessment of surgical timing and postoperative visual recovery in patients with or without optic chiasm distortion.
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Affiliation(s)
- Anil Ergen
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Sebnem Kaya Ergen
- Department of Ophthalmology, Kocaeli Seka State Hospital, Kocaeli, Turkey
| | - Busra Gunduz
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Sevgi Subasi
- Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Melih Caklili
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Burak Cabuk
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Ihsan Anik
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Savas Ceylan
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey.
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Ito M, Suda K, Nakano E, Tagawa M, Miyata M, Kashii S, Tanji M, Miyamoto S, Tsujikawa A. Influence of Tumor Characteristics on Visual Field Outcomes After Pituitary Adenoma Surgery. J Neuroophthalmol 2023; 43:376-382. [PMID: 36730898 DOI: 10.1097/wno.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There were few reports about the influence of tumor characteristics on the postoperative visual field outcomes after transsphenoidal surgery for pituitary adenoma. The purpose of this study was to explore the tumor characteristics that influenced perioperative visual field changes. METHODS Patients who underwent transsphenoidal surgery under a diagnosis of pituitary adenoma at the Kyoto University Hospital between April 2012 and December 2018 were retrospectively enrolled. Correlations among circumpapillary retinal nerve fiber layer thickness, preoperative and postoperative mean deviation (MD) of visual field, MD change after the surgery, and maximum tumor diameter were evaluated by measuring Pearson correlation coefficient. We evaluated the influences on postoperative MD using a generalized estimating equation for univariate and multivariate regression analyses. We also compared the characteristics of cystic and solid tumors. RESULTS Thirty-two eyes of 18 patients were included in this study (9 male and 9 female patients). Postoperative MD positively correlated with maximum tumor diameter only in multivariate regression {β = 0.22 (95% confidence interval [CI], 0.004-0.43), P = 0.046}, although maximum tumor diameter negatively correlated with postoperative MD in univariate regression (β = -0.16 [95% CI, -0.58 to 0.26], P = 0.46). In the investigation of perioperative MD changes, eyes with cystic tumors showed significantly better improvement those with solid tumors (8.93 ± 7.85 vs 0.18 ± 6.56 dB, P = 0.007). CONCLUSIONS Cystic and solid tumors show different characteristics of visual loss and visual field defects. The MD in eyes with cystic tumors improved significantly more than that in eyes with solid tumors.
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Affiliation(s)
- Munekatsu Ito
- Department of Ophthalmology and Visual Sciences (MI, KS, EN, Miho Tagawa, MM, AT), and Department of Neurosurgery (Masahiro Tanji, SM), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Ophthalmology (MI), Kurashiki Central Hospital, Okayama, Japan; and Department of Vision Science (SK), Aichi Shukutoku University School of Health and Medical Science, Aichi, Japan
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Sasagawa Y, Nakahara M, Takemoto D, Nakada M. Optical coherence tomography detects early optic nerve damage before visual field defect in patients with pituitary tumors. Neurosurg Rev 2023; 46:85. [PMID: 37058150 DOI: 10.1007/s10143-023-01990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/15/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023]
Abstract
Optical coherence tomography (OCT) is a useful tool for predicting visual recovery after the removal of pituitary tumors. However, the utility of OCT in patients with pituitary tumors and a normal visual field is unclear. We aimed to analyze OCT features in pituitary tumors without visual field defects. Pituitary tumors without visual field defects were selected. A total of 138 eyes from 69 patients, assessed by the Humphrey visual field test and OCT, were enrolled in this study. Using preoperative coronal sections of MR images, patients were divided into chiasmal compression (CC) and non-chiasmal compression (non-CC) groups, and OCT characteristics were examined. The CC and non-CC groups consisted of 40 and 29 patients, respectively. There were no differences in age, sex, tumor type, or degree of visual field testing, but the tumor size was different between the two groups. On OCT, macular thickness ganglion cell complex (mGCC) was significantly thinner in the CC group than that in the non-CC group (112.5 vs 117.4 um, P < 0.05). Based on a database of healthy participants, 24% and 2% of eyes in the CC and non-CC groups had abnormal mGCC thickness (P < 0.01), respectively. In a sub-analysis of the CC group, patients with an abnormal mGCC thickness were older than a normal one (58.2 vs 41.1 years, p < 0.01). OCT can detect early optic nerve damage due to optic CC by pituitary tumors, even in normal visual fields. The degree of mGCC thinning may provide an appropriate surgical timing for pituitary tumors that compress the optic chiasm.
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Affiliation(s)
- Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Mitsutaka Nakahara
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Takemoto
- Ophthalmology and Visual Science, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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Kapelushnik N, Dror S, Huna-Baron R. Prognostic Value of Optical Coherence Tomography Characteristics in Anterior Visual Pathway Meningiomas. J Neuroophthalmol 2023; 43:96-101. [PMID: 36044686 DOI: 10.1097/wno.0000000000001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anterior visual pathway meningiomas (AVPM) represent 2.5%-18% of all meningiomas. They may affect visual function, including visual acuity (VA) and visual field (VF). The principal modes of treatment are surgery and radiotherapy. The prognostic value of macular ganglion cell complex count (GCC) thickness has not been assessed in the literature thus far. The purpose of this study was to evaluate the prognostic value of pre-treatment optical coherence tomography (OCT) parameters (retinal nerve fiber layer and GCC) for visual outcomes in patients with AVPM. METHODS We retrospectively reviewed the medical records of all patients with AVPM who were treated in the Sheba Medical Center between 2011 and 2020. Included were patients with valid data containing preintervention OCT findings on the CIRRUS device and a minimum follow-up of 6 months. Preintervention and postintervention data on comprehensive ophthalmic examinations and OCT parameters of the affected eyes were retrieved. The correlation between preintervention OCT parameters and the visual outcome was assessed. The patients were also divided into 2 groups according to preintervention GCC (thin vs normal), and the visual outcome was compared between groups. RESULTS In total, 186 patients' medical records were analyzed, and 38 patients who met the inclusion criteria were included in the study (mean age at diagnosis 52.8 ± 12.2 years, 28 women). Twenty-nine patients had 1 affected eye, and 9 had bilateral insult. A higher preinterventional average GCC was associated with better VA at 6 months, 1 year, and 2 years after intervention (r = -0.5, P ≤ 0.004, 0.005, and 0.03, respectively). There was a significant correlation between preinterventional GCC and VF mean deviation 2 years after intervention (r = 0.7, P ≤ 0.001). The thinner the GCC, the more prominent was the change in VA from before intervention to 2 years after intervention ( P ≤ 0.008). Correction for multiple comparisons with the Benjamini-Hochberg procedure did not change the significance of our findings. CONCLUSIONS OCT parameters (GCC) have a predictive value in AVPM. There is strong correlation between preinterventional GCC and VA shortly after the intervention. Although a thin GCC is generally considered a negative prognostic factor, improvement in clinical parameters was also evident in patients with thin GCC. The potential of improvement despite preinterventional GCC thinning can add to the clinical discussion of the prognosis, and therefore, we recommend the patients with AVPM to undergo OCT and to be advised that GCC thinning alone should not be used as a major criterion in deciding whether treatment should be pursued.
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Affiliation(s)
- Noa Kapelushnik
- The Goldschleger Eye Institute and the Arrow Project (NK, SD, RH-B), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Menon S, Nair S, Kodnani A, Hegde A, Nayak R, Menon G. Retinal nerve fiber layer thickness and its correlation with visual symptoms and radiological features in pituitary macroadenoma. J Neurosci Rural Pract 2023; 14:41-47. [PMID: 36891116 PMCID: PMC9943945 DOI: 10.25259/jnrp_18_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of the study was to evaluate the association of the thickness of retinal nerve fiber layer (RNFL) with (i) visual symptoms and (ii) suprasellar extension defined by magnetic resonance imaging (MRI) in patients with pituitary macroadenoma. Materials and Methods RNFL thickness of 50 consecutive patients operated for pituitary macroadenoma between July 2019 and April 2021 were compared with standard visual examination findings and MRI measurements such as optic chiasm height, distance between the optic chiasm and adenoma, suprasellar extension, and chiasmal lift. Results The study group included 100 eyes of 50 patients operated for pituitary adenomas with suprasellar extension. RNFL thinning predominantly involved the nasal (84.26 ± 16.43 μm) and temporal quadrants (70.72 ± 14.80 μm) and correlated well with the visual field deficit (P < 0.001). Patients with moderate-to-severe deficit in visual acuity had a mean RNFL thickness <85 μm and patients with severe disc pallor had extremely thin RNFLs (<70 μm). Suprasellar extension defined as Wilsons Grade C, D, and E and Fujimotos Grades 3 and 4 were significantly associated with thin RNFLs <85 μm (P < 0.01). Chiasmal lift more than 1 cm and tumor chiasm distance of <0.5 mm were associated with thin RNFL (P < 0.002). Conclusion RNFL thinning correlates directly with the severity of visual deficits in patients with pituitary adenoma. Wilsons Grade D and E, Fujimoto Grade 3 and 4, chiasmal lift more than 1 cm, and chiasm tumor distance <0.5 mm are strong predictors of RNFL thinning and poor vision. Pituitary macro adenoma and other suprasellar tumors need to be excluded in patients with preserved vision but having obvious RNFL thinning.
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Affiliation(s)
- Sudha Menon
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Soumya Nair
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Anuj Kodnani
- Department of Ophthalmology, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India
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12
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Banc A, Biousse V, Newman NJ, Kedar S. Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review. Neurosurgery 2023; 92:42-67. [PMID: 36519859 PMCID: PMC10158913 DOI: 10.1227/neu.0000000000002186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/15/2022] [Indexed: 12/23/2022] Open
Abstract
Compression of the anterior visual pathways by sellar and parasellar masses can produce irreversible and devastating visual loss. Optical coherence tomography (OCT) is a noninvasive high-resolution ocular imaging modality routinely used in ophthalmology clinics for qualitative and quantitative analysis of optic nerve and retinal structures, including the retinal ganglion cells. By demonstrating structural loss of the retinal ganglion cells whose axons form the optic nerve before decussating in the optic chiasm, OCT imaging of the optic nerve and retina provides an excellent tool for detection and monitoring of compressive optic neuropathies and chiasmopathies due to sellar and parasellar masses. Recent studies have highlighted the role of OCT imaging in the diagnosis, follow-up, and prognostication of the visual outcomes in patients with chiasmal compression. OCT parameters of optic nerve and macular scans such as peripapillary retinal nerve fiber layer thickness and macular ganglion cell thickness are correlated with the degree of visual loss; additionally, OCT can detect clinically significant optic nerve and chiasmal compression before visual field loss is revealed on automated perimetry. Preoperative values of OCT optic nerve and macular parameters represent a prognostic tool for postoperative visual outcome. This review provides a qualitative analysis of the current applications of OCT imaging of the retina and optic nerve in patients with anterior visual pathway compression from sellar and parasellar masses. We also review the role of new technologies such as OCT-angiography, which could improve the prognostic ability of OCT to predict postoperative visual function.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
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Thammakumpee K, Buddawong J, Vanikieti K, Jindahra P, Padungkiatsagul T. Preoperative Peripapillary Retinal Nerve Fiber Layer Thickness as the Prognostic Factor of Postoperative Visual Functions After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma. Clin Ophthalmol 2022; 16:4191-4198. [PMID: 36544895 PMCID: PMC9762988 DOI: 10.2147/opth.s392987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the prognostic ability of preoperative peripapillary retinal nerve fiber layer thickness (pRNFLT) for predicting postoperative visual functions, including the visual field index (VFI) and visual acuity (VA), of subjects with pituitary adenoma (PA) who were treated with endoscopic transsphenoidal surgery for pituitary adenoma (ETSS-PA) exclusively. Subjects and Methods This 11-year retrospective study was performed at a single institution in Thailand. Sixty-six eyes of 33 subjects who had a PA compressing the anterior visual pathway and were treated with ETSS-PA alone were included. The pRNFLT was measured globally and in the four quadrants preoperatively, using optical coherence tomography. Multivariable analysis and area under the curve (AUC) were used to demonstrate the prognostic ability of preoperative pRNFLT for postoperative visual functions (> 1 month but < 6 months after ETSS-PA). Results The mean postoperative VFI and median postoperative VA were 79.45% ± 24.24% and 0.14 [interquartile range: 0.02, 0.40] logarithm of the minimum angle of resolution. Among the 56 eyes with a reliable postoperative VFI, thicker preoperative temporal (odds ratio, 1.18; p = 0.024) and inferior (odds ratio, 1.07; p = 0.013) pRNFLT values were associated with a postoperative VFI > 90%. The strongest association occurred with the preoperative temporal pRNFLT (AUC = 0.821, 95% CI: 0.720-0.923) with a cut-off value of 60 µm. Multivariable analysis for all 66 eyes showed that thicker preoperative inferior-quadrant pRNFLT (odds ratio, 1.05; p = 0.001) was associated with a postoperative VA of at least 20/25. The strongest performance was found with the preoperative inferior pRNFLT (AUC = 0.732, 95% CI: 0.615-0.849) with a cut-off value of 105 µm. Conclusion Preoperative pRNFLT offers clinical utility for predicting visual functions after ETSS-PA. Temporal pRNFLT ≥ 60 µm and inferior pRNFLT ≥105 µm predicted postoperative VFI > 90% and postoperative VA better than or equal to 20/25, respectively.
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Affiliation(s)
- Kanyarat Thammakumpee
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Department of Ophthalmology, Faculty of Medicine, Burapha University, Chonburi, Thailand
| | - Jiraporn Buddawong
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Correspondence: Tanyatuth Padungkiatsagul, Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand, Tel +662 201 1526, Email
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Optical coherence tomographic angiography detects retinal vascular changes associated with pituitary adenoma. Am J Ophthalmol Case Rep 2022; 28:101711. [PMID: 36164560 PMCID: PMC9508429 DOI: 10.1016/j.ajoc.2022.101711] [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: 04/25/2022] [Revised: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Observations Conclusions and importance
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15
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Kockar A, Gün RD, Temizsoylu O, Sengul EA, Alataş İ, Yüzbaşıoğlu E. Evaluation of ganglion cell complex and retinal nerve fiber layer in children with spina bifida using optical coherence tomography. Photodiagnosis Photodyn Ther 2022; 40:103125. [PMID: 36126829 DOI: 10.1016/j.pdpdt.2022.103125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/05/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Spina bifida (SB) is a congenital disorder caused by the incomplete fusion of the embryonic neural tube during spinal cord development. In this study, we used Spectral Domain Optic Coherence Tomography (SD-OCT) for retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) analyses and compared the results of healthy children and SB patients in a similar age group. METHODS Our study was planned prospectively and conducted between June 2017 and July 2019. One hundred eyes of 50 participants, consisting of 28 SB patients and 22 healthy children were included. In all cases, RNFL and GCC measurements were undertaken using SD-OCT. The circumpapillary RNFL analysis was conducted by examining the circular area of 3.45 mm in diameter around the centre of the optic disc. GCC parameters were determined with MM7 protocols by taking 15 vertical sections from a 7-mm macular square centred in the fovea. RESULTS The mean GCC thickness of the participants was 91.120 ± 5.224 µm in the control group and 91.696 ± 7.410 µm in the SB group. The difference between the two groups was not statistically significant (p > 0.05). The mean RNFL thickness was 102.499 ± 11.250 µm in the control group and 99.549 ± 15.235 µm in the SB group. The mean RNFL thickness of the patients in the SB group was lower than that of the control group, but the difference was not statistically significant (p > 0.05). CONCLUSIONS In this study, the lack of a statistically significant difference in the RNFL and GCC values between the SB and control groups can be attributed to successful clinical management.
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Affiliation(s)
- Alev Kockar
- Ümraniye Training and Research Hospital Ophthalmology Department, Turkey.
| | - Raziye Dönmez Gün
- Kartal Lütfi Kırdar Training and Research Hospital Ophthalmology Department, Turkey
| | | | - Elvan Alper Sengul
- T.C. Istanbul Demiroğlu Bilim University Medical Faculty Ophthalmology Department, Turkey
| | - İbrahim Alataş
- T.C. Istanbul Demiroğlu Bilim University Medical Faculty Neurosurgery Department, Turkey
| | - Erdal Yüzbaşıoğlu
- T.C. Istanbul Demiroğlu Bilim University Medical Faculty Ophthalmology Department, Turkey
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Boertien TM, Van Someren EJW, Coumou AD, van den Broek AK, Klunder JH, Wong WY, van der Hoeven AE, Drent ML, Romijn JA, Fliers E, Bisschop PH. Compression of the optic chiasm is associated with reduced photoentrainment of the central biological clock. Eur J Endocrinol 2022; 187:809-821. [PMID: 36201161 DOI: 10.1530/eje-22-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pituitary tumours that compress the optic chiasm are associated with long-term alterations in sleep-wake rhythm. This may result from damage to intrinsically photosensitive retinal ganglion cells (ipRGCs) projecting from the retina to the hypothalamic suprachiasmatic nucleus via the optic chiasm to ensure photoentrainment (i.e. synchronisation to the 24-h solar cycle through light). To test this hypothesis, we compared the post-illumination pupil response (PIPR), a direct indicator of ipRGC function, between hypopituitarism patients with and without a history of optic chiasm compression. DESIGN Observational study, comparing two predefined groups. METHODS We studied 49 patients with adequately substituted hypopituitarism: 25 patients with previous optic chiasm compression causing visual disturbances (CC+ group) and 24 patients without (CC- group). The PIPR was assessed by chromatic pupillometry and expressed as the relative change between baseline and post-blue-light stimulus pupil diameter. Objective and subjective sleep parameters were obtained using polysomnography, actigraphy, and questionnaires. RESULTS Post-blue-light stimulus pupillary constriction was less sustained in CC+ patients compared with CC- patients, resulting in a significantly smaller extended PIPR (mean difference: 8.1%, 95% CI: 2.2-13.9%, P = 0.008, Cohen's d = 0.78). Sleep-wake timing was consistently later in CC+ patients, without differences in sleep duration, efficiency, or other rest-activity rhythm features. Subjective sleep did not differ between groups. CONCLUSION Previous optic chiasm compression due to a pituitary tumour in patients with hypopituitarism is associated with an attenuated PIPR and delayed sleep timing. Together, these data suggest that ipRGC function and consequently photoentrainment of the central biological clock is impaired in patients with a history of optic chiasm compression.
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Affiliation(s)
- Tessel M Boertien
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Netherlands Institute for Neuroscience (NIN), Sleep and Cognition, Amsterdam, The Netherlands
- Amsterdam UMC location VU University, Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam, The Netherlands
- VU University, Centre for Neurogenomics and Cognitive Research, Integrative Neurophysiology, Amsterdam, The Netherlands
| | - Adriaan D Coumou
- Amsterdam UMC location University of Amsterdam, Ophthalmology, Amsterdam, The Netherlands
| | - Annemieke K van den Broek
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Jet H Klunder
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Wing-Yi Wong
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Adrienne E van der Hoeven
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Madeleine L Drent
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
- Amsterdam UMC location VU University, Internal Medicine, Section of Endocrinology, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Eric Fliers
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Amsterdam UMC location University of Amsterdam, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, Metabolism and Nutrition, Amsterdam, The Netherlands
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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.
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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
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Lee G, Park K, Lee D, Oh SY, Kong D, Hong SD. Predicting visual outcomes after decompression of pituitary tumours based on stratified inner‐retinal layer thickness and age. Acta Ophthalmol 2022; 101:301-309. [PMID: 36398459 DOI: 10.1111/aos.15281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the potential role of stratified preoperative optical coherence tomography (OCT) measurements and age in predicting postoperative visual field (VF) improvement among adult patients with chiasmal compression due to pituitary tumours after decompression surgery. METHODS Postoperative visual outcomes were analysed using mean deviation of the VF test. Eyes were divided into three groups based on preoperative OCT parameters including peripapillary retinal nerve fibre layer (pRNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness: groups 1, 2 and 3 with pRNFL thickness <65 μm, 65 μm or more but <85 μm, and 85 μm or more, respectively. The GCIPL thickness was also divided into three groups based on values ranging from 55 to 77 μm. Each group was further categorized according to age: 20 years or older but younger than 40 years, 40 years or older but younger than 60, and 60 years or older. RESULTS This study included 197 eyes of 197 patients with chiasmal compression due to pituitary tumours. No patient showed complete VF recovery in group 1 with a preoperative pRNFL thickness <65 μm or a GCIPL thickness <55 μm regardless of age. These groups showed the worst VF outcome (pRNFL, p = 0.0001; GCIPL, p < 0.0001). However, a significant recovery in VF (greater than 2 dB) was observed in 45% of group 1 patients based on pRNFL thickness and in 61.54% of group 1 patients according to GCIPL thickness. In groups 2 and 3 with a preoperative pRNFL thickness of 65 μm or more and a GCIPL thickness of 55 μm or more, the rate of complete VF recovery decreased as subjects' ages increased. Group 3 with a preoperative pRNFL thickness of 85 μm or more and a GCIPL thickness of 77 μm or more were 2.5-fold and 4.0-fold more likely to completely recover VF, respectively, compared with group 2. CONCLUSIONS Stratified preoperative pRNFL and GCIPL thicknesses measured via OCT in different age categories are effective biomarkers for predicting visual functional outcomes.
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Affiliation(s)
- Ga‐In Lee
- Hangil Eye Hospital Incheon Republic of Korea
| | - Kyung‐Ah Park
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doo‐Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology‐Head and Neck Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
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Assessment the neurodegenaration process of post-geniculate optic pathway in thalamic tumors using optical coherence tomography: Post-geniculate optic pathway in thalamic tumors. Int Ophthalmol 2022; 43:1487-1499. [PMID: 36227400 DOI: 10.1007/s10792-022-02545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the effect of thalamic tumors related to post-geniculate optic pathway and those of microsurgical removal on neurodegeneration process of visual pathway using OCT. METHODS This cross-sectional study included 30 eyes of 15 patients with thalamic tumors and data compiled from 45 eyes of 45 healthy participants. The analysis of variables was divided into ipsilateral and contralateral eye depends on the laterality of brain tumors. The data gained at baseline, postoperative 3rd and postoperative 6th month period was analyzed in One-Way Repeated Measures ANOVA. RESULTS The mean superior quadrant retinal nerve fiber layer (RNFL) thickness of ipsilateral eye was significantly thicker (p = 0.02), while inferior hemifield ganglion cell-inner plexiform layer (GC-IPL) thickness of contralateral eye was significantly higher compared to control groups (p = 0.02). Significant negative correlations were found between the mean preop. mean deviation (MD) and tumor volume and time interval between initial diagnosis and surgery (r = - 0.730, p = 0.002 and r = - 0.680, p = 0.005, respectively) in the ipsilateral eye. In repeated measure analysis, there was no unfavourable effect of thalamic microsurgery on peripapillary average RNFL thickness on both ipsilateral and contralateral eyes (Ipsilateral eye; f (1.5,21.7) 0.76 p = 0.51 and contralateral eye; f (1.4,20.4) 0.42 p = 0.59). CONCLUSION This study suggests that thalamic tumors affecting post-geniculate optic pathway may lead to significant increase in RNFL and GC-IPL thicknesses and changes in VF parameters. Timely intervention in thalamic tumors may prevent irreversible loss of retinal axons secondary to neurodegeneration process.
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Lee GI, Kim J, Lee D, Park KA, Oh SY, Kong DS, Hong SD. Ganglion cell inner plexiform layer thickness measured by optical coherence tomography to predict visual outcome in chiasmal compression. Sci Rep 2022; 12:14826. [PMID: 36050400 PMCID: PMC9437084 DOI: 10.1038/s41598-022-17193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
We evaluated the prognostic value of the preoperative macular ganglion cell inner plexiform layer (mGCIPL) thickness along with peripapillary retinal nerve fiber layer (pRNFL) thickness measured by optical coherence tomography (OCT) and estimated an optimal cut-off value to predict postoperative visual field (VF) recovery in adult patients with chiasmal compression after decompression surgery. Two hundred forty eyes of 240 patients aged 20 years or older for which preoperative high-definition Cirrus OCT parameters and pre- and postoperative visual function data were available. The prognostic power of pRNFL and mGCIPL thicknesses for complete postoperative VF recovery or significant VF improvement (improvement ≥ 2 dB in the mean deviation) were assessed. The cut-off values for OCT parameters for VF recovery were estimated. The study found that the higher the preoperative pRNFL and mGCIPL thicknesses, the higher the probability of complete postoperative VF recovery (p = 0.0378 and p = 0.0051, respectively) or significant VF improvement (p = 0.0436 and p = 0.0177, respectively). The area under the receiver operating characteristic analysis of preoperative OCT parameters demonstrated that the mGCIPL thickness showed an area under the curve (AUC) of more than 0.7 for complete VF recovery after decompression surgery (AUC = 0.725, 95% CI: 0.655, 0.795), and the optimal mGCIPL thickness cut-off value for complete VF recovery was 77.25 µm (sensitivity 69% and specificity 69%). Preoperative mGCIPL thickness was a powerful predictor of visual functional outcome after decompression surgery for chiasmal compression.
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Affiliation(s)
| | - Joonhyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Doo-Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Xia L, Wenhui J, Xiaowen Y, Wenfang X, Wei Z, Yanjun H, Xiaoyan P. Predictive value of macular ganglion cell-inner plexiform layer thickness in visual field defect of pituitary adenoma patients: a case-control study. Pituitary 2022; 25:667-672. [PMID: 35834154 DOI: 10.1007/s11102-022-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study explored the association between preoperative macular ganglion cell-inner plexiform layer thickness (GCIPL) and retinal nerve fiber layer thickness (RNFL) measured by optical coherence tomography (OCT) and the recovery of visual field (VF) defect after surgery in pituitary adenoma patients. METHODS This case-control study included patients with pituitary adenoma in the Neurosurgery Department of Shanxi Provincial People's Hospital between October 2019 and June 2021. Cranial MRI examination, three-dimensional OCT, and VF testing (Humphrey Field Analyzer II750) were performed before and at 6months after the surgery. RESULTS Fifty-three pituitary adenoma patients (81 eyes) were enrolled; 15 patients (23 eyes) were in the visual field did not recover group (VFNR), and 38 patients (58 eyes) were in the visual field recovered group (VFR). The temporal RNFL (P = 0.002) and average RNFL (P = 0.009) in the VFNR group were significantly lower than in the VFR group. The superior nasal GCIPL (P = 0.001), inferior nasal GCIPL (P = 0.001) and average GCIPL (P = 0.01) were significantly lower in the VFNR group than in the VFR group (all P < 0.01).The multivariable logistic regression analysis showed that nasal inferior GCIPL was an independent risk factor for VF recovery (odds ratio (OR) = 1.376,95% confidence interval (CI):1.089-1.739,P = 0.007). In the received operating characteristics (ROC) analysis, the area under the ROC curve (AUROCs) was the highest for nasal inferior GCIPL (AUROC = 0.739). CONCLUSIONS In patients who underwent resection of pituitary adenoma, nasal inferior GCIPL was an independent risk factor of visual field defect recover after surgery.
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Affiliation(s)
- Li Xia
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmolgy and Visual Science Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No.17 Hougou Lane, Chongnei Street, 100005, Beijing, People's Republic of China
- Department of Ophthalmology, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Jia Wenhui
- Department of neurology, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Yang Xiaowen
- Infectious disease department, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Xie Wenfang
- Department of Ophthalmology, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Zhang Wei
- Department of Ophthalmology, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Hu Yanjun
- Department of nuclear magnetic, Shanxi Provincial People's Hospital, No.29 Twin Towers, YingZe District, 030000, Taiyuan, People's Republic of China
| | - Peng Xiaoyan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmolgy and Visual Science Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No.17 Hougou Lane, Chongnei Street, 100005, Beijing, People's Republic of China.
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22
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Meyer J, Diouf I, King J, Drummond K, Stylli S, Kaye A, Kalincik T, Danesh-Meyer H, Symons RCA. A comparison of macular ganglion cell and retinal nerve fibre layer optical coherence tomographic parameters as predictors of visual outcomes of surgery for pituitary tumours. Pituitary 2022; 25:563-572. [PMID: 35552990 DOI: 10.1007/s11102-022-01228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The prognostic value of optical coherence tomography (OCT) of the macular ganglion cell layer (mGGL) versus peripapillary retinal nerve fibre layers (pRNFL) following chiasmal decompression is unclear. This study is the largest comparison of the two parameters to date and aims to clarify how their performance as covariates compare in predictive models of long-term visual outcomes following pituitary or parasellar tumour surgical resection. METHODS This was a prospective, two-year, longitudinal cohort study in a single centre tertiary hospital setting. Participants with MRI evidence of pituitary or parasellar tumour compression of the optic chiasm who underwent surgical decompression, were enrolled. Associations between pre-operative OCT parameters and long-term visual outcomes were assessed using multivariable generalised linear mixed models and an age matched normative database. RESULTS Final analysis included 216 eyes of 108 participants with a mean age (standard deviation) of 51.6 (17.04) years, of whom 58 (49%) were female. The superior inner mGCL was the best predictor of long-term visual field recovery, with an area under the curve of 0.90, a sensitivity of 80%, specificity of 88%, positive predictive value of 86%, and negative predictive value of 83%. CONCLUSION mGCL performed better in predicting long-term visual field recovery post-pituitary or parasellar surgical resection. The superior inner mGCL was the best specific measure which may provide clinical utility in pre-operative counselling. In this study we clarify previously variable comparisons of mGCL and pRNFL parameters in post-operative predictive modelling.
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Affiliation(s)
- Joos Meyer
- Ophthalmology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.
| | - Ibrahima Diouf
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - James King
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Kate Drummond
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Stan Stylli
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Andrew Kaye
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
- Department of Neurosurgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, MS Centre, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Helen Danesh-Meyer
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - R C Andrew Symons
- Ophthalmology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Centre For Eye Research Australia, Level 7/32 Gisborne St, East Melbourne, VIC, 3002, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Monash Medical Centre Level 5, Monash University, Block E 246 Clayton Road, Clayton, 3168, Australia
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23
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Benderradji H, Vernotte E, Soto Ares G, Woillez JP, Jannin A, Perbet R, Karnoub MA, Soudan B, Assaker R, Buée L, Prevot V, Maurage CA, Pigny P, Vantyghem MC, Merlen E, Cortet C. Efficacy of lanreotide 120 mg primary therapy on tumour shrinkage and ophthalmologic symptoms in acromegaly after 1 month. Clin Endocrinol (Oxf) 2022; 97:52-63. [PMID: 35470446 DOI: 10.1111/cen.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Few studies have attempted to evaluate the early efficacy of first-generation somatostatin analogues in somatotroph macroadenomas. OBJECTIVE To investigate the short-term efficacy of primary therapy with lanreotide 120 mg at 1 and 3 months on tumour shrinkage and ophthalmologic symptoms in newly diagnosed patients with acromegaly. DESIGN AND PATIENTS This single-centre retrospective study included 21 patients with de novo acromegaly resulting from pituitary macroadenoma, with optic chiasm compression (Grade ≤ 2) and/or cavernous sinus invasion, treated with a monthly injection of lanreotide 120 mg. Clinical, hormonal, ophthalmologic and magnetic resonance imaging scan evaluations were conducted after the first and the third months of treatment. RESULTS Tumour volume reduction was more pronounced at 1 month; mean volume change: -31.4 ± 19.5%, p < .0001 than between the first and third month of treatment; mean volume reduction: -20.6 ± 13.4%, p = .0009. The mean volume change between baseline and the third month was - 46.4 ± 21.6, (p < .0001). A significant volume reduction (≥25%) was observed in 61.9% of individuals (13/21) at the first month. Among 14 individuals with optic chiasm compression and visual field defects, visual field normalization or improvement were observed in seven cases (50%), stabilization in four cases (28.5%), and mild worsening in three cases (21.4%) at 1 month. The decrease in growth hormone and IGF-1 serum values was significant at 1 month. CONCLUSIONS Primary treatment with lanreotide 120 mg in patients with somatotroph macroadenomas provides early significant tumour shrinkage with rapid improvement of visual symptoms at the end of the first month in 50% of patients.
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Affiliation(s)
- Hamza Benderradji
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
| | - Elise Vernotte
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
| | | | | | - Arnaud Jannin
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Inserm, U 1277, Lille, France
| | - Romain Perbet
- University of Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
- Department of Pathology, Lille University Hospital, Lille, France
| | | | - Benoît Soudan
- Department of Biochemistry & Hormonology, Lille University Hospital, Lille, France
| | - Richard Assaker
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Luc Buée
- University of Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
| | - Vincent Prevot
- University of Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
| | - Claude-Alain Maurage
- University of Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, UMR-S1172, Lille, France
- Department of Pathology, Lille University Hospital, Lille, France
| | - Pascal Pigny
- University of Lille, Inserm, U 1277, Lille, France
- Department of Biochemistry & Hormonology, Lille University Hospital, Lille, France
| | - Marie-Christine Vantyghem
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
- University of Lille, Inserm, U1190, EGID, Lille, France
| | - Emilie Merlen
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
| | - Christine Cortet
- Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France
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24
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Kurian DE, V R, Horo S, Chacko AG, Prabhu K, Mahasampath G, Korah S. Predictive value of retinal nerve fibre layer thickness for postoperative visual improvement in patients with pituitary macroadenoma. BMJ Open Ophthalmol 2022; 7:bmjophth-2021-000964. [PMID: 36161840 PMCID: PMC9263901 DOI: 10.1136/bmjophth-2021-000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To determine the usefulness of retinal nerve fibre layer (RNFL) thickness and a reliable cut-off value that can predict postoperative visual function improvement in patients with pituitary macroadenoma. Methods and Analysis This was a prospective observational study. Preoperative optical coherence tomography of the RNFL was performed in patients with pituitary macroadenoma. Postoperative visual function changes (acuity and visual fields) were identified using predefined criteria. Receiver operating characteristic curves were constructed for RNFL values to define the ideal cut-off value that predicted improvement. Other variables including preoperative visual acuity, mean deviation, visual field index and tumour volume were also analysed. Results Twenty-nine eligible subjects (58 eyes) were recruited. The mean (±SD) age was 43.9 (±12.85) years and 65.5% were male. The mean (±SE) follow-up duration was 20.8 (±6.42) months. RNFL thickness was significantly thinner in eyes with visual dysfunction and optic disc pallor. Better preoperative logarithmic minimum angle of resolution (logMAR) visual acuity, higher RNFL thickness and smaller tumour volume were associated with postoperative visual field improvement on univariate analysis; however, only mean RNFL thickness had significant association on multivariate analysis. None of the preoperative variables showed significant association with improvement in visual acuity. The best cut-off of mean RNFL thickness for visual field improvement was estimated at 81 μm with 73.1% sensitivity and 62.5% specificity. Conclusion Preoperative RNFL thickness can be an objective predictor of visual field outcomes in patients undergoing surgery for pituitary macroadenomas, with moderate sensitivity and specificity. It is, however, not a good predictor of visual acuity outcome.
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Affiliation(s)
| | - Rajshekhar V
- Department of Neurological Sciences, CMC Vellore, Vellore, Tamil Nadu, India
| | - Saban Horo
- Ophthalmology, CMC Vellore, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurological Sciences, CMC Vellore, Vellore, Tamil Nadu, India
| | - Krishna Prabhu
- Department of Neurological Sciences, CMC Vellore, Vellore, Tamil Nadu, India
| | | | - Sanita Korah
- Ophthalmology, CMC Vellore, Vellore, Tamil Nadu, India
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25
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Parikh D, Robins JMW, Garretty T, Sheikh AJ, Tyagi AK, Nix PA, Phillips NI. Quantitative and functional visual field outcomes after endoscopic trans-sphenoidal pituitary adenectomy. Acta Neurochir (Wien) 2022; 164:1605-1614. [PMID: 35426509 DOI: 10.1007/s00701-022-05198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/26/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Quantitative data on visual outcomes after trans-sphenoidal surgery is lacking in the literature. This study aims to address this by quantitatively assessing visual field outcomes after endoscopic trans-sphenoidal pituitary adenectomy using the capabilities of modern semi-automated kinetic perimetry. METHODS Visual field area (deg2) calculated on perimetry performed before and after surgery was statistically analysed. Functional improvement was assessed against UK driving standards. RESULTS Sixty-four patients (128 eyes) were analysed (May 2016-Nov 2019). I4e and I3e isopter area significantly increased after surgery (p < 0.0001). Of eyes with pre-operative deficits: 80.7% improved and 7.9% worsened; the median amount of improvement was 60% (IQR 6-246%). Median increase in I4e isopter was 2213deg2 (IQR 595-4271deg2) and in I3e isopter 1034 deg2 (IQR 180-2001 deg2). Thirteen out of fifteen (87%) patients with III4e data regained driving eligibility after surgery. Age and extent of resection (EOR) did not correlate with visual improvement. Better pre-operative visual field area correlated with a better post-operative area (p < 0.0001). However, the rate of improvement in the visual field area increased with poorer pre-operative vision (p < 0.0001). CONCLUSIONS A median visual field improvement of 60% may be expected in over 80% of patients. Functionally, a significant proportion of patients can expect to regain driving eligibility. EOR did not impact on visual recovery. When the primary goal of surgery is alleviating visual impairment, optic apparatus decompression without the aim for gross total resection appears a valid strategy. Patients with the worst pre-operative visual field often experience the greatest improvement, and therefore, poor pre-operative vision alone should not preclude surgical intervention.
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26
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Prognostic value of radial peripapillary capillary density for visual field outcomes in pituitary adenoma: A case-control study. J Clin Neurosci 2022; 100:113-119. [DOI: 10.1016/j.jocn.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
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27
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Özcan Y, Kayıran A, Kelestimur F, Ekinci G, Türe U. Changes in the peripapillary and subfoveal choroidal vascularity index after transsphenoidal surgery for pituitary macroadenoma. Int Ophthalmol 2022; 42:3691-3702. [DOI: 10.1007/s10792-022-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
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28
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Jozaghi Y, Phan J, Hanna EY, Kupferman ME, Su SY. Functional Outcomes and Quality of Life in Patients with Sinonasal, Nasopharyngeal, and Anterior Skull Base Tumors. Curr Oncol Rep 2022; 24:775-781. [PMID: 35290597 DOI: 10.1007/s11912-022-01214-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This article will review functional and QOL outcomes among patients treated predominantly for sinonasal and nasopharyngeal malignancies. RECENT FINDINGS Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the reduction in quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. Recent progress in QOL and Patient-Reported Outcome (PRO) instruments for this population will be covered. Sinonasal and nasopharyngeal tumors affect patients' quality of life, appearance, and critical functions. Tumors arise in proximity of vital structures including the orbit, cranial nerves, carotid artery, brain, cervical spine, and pituitary gland. Surgical morbidity, along with acute and late effects of systemic therapy and radiotherapy on normal tissues in this functionally critical region, may result in wide-ranging symptoms. Patients with skull base tumors report a high symptom burden at presentation, prior to treatment, relative to other malignancies in the head and neck region.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA.
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Jeong SS, Funari A, Agarwal V. Diagnostic and Prognostic Utility of Optical Coherence Tomography in Patients with Sellar/Suprasellar Lesions with Chiasm Impingement: A Systematic Review/ Meta-Analyses. World Neurosurg 2022; 162:163-176.e2. [PMID: 35276393 DOI: 10.1016/j.wneu.2022.03.011] [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: 01/26/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this review, we appraised the current literature on the utility of optical coherence tomography (OCT) as a diagnostic and predictive factor for postoperative visual function outcomes in patients with sellar/suprasellar lesions with chiasmal impingement. METHODS A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following PRISMA guidelines. Included studies described diagnostic or prognostic utility of OCT in patients with sellar/suprasellar lesions with chiasmal impingement. Meta-analysis was represented with mean difference (MD) with 95% confidence intervals. Meta-regression was performed to determine predictive factors of visual outcomes. RESULTS Forty-eight articles were identified for final pooled analysis, representing a total of 2,435 patients with compressive sellar/suprasellar lesions and 952 healthy controls. Mean age was 43.3(11.4) years, with 1,494(48.8%) male and 1,566(51.2%) female patients. Mean retinal nerve fiber layer(RNFL) was significantly different in the study population compared to healthy controls(75.8μ[13.2] vs 91.4μ[10.8], p<0.00001). The nasal segment of RNFL had the largest mean difference (MD -9.76[-12.39, -7.13], p<0.0001). Visual acuity, visual field mean deviation (VF-MD), and visual field pattern standard deviation, all showed significant differences between the study population and healthy controls as well(p<0.0001). Meta-regressions showed significant predictive capability of preoperative RNFL in determining visual function outcome (p<0.05). CONCLUSION Our findings provide promising support for the growing evidence that OCT parameters can be utilized as both a diagnostic and prognostic tool for patients with compression of the optic apparatus. There is a need for further studies to gain a better understanding of OCTs and to improve patient outcomes.
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Affiliation(s)
- Seth S Jeong
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Abigail Funari
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Vijay Agarwal
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA; Department of Otolaryngology, Montefiore Medical Center, Bronx, New York, USA
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30
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Santorini M, Ferreira De Moura T, Barraud S, Litré CF, Brugniart C, Denoyer A, Djerada Z, Arndt C. Comparative Evaluation of Two SD-OCT Macular Parameters (GCC, GCL) and RNFL in Chiasmal Compression. Eye Brain 2022; 14:35-48. [PMID: 35282333 PMCID: PMC8906826 DOI: 10.2147/eb.s337333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the relationship between different macular thickness parameters analyzed by SD-OCT and the central visual field (VF) evaluated with automated kinetic perimetry in a cohort of patients with pituitary tumors. Methods Data from patients with pituitary adenoma treated at Reims University Hospital between October 1st, 2017, and May 31st, 2018 were collected. All patients underwent an automated kinetic perimetry and a SD-OCT to map the ganglion cell complex (GCC), the ganglion cell layer (GCL) thickness and the retinal nerve fiber layer (RNFL) using devices from two different manufacturers. Univariate and multivariate analysis were used to evaluate the correlation between the area of central VF in square degrees (deg2) and the SD-OCT parameters (μm). Results Eighty-eight eyes were included in the analysis. All the thickness parameters measured in SD-OCT decreased with the visual field alteration. The best correlation was observed between superior thickness parameters (GCC, GCL) and the inferior central visual field. The most pertinent predictive factors for visual field loss were the inferior central GCL and the nasal RNFL (both AUC=0.775) with a sensitivity respectively of 86% and 70%. Conclusion This study suggests that both GCC, GCL thickness parameters could be reliable predictors of central visual field impairment in patients with pituitary tumors. There was no significative difference between both devices.
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Affiliation(s)
- Mélissa Santorini
- Department of Ophthalmology, Robert Debré Hospital, Reims, France
- Correspondence: Mélissa Santorini, Department of Ophthalmology, Robert Debré Hospital, Reims, France, Tel +33616521403, Email
| | | | - Sara Barraud
- Department of Endocrinology, Robert Debré Hospital, Reims, France
| | | | | | | | - Zoubir Djerada
- Department of Pharmacology, Robert Debré Hospital, Reims, France
| | - Carl Arndt
- Department of Ophthalmology, Robert Debré Hospital, Reims, France
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Optical coherence tomography and visual evoked potentials in evaluation of optic chiasm decompression. Sci Rep 2022; 12:2102. [PMID: 35136174 PMCID: PMC8825827 DOI: 10.1038/s41598-022-06097-8] [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: 07/19/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Chiasmal compression is a known cause of visual impairment, often leading to surgical decompression of the optic chiasm (OC). A prospective study was held at University Hospital in Hradec Králové to explore sensitivity of optical coherence tomography (OCT) and visual evoked potentials (VEPs) to OC compression and eventual changes after a decompression. 16 patients with OC compression, caused by different sellar pathologies, were included. The main inclusion criterion was the indication for decompressive surgery. Visual acuity (VA), visual field (VF), retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness, and peak time and amplitude of pattern-reversal (P-VEPs) and motion-onset VEPs (M-VEPs) were measured pre- and postoperatively. The degree of OC compression was determined on preoperative magnetic resonance imaging. For M-VEPs, there was a significant postoperative shortening of the peak time (N160) (p < 0.05). P100 peak time and its amplitude did not change significantly. The M-VEPs N160 amplitude showed a close relationship to the VF improvement. Thinner preoperative RNFL does not present a statistically important limiting factor for better functional outcomes. The morphological status of the sellar region should be taken into consideration when one evaluates the chiasmal syndrome. M-VEPs enable detection of functional changes in the visual pathway better than P-VEPs.
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Zhang QL, Wang JH, Sun LY, Wang JB, Ma Y, Zhang YQ. Optical Coherence Tomography Angiography Predicts Visual Outcomes for Craniopharyngioma in Children by Quantifying Choroidal Capillaries. Front Med (Lausanne) 2022; 8:819662. [PMID: 35096911 PMCID: PMC8790536 DOI: 10.3389/fmed.2021.819662] [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: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To predict the prognosis of craniopharyngioma in children by optical coherence tomography angiography (OCTA). Methods: We evaluated if the relationship between preoperative OCTA of the choroidal capillary density (CCD) and visual outcome continued over long-term visual recovery in 38 patients undergoing craniopharyngioma resection. Patients were evaluated 3 times: 1 week before surgery (Visit1), followed-up at 6–10 weeks (Visit2), and 9–15 months (Visit3) after surgery. Results: In total 38 patients (70 eyes) with craniopharyngiomas, which included 20 (52.6%) boys and 18 (47.4%)girls, the mean age was 11.8 ± 2.7 years (range: 6–18 years). The age (p = 0.71), gender (p = 1.00), mean refractive error (p = 0.55), and axial length (p = 0.23) of 38 normal volunteers (76 eyes) were matched. After surgery, the cross-compression of patients was relieved. The average visual acuity change in the normal CCD group was 0.07 ± 0.02; the average visual acuity change in the low CCD group was 0.01 ± 0.01, p < 0.001. Preoperative CCD value is related to the preoperative BCVA (p < 0.001), and the visual function after the long-term follow-up (9–15 months) (p < 0.001). The prognosis of CCD has the same trend as the BCVA. Further correlation analysis shows that CCD and BCVA are significantly correlated (r = 0.878; p < 0.001). CCD has a weak but significant correlation both with MD (r = 0.19; p < 0.001) and PSD (r = −0.21; p <0.001). A natural cutoff of CCD is approximately 38%. With the normal CCD group the maximum improvement of BCVA exceeds 0.3 post-operatively, compared to eyes in the low CCD group that improve by <0.03, and worse after surgery. Conclusions: Long-term vision recovery after surgical decompression of craniopharyngiomas in children can be predicted by preoperative by OCTA. Patients with normal CCD before surgery showed a tendency to improve vision; this trend of improvement persisted in subsequent follow-ups. The CCD baseline natural cutoff value for predicting visual prognosis before and after surgery is about 38%.
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Affiliation(s)
- Qing Lin Zhang
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Jun Hua Wang
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Li Ying Sun
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Jian Bin Wang
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yu Ma
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yu Qi Zhang
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing, China
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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.
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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.)
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Qiao N, Li C, Xu J, Ma G, Kang J, Jin L, Cao L, Liu C, Zhang Y, Gui S. Prognostic Utility of Optical Coherence Tomography for Visual Outcome After Extended Endoscopic Endonasal Surgery for Adult Craniopharyngiomas. Front Oncol 2022; 11:764582. [PMID: 35070970 PMCID: PMC8770264 DOI: 10.3389/fonc.2021.764582] [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: 08/25/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Owing to the close vicinity of the optic chiasma, visual dysfunction is known as one of the most common surgical indications and postoperative complications in adult patients with craniopharyngiomas, probably leading to poor quality of life. Historically, very few consistent predictive factors associated with the visual outcome are identified, which may not be helpful for patient counseling and preoperative decision making. Recently, optical coherence tomography (OCT) serving as a novel high-resolution imaging technique can assess the retinal morphology by measuring the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex thickness. However, few studies have examined the prognostic utility of OCT parameters for visual outcome after surgery for craniopharyngiomas. This study aims to use the largest series to evaluate the association between OCT parameters and visual outcome after extended endoscopic endonasal surgery (EEES) for primary craniopharyngiomas in adults. MATERIAL AND METHODS From October 2018 to October 2020, one hundred and seventy eyes in 88 adult patients with newly confirmed craniopharyngiomas were retrospectively reviewed and pertinent prognostic factors were analyzed. RESULTS Gross total resection was performed in 82 (93.2%) patients. The median postoperative follow-up time was 10.9 months. Multiple logistic regression analysis showed that increased temporal cpRNFL thickness was associated with higher odds of visual acuity (VA) improvement and maintenance (OR = 1.070; 95% CI, 1.005-1.140; p = 0.035), and greater inferior cpRNFL thickness was significantly associated with visual field (VF) improvement and maintenance (OR = 1.034; 95% CI, 1.001-1.068; p = 0.046). Furthermore, tight adhesion between optic nerves and craniopharyngiomas was demonstrated as an independent adverse factor for either postoperative VA or VF (p = 0.048, p = 0.030, respectively). The ROC results further verified the robustness of the prediction model either in VA (AUC = 0.843; 95% CI, 0.734-0.952; p < 0.001) or VF (AUC = 0.849; 95% CI, 0.741-0.958; p < 0.001). CONCLUSION Preoperative OCT can effectively predict visual outcome after EEES for adult craniopharyngiomas. It can also serve as a reliable alternative to evaluate preoperative visual field defects, especially for patients with lower compliance. Tight adhesion was confirmed as an independent risk factor for postoperative visual outcome. The OCT-based multivariable prediction models developed in the present study may contribute to patient counseling on visual prognosis.
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Affiliation(s)
- Ning Qiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jing Xu
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guofo Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunhui Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Optical Coherence Tomography Identifies Visual Pathway Involvement Earlier than Visual Function Tests in Children with MRI-Verified Optic Pathway Gliomas. Cancers (Basel) 2022; 14:cancers14020318. [PMID: 35053482 PMCID: PMC8774215 DOI: 10.3390/cancers14020318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Retrograde degeneration of the eye’s retinal ganglion cells, causing visual loss and even blindness, is a feared consequence of optic pathway gliomas. Optical coherence tomography (OCT) is a patient-friendly, high-resolution imaging technique enabling objective measurements of the integrity of the retinal ganglion cell layer. Children with optic pathway glioma unable to complete formal visual field testing and/or reliable visual acuity testing, may undergo OCT, providing objective information about visual loss and potential clinical progression. By combining visual functional measurements with OCT findings, the clinical examination will be safer and more reliable. By improving the clinical follow-up of the tumor, the treatment choices can be optimized thereby preventing further visual loss and, in the worst case, blindness. Abstract This study investigates whether optical coherence tomography (OCT) could add useful information in the examination of children with optic pathway glioma (OPG) at high risk of developing vision loss. For this purpose, the relationship between ganglion cell-inner plexiform layer (GC-IPL) thickness and visual function, evaluated with tests of visual acuity (VA) and visual field (VF), as well as tumor site according to magnetic resonance imaging (MRI), were examined in a geographically defined group of children with OPG. Methods: Children aged <18 years with OPG underwent ophthalmic examination including VA, VF (Zeiss HFA perimetry) and OCT imaging (Zeiss Cirrus HD-OCT). Results: Out of 51 patients included, 45 provided 77 eyes with MRI-verified OPG, and 19 patients provided 25 eyes without OPG. Significant correlations were found between GC-IPL, VF and VA (p < 0.001). The GC-IPL pattern loss corresponded in 95% to VF defects and in 92% to MRI findings. Conclusions: Our study indicates that GC-IPL measures could serve as an early marker of vision-threatening changes related to OPG and as a valuable link between MRI and visual function tests. Thinning of GC-IPL and differences in topography between eyes are strong indicators of and predictive of vision loss related to OPG.
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Zhu H, Qiao N, Yang X, Li C, Ma G, Kang J, Liu C, Cao L, Zhang Y, Gui S. The clinical application of intraoperative visual evoked potential in recurrent craniopharyngiomas resected by extended endoscopic endonasal surgery. Clin Neurol Neurosurg 2022; 214:107149. [PMID: 35151969 DOI: 10.1016/j.clineuro.2022.107149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/18/2021] [Accepted: 01/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The protection of visual function is a major challenge for recurrent craniopharyngioma due to the interface between tumor and surrounding structure (esp. optic nerve) is more unclear. Intraoperative visual evoked potential (VEP) has been integrated into transsphenoidal surgery for pituitary adenomas and primary craniopharyngiomas in the prediction of postoperative visual outcome. In the present study, we firstly analyzed the clinical value of the VEP in the prediction of postoperative visual outcome for recurrent craniopharyngiomas by extended endoscopic endonasal surgery (EEES). METHODS Thirty-six patients with recurrent craniopharyngiomas who underwent EEES with intraoperative VEP monitoring were retrospectively reviewed. The association between the changes in the VEP amplitude and postoperative visual outcome was determined. In addition, other potential prognostic factors with regard to postoperative visual outcomes were also included in the analysis. RESULTS Gross total resection (GTR) was achieved in 32 patients (88.9%). Reproducible and stable VEP was recorded in 72 eyes. We recorded that there were 29 eyes remained stable VEP amplitude intraoperation, 4 (13.8%) of which suffered new visual acuity (VA) and 5 (17.2%) suffered new visual field (VF) defects after surgery. A transient VEP decrease was recorded in 41 eyes, 8 (19.5%) of which suffered from visual deterioration. Of 2 eyes with a permanent VEP decrease, 2 (100%) experienced postoperative visual impairment. Clinical variable analyses revealed a significant correlation between recurrent craniopharyngioma and age, adhesion with optic nerve, postoperative VA, and intraoperative VEP amplitude. Unstable VEP amplitude during operation and tight adhesion were independent risk factors for postoperative VA. Tight adhesion and a larger tumor volume were independent risk factors for postoperative VF defects. CONCLUSIONS EEES provides a unique view for the lesions under and behind the chiasm and achieve higher rates of GTR with improved visual outcomes. Tight adhesion and unstable VEP amplitude were strong predictors of postoperative visual impairment. Recurrent craniopharyngiomas are more likely to adhere to the optic nerve, VEP is more likely to be unstable during operation, and the improvement rate of postoperative visual function is lower than primary craniopharyngiomas. So intraoperative VEP is more necessary for recurrent craniopharyngiomas.
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Corniola MV, Roche PH, Bruneau M, Cavallo LM, Daniel RT, Messerer M, Froelich S, Gardner PA, Gentili F, Kawase T, Paraskevopoulos D, Régis J, Schroeder HW, Schwartz TH, Sindou M, Cornelius JF, Tatagiba M, Meling TR. Management of cavernous sinus meningiomas: Consensus statement on behalf of the EANS skull base section. BRAIN AND SPINE 2022; 2:100864. [PMID: 36248124 PMCID: PMC9560706 DOI: 10.1016/j.bas.2022.100864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 01/04/2023]
Abstract
Introduction The evolution of cavernous sinus meningiomas (CSMs) might be unpredictable and the efficacy of their treatments is challenging due to their indolent evolution, variations and fluctuations of symptoms, heterogeneity of classifications and lack of randomized controlled trials. Here, a dedicated task force provides a consensus statement on the overall management of CSMs. Research question To determine the best overall management of CSMs, depending on their clinical presentation, size, and evolution as well as patient characteristics. Material and methods Using the PRISMA 2020 guidelines, we included literature from January 2000 to December 2020. A total of 400 abstracts and 77 titles were kept for full-paper screening. Results The task force formulated 8 recommendations (Level C evidence). CSMs should be managed by a highly specialized multidisciplinary team. The initial evaluation of patients includes clinical, ophthalmological, endocrinological and radiological assessment. Treatment of CSM should involve experienced skull-base neurosurgeons or neuro-radiosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists. Discussion and conclusion Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions/in elderly patients, while large CSMs not amenable to resection or WHO grade II-III are candidates for radiotherapy. Microsurgery is an option in aggressive/rapidly progressing lesions in young patients presenting with oculomotor/visual/endocrinological impairment. Whenever surgery is offered, open cranial approaches are the current standard. There is limited experience reported about endoscopic endonasal approach for CSMs and the main indication is decompression of the cavernous sinus to improve symptoms. Whenever surgery is indicated, the current trend is to offer decompression followed by radiosurgery. A thorough evaluation of cavernous sinus meningiomas by a multidisciplinary team is mandatory. Microsurgery should be considered for aggressive lesions in young patients. Extended endoscopic approaches can be effective when combined with radiotherapy. Stereotaxic radiotherapy and stereotaxic radiosurgery offer excellent tumour control in small/asymptomatic lesions .
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Zhang Y, Kim J, Andrews C, Archer E, Bursztyn L, Grabe H, Margolin E, Sullivan S, Trobe J. Visual Outcomes in Surgically Treated Intracranial Meningiomas. J Neuroophthalmol 2021; 41:e548-e559. [PMID: 33870941 DOI: 10.1097/wno.0000000000001205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intracranial meningiomas that arise from the medial sphenoid ridge, anterior clinoid process, tuberculum sellae, or planum sphenoidale often impair vision by compressing the optic nerves and optic chiasm. Although many studies have reported visual outcome following surgery for these tumors, documentation has often been incomplete and not validated by patient self-report. METHODS Retrospective study of 40 patients drawn from a single, academic, medical center. We used a unique method of assessing visual outcome based on whether the change in visual function affected the preoperatively better-sighted or worse-sighted eye in the belief that this method would correlate with effects on activities of daily living (ADL). To elicit patient self-reports of those effects, we conducted telephone interviews of 25 patients with a standard questionnaire. We also assessed putative ophthalmic, imaging, and surgical predictors of visual outcome. RESULTS Visual improvement occurred in 61% of patients with preoperative monocular visual dysfunction, but only 22% of patients reported improvement in their ability to conduct ADL, and 17% lost vision. Visual outcomes were better in patients with preoperative binocular visual dysfunction, where visual improvement occurred in 73% and no patient lost vision in the preoperatively better-sighted eye. However, only 27% of patients with preoperative binocular visual dysfunction reported improvement in their ability to conduct ADL. Long duration of vision impairment, presence of optic disc pallor, large tumor size, and imaging-based preoperative optic canal involvement did not preclude a favorable visual outcome. Aggressive surgical reduction in displacement of the optic nerves was not necessary to obtain a favorable visual outcome and sometimes led to an unfavorable visual outcome. CONCLUSIONS In this study, surgery often improved vision, especially in patients with preoperative binocular visual dysfunction. But patients indicated that the effect on their ability to perform ADL was more modest. Moreover, 17% of patients with preoperative monocular visual dysfunction lost vision in the only affected eye, often to a considerable degree. In those patients, surgery would be justified primarily to relieve the concern of having a large brain tumor and to prevent tumor growth. Preoperative ophthalmic and imaging features poorly predicted visual outcomes. Favorable visual outcomes occurred without aggressive surgical debulking of the tumors.
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Affiliation(s)
- Yibing Zhang
- Department of Ophthalmology and Visual Sciences (Kellogg Eye Center) (YZ, CA, EA, LB, HG, EM, JT); Department of Radiology (Neuroradiology) (JK); Department of Neurosurgery (SS, JT); and Department of Neurology (JT), University of Michigan
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Qiao N, Yang X, Li C, Ma G, Kang J, Liu C, Cao L, Zhang Y, Gui S. The predictive value of intraoperative visual evoked potential for visual outcome after extended endoscopic endonasal surgery for adult craniopharyngioma. J Neurosurg 2021; 135:1714-1724. [PMID: 33962373 DOI: 10.3171/2020.10.jns202779] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Due to the proximity of craniopharyngioma to the optic apparatus, one of the most common complications after surgery is visual deterioration. Intraoperative visual evoked potential (VEP), as a means of real-time visual function monitoring, has been integrated into transsphenoidal surgery for pituitary adenoma to predict postoperative visual outcome. Compared with pituitary tumor, craniopharyngioma often adheres to optic nerves, with increased risk of postoperative visual impairment. Furthermore, extended endoscopic endonasal surgery (EEES) can provide direct visualization of the surgical plane between the craniopharyngioma and the optic nerves, which contributes to analysis of the mechanism of real-time VEP changes during surgery. Therefore, VEP monitoring applied during EEES for craniopharyngioma may have more clinical value. However, only 9 patients who underwent EEES with VEP monitoring for craniopharyngioma have been sporadically reported to date. In this paper, the authors present the largest series to date analyzing the clinical value of VEP to predict postoperative visual outcome in adult patients with craniopharyngioma. METHODS Sixty-five adult patients who underwent EEES with intraoperative VEP monitoring for primary craniopharyngioma were retrospectively reviewed. The association between changes in VEP amplitude and postoperative visual outcome was determined. In addition, other potential prognostic factors with regard to postoperative visual outcomes were included in the analysis. RESULTS Gross-total resection was achieved in 59 patients (90.8%). Reproducible and stable VEP was recorded in 128 of 130 eyes (98.5%). During surgery, VEP remained stable in 108 eyes, 10 (9.3%) of which had new visual acuity (VA) and/or visual field (VF) defects after surgery. Transient VEP decrease was recorded in 15 eyes, 4 (26.7%) of which had visual deterioration. Of the 5 eyes with permanent VEP decrease, 3 (60%) experienced postoperative visual impairment. Permanent VEP decrease (OR 19.868, p = 0.007) and tight adhesion (OR 6.104, p = 0.040) were independent adverse factors for postoperative VA deterioration. Tight adhesion (OR 7.150, p = 0.002) and larger tumor volume (OR 1.066, p = 0.001) were significant risk factors for postoperative VF defects. CONCLUSIONS Intraoperative VEP monitoring can serve as a real-time warning to guide surgeons to avoid postoperative visual impairment. It effectively predicted VA changes in adult patients with craniopharyngioma after EEES. Tight adhesion and larger tumor volume were also strong predictors of postoperative visual impairment.
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Affiliation(s)
- Ning Qiao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
| | | | - Chuzhong Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
- 3Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Guofo Ma
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
| | - Jie Kang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
| | - Chunhui Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
| | - Lei Cao
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
| | - Yazhuo Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
- 3Cell Biology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Songbai Gui
- 1Department of Neurosurgery, Beijing Tiantan Hospital, and
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Lang ST, Ryu WHA, Starreveld YP, Costello FE. Good Visual Outcomes After Pituitary Tumor Surgery Are Associated With Increased Visual Cortex Functional Connectivity. J Neuroophthalmol 2021; 41:504-511. [PMID: 33399415 DOI: 10.1097/wno.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients presenting with visual impairment secondary to pituitary macroadenomas often experience variable recovery after surgery. Several factors may impact visual outcomes including the extent of neuroaxonal damage in the afferent visual pathway and cortical plasticity. Optical coherence tomography (OCT) measures of retinal structure and resting-state functional MRI (rsfMRI) can be used to evaluate the impact of neuroaxonal injury and cortical adaptive processes, respectively. The purpose of this study was to determine whether rsfMRI patterns of functional connectivity (FC) distinguish patients with good vs poor visual outcomes after surgical decompression of pituitary adenomas. METHODS In this retrospective cohort study, we compared FC patterns between patients who manifested good (GO) vs poor (PO) visual outcomes after pituitary tumor surgery. Patients (n = 21) underwent postoperative rsfMRI a minimum of 1 year after tumor surgery. Seed-based connectivity of the visual cortex (primary [V1], prestriate [V2], and extrastriate [V5]) was compared between GO and PO patients and between patients and healthy controls (HCs) (n = 19). Demographics, visual function, and OCT data were compared preoperatively and postoperatively between patient groups. The threshold for GO was visual field mean deviation equal or less than -5.00 dB and/or visual acuity equal to or better than 20/40. RESULTS Increased postoperative FC of the visual system was noted for GO relative to PO patients. Specifically, good visual outcomes were associated with increased connectivity of right V5 to the bilateral frontal cortices. Compared with HCs, GO patients showed increased connectivity of V1 and left V2 to sensorimotor cortex, increased connectivity of right and left V2 to medial prefrontal cortex, and increased connectivity of right V5 the right temporal and frontal cortices. CONCLUSIONS Increased visual cortex connectivity is associated with good visual outcomes in patients with pituitary tumor, at late phase of recovery. Our findings suggest that rsfMRI does distinguish GO and PO patients after pituitary tumor surgery. This imaging modality may have a future role in characterizing the impact of cortical adaptation on visual recovery.
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Affiliation(s)
- Stefan T Lang
- Division of Neurosurgery (STL, WHAR, YPS), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Division of Ophthalmology (FEC), Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada; Division of Neurology (FEC), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Neurological Surgery (WHAR), Rush University, Chicago, IL; and Hotchkiss Brain Institute (STL, FEC), University of Calgary, Calgary, Canada
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Peripapillary Microvascularization Analysis Using Swept-Source Optical Coherence Tomography Angiography in Optic Chiasmal Compression. J Ophthalmol 2021; 2021:5531959. [PMID: 34527375 PMCID: PMC8437637 DOI: 10.1155/2021/5531959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the vessel density (VD) of the radial peripapillary capillary (RPC) network using swept-source optical coherence tomography angiography (SS-OCTA) “en face” images of eyes with chiasmal compression caused by brain tumors before and after decompressive surgery compared with healthy controls. Methods A cross-sectional study was conducted in 12 patients with chiasmal compression confirmed by neuroimaging. Sixteen healthy participants were also included. All patients with chiasmal compression underwent a neuro-ophthalmological examination one week before and 6 months after brain surgery, including static automated perimetry as well as measurement of the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) with spectral-domain optical coherence tomography (SD-OCT). Based on this neuro-ophthalmological examination, the presence of an optic neuropathy (ON) was evaluated. Peripapillary VD was obtained in four sectors on a 6 × 6 mm SS-OCTA image using the Cirrus Plex Elite 9000. Results Baseline average VD was significantly lower in patients with chiasmal compression and ON than in controls (median: 55.62; interquartile range (IQR): 2.96 vs. 58.53; IQR: 2.02; p=0.003). This decrease was also found in the temporal, superior, and nasal sectors. Average postoperative VD was decreased in patients with chiasmal compression compared with average preoperative VD (median: 56.16; IQR: 4.07 vs. 57.48; IQR: 3.83; p=0.004). Preoperative VD was significantly correlated with RNFL, GCC thickness, and visual field defects. Conclusions The VD of the RPC network was decreased in chiasmal compressive ON, and it was further decreased at 6 months after decompressive surgery.
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Agarwal R, Jain VK, Singh S, Charlotte A, Kanaujia V, Mishra P, Sharma K. Segmented retinal analysis in pituitary adenoma with chiasmal compression: A prospective comparative study. Indian J Ophthalmol 2021; 69:2378-2384. [PMID: 34427226 PMCID: PMC8544063 DOI: 10.4103/ijo.ijo_2086_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: The aim of this study was to determine the alteration in ganglion cell complex and its relationship with retinal nerve fiber layer (RNFL) thickness as measured by spectral-domain optical coherence tomography (OCT) in pituitary adenoma cases and also its correlation with visual field (VF). Methods: This is a prospective comparative study wherein detailed neuro-ophthalmic examination including perimetry, RNFL and ganglion cell layer inner plexiform layer (GCL-IPL) thickness were measured preoperatively in the cases of pituitary adenoma with chiasmal compression with visual symptoms and field changes who were planned for neuro-surgical intervention. These parameters were repeated 1 year after the surgery. GCL-IPL, RNFL parameters were compared with controls and were correlated with VF mean deviation (MD). The diagnostic power of GCL-IPL was tested using the receiver operating characteristic (ROC) curve. Healthy age and sex-matched controls without any ocular and systemic abnormality were taken for comparison. Results: Twenty-four patients qualified the inclusion criteria. A significant thinning of GCL-IPL (P = 0.002) and RNFL (P = 0.039) was noticed in the pituitary adenoma group. GCL-IPL (r = 0.780 P < 0.001) and RNFL (r = 0.669, P < 0.001) were significantly correlated with the MD. The ROC curve values of GCL-IPL were 0.859 (95% confidence interval 0.744% to 0.973) and of RNFL were 0.731 (95% confidence interval 0.585–0.877). The diagnostic ability of GCL-IPL was more as compared to the RNFL analysis, although it was statistically insignificant (P = 0.122). Conclusion: GCL-IPL measurements on the OCT are a sensitive tool to detect early anterior visual pathway changes in chiasmal compression for pituitary adenoma patients.
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Affiliation(s)
- Rachna Agarwal
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vaibhav K Jain
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akshata Charlotte
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Kanaujia
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumudini Sharma
- Department of Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kynčl M, Kasl Z, Rusňák Š, Sobotová M, Krčma M, Tintěra J, Fůs M, Lešták J. Pituitary apoplexy without chiasm compression: A case report. Mol Clin Oncol 2021; 15:176. [PMID: 34276995 PMCID: PMC8278391 DOI: 10.3892/mco.2021.2338] [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: 12/07/2020] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
The present report presents a rare case in which a patient with pituitary apoplexy (PA) without compression of the optic chiasm experienced diagnosable visual impairment in the ensuing months. Endocrinologically, the condition was a prolactinoma followed by bleeding into the pituitary gland. Due to the unexplained functional changes in the patient, an electrophysiological examination (pattern electroretinogram and pattern visual evoked potentials) was performed, which verified a bilateral non-inflammatory neurogenic lesion. This finding was confirmed by functional magnetic resonance imaging (fMRI) examination. Structural MRI did not reveal chiasm compression in the time sequence or alteration of the optic nerves (the diameter of the optic nerve at different distances from the eye and the diameter of the optic nerve sheath at different distances from the eye). Similarly, neither the retinal nerve fiber layer (RNFL) nor the vessel density was altered. The present report suggests that changes in visual fields may be due to ischemia in the area of the chiasm and optic nerves, similar to PA.
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Affiliation(s)
- Martin Kynčl
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Zdeněk Kasl
- Department of Ophthalmology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic
| | - Štěpán Rusňák
- Department of Ophthalmology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic
| | - Marketa Sobotová
- Department of Ophthalmology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic
| | - Michal Krčma
- First Clinic of Internal Medicine, Department of Endocrinology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic
| | - Jaroslav Tintěra
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Martin Fůs
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Jan Lešták
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
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Meyer J, Karri R, Danesh-Meyer H, Drummond K, Symons A. A normative database of A-scan data using the Heidelberg Spectralis Spectral Domain Optical Coherence Tomography machine. PLoS One 2021; 16:e0253720. [PMID: 34197499 PMCID: PMC8248651 DOI: 10.1371/journal.pone.0253720] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To develop the first normative database of macular and circumpapillary scans with reference values at the level of the A-scan using the Heidelberg Spectralis Optical Coherence Tomography (OCT) machine. Methods This study is a retrospective cross sectional analysis of macular and circumpapillary OCT scans of healthy individuals. All participants had a full ophthalmic examination, including best corrected visual acuity, intraocular pressure, biomicroscopy, posterior segment examination and OCT scan. The volume and thickness of each of the nine Early Treatment Diabetic Retinopathy zones at the macula were analysed for the total retinal thickness, retinal nerve fibre layer (RNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL). The thickness of the circumpapillary RNFL was analysed at the disc. Associations between age, gender, refractive error and OCT measurements were explored. De-identified A-scans were extracted from the OCT machine as separate tab-separated text file and made available according to the data sharing statement. Results Two-hundred eyes from 146 participants were included of which 69 (47%) were female. The mean age (SD) was 48.52 (17.52). Participants were evenly distributed across four age groups and represented nine broad ethnic groups in proportions comparable to the local distribution. All the macular scans were 20° x 20° (5.9 mm x 5.9 mm), with a total scan density between 12,800 and 49,152 A-scans. The peripapillary scans were all 12° (3.5 mm), at a scan density of 768 A-scans. The mean retinal, GCL and IPL volumes were significantly greater in males than females. Mean peripapillary RNFL thickness did not differ significantly between males and females. Age and total retinal volume (r = –0.2561, P = 0.0003), GCL volume (–0.2911, P < 0.0001) and IPL volume (–0.3194, P < 0.0001) were negatively correlated. The IPL had the strongest three significant negatively associated segments; superior inner IPL (r = –0.3444, P < 0.0001), nasal outer IPL (r = –0.3217, P < 0.0001) and inferior inner IPL (r = –0.3179, P < 0.0001). The temporal inner macular RNFL showed a statistically significant positive correlation (r = 0.1929, P = 0.0062) with age. The only significant association between age and thickness at the peripapillary disc scan was the superior temporal sector (r = –0.1910, P = 0.0067). All retinal layers were negatively correlated for refractive error, except for the central RNFL which was positively correlated (r = 0.1426, P = 0.044). Conclusion This study provides a normative database of macular and circumpapillary scans with reference values at the level of the A-scan using the Heidelberg Spectralis Optical Coherence Tomography (OCT) machine.
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Affiliation(s)
- Joos Meyer
- Ophthalmology Department, The Royal Melbourne Hospital, Parkville, VIC, Australia
- * E-mail:
| | - Roshan Karri
- The Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Danesh-Meyer
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Kate Drummond
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- The Royal Melbourne Hospital, Neurosurgery Department, Parkville, VIC, Australia
| | - Andrew Symons
- Ophthalmology Department, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
- Centre For Eye Research Australia, East Melbourne, VIC, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Monash University Department of Surgery, Monash Medical Centre Level 5, North Melbourne, Australia
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Özcan Y, Talıpınar S, Kayıran A, Türe U. How do intracranial tumors associated with visual pathways affect quadrant and sectoral based optical coherence tomography measurements: The effect of intracranial tumors on RNFL and GC-IPL thickness. Eur J Ophthalmol 2021; 32:1751-1759. [PMID: 34162240 DOI: 10.1177/11206721211028035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To investigate the quantitative sectoral and regional changes of retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness in different types of intracranial tumors associated with visual pathways. METHODS This comparative retrospective study included 58 eyes of 30 patients with intracranial tumors and the data of 62 eyes of 31 healthy subjects. The RNFL and GCIPL thicknesses were analyzed using spectral-domain optical coherence tomography (OCT). The tumors were classified into ones that affect pre-geniculate and post-geniculate pathway. RESULTS The mean RNFL thickness in temporal quadrant was significantly thinner in eyes with intracranial tumors affecting the pre-geniculate optic pathway compared to controls (p = 0.04). In contrast, the mean superior quadrant RNFL thickness was significantly thicker in eyes with brain tumors associated with post-geniculate optic pathway (p = 0.01). The mean GC-IPL thicknesses of the inner ring superotemporal, superonasal, inferotemporal and inferionasal sectors and outer ring superonasal and inferonasal sectors were significantly thinner in eyes with intracranial tumors affecting the pre-geniculate optic pathway compared to control eyes (p = 0.02, p = 0.001, p = 0.02, p = 0.003, p = 0.008 and p = 0.03 respectively). CONCLUSION The results of this study showed that significant changes can be seen in the different RNFL quadrants and GC-IPL sectors in eyes with intracranial tumors affecting pre-geniculate or post-geniculate optic pathway. OCT is a very useful imaging technique to quantify these structural changes which take place during the neurodegeneration process of visual pathways in intracranial tumors.
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Affiliation(s)
- Yasin Özcan
- Ophthalmology Department, Yeditepe University Medical Faculty, Yeditepe University Speciality Hospital, Istanbul, Turkey
| | - Sinan Talıpınar
- Ophthalmology Department, Yeditepe University Medical Faculty, Yeditepe Eye Center, Istanbul, Turkey
| | - Alp Kayıran
- Ophthalmology Department, Yeditepe University Medical Faculty, Yeditepe Eye Center, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgeon, Yeditepe University Medical Faculty, Yeditepe University Speciality Hospital, Istanbul, Turkey
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Changes of Peripapillary Region Perfusion in Patients with Chiasmal Compression Caused by Sellar Region Mass. J Ophthalmol 2021; 2021:5588077. [PMID: 34221493 PMCID: PMC8219428 DOI: 10.1155/2021/5588077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose To evaluate the peripapillary vessel density (pVD) and the peripapillary nerve fiber layer (pRNFL) thickness in patients with chiasmal compression caused by sellar region mass using optical coherence tomography angiography (OCTA). Methods This is an observational, cross-sectional study of 31 patients (31 eyes) with chiasmal compression caused by sellar region mass and 34 healthy controls (34 eyes). Automated perimetry and OCTA were performed. The pVD and pRNFL thickness were compared between the two groups. The impact of tumor diameter, duration of symptoms, and cavernous sinus (CS) invasion on visual dysfunction, pVD, and pRNFL thickness was also analyzed. Furthermore, we divided the patients into two subgroups according to whether there was an absolute defect in the central visual field and evaluated their pVD and pRNFL thickness, respectively. Results Compared to the healthy control group, there was a statistically significant decrease in pVD and pRNFL thickness in patients with chiasmal compression (p < 0.05), especially in patients with substantial absolute defects in the central visual field. Tumor diameter, duration of symptoms, and CS invasion did not appear to be associated with pVD and pRNFL thickness. There was a significant positive correlation between the pVD and pRNFL thickness in patients with chiasmal compression (p < 0.001). Conclusion pVD and pRNFL thickness are significantly decreased in patients with chiasmal compression revealed by OCTA, especially in patients with more severe visual field defects. A significant correlation between pVD and pRNFL thickness was demonstrated, which provides a clue for the study of the mechanism of changes in retinal perfusion in compressive optic neuropathy. It requires considerable attention that OCTA may play an important role in disease monitoring of sellar region mass. Hence, further studies are needed to verify whether OCTA is helpful to predict the prognosis of visual function after decompression surgery.
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Long term predictive ability of preoperative retinal nerve fiber layer thickness in visual prognosis after chiasmal decompression surgery. Clin Neurol Neurosurg 2021; 207:106734. [PMID: 34119898 DOI: 10.1016/j.clineuro.2021.106734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between preoperative retinal nerve fiber layer (RNFL) thickness and the recovery of visual field (VF) and visual acuity (VA) 1 year after surgery in chiasmal compression patients presenting with visual impairment. PATIENTS AND METHODS Twenty-nine eyes of 16 patients with chiasmal compression and 14 eyes of 14 control subjects were enrolled. All patients undergoing chiasmal decompression surgery via a transsphenoidal approach were prospectively evaluated before and 1 year after surgery with best corrected visual acuity (BCVA, logMAR), mean deviation (MD) value with standard automated perimetry (SAP) and RNFL thickness with optical coherence tomography. Eyes with chiasmal compression were divided into two groups according to the mean preoperative RNFL thickness: ≥ 100 µm (Group 1) and < 100 µm (Group 2). The relationship between the mean preoperative RNFL thickness and visual prognosis parameters (VF, VA) was analyzed. RESULTS The mean preoperative RNFL thickness was 115.92 ± 8.97 µm, 84.0 ± 8.85 µm, and 114.21 ± 7.75 µm in Group 1 (n = 15 eyes), Group 2 (n = 14 eyes) and the control group (n = 14 eyes), respectively. The mean preoperative BCVA was 0.15 ± 0.3 in Group 1, and 0.41 ± 0.39 in Group 2. The mean BCVA increased to 0.03 ± 0.1 in Group 1 in the postoperative period but did not change in Group 2. MD value was - 6.10 ± 5.54 in the preoperative period and - 2.59 ± 2.23 in the postoperative period for Group 1 (p = 0.014), while it was - 18.97 ± 4.14 in the preoperative period and - 18.57 ± 4.51 in the postoperative period in Group 2 (p = 0.24). CONCLUSIONS This study suggests that lower mean preoperative RNFL thickness was associated with poorer long-term visual prognosis. Preoperative RNFL thickness measurements may be helpful in predicting the recovery of VF and VA after decompression surgery in patients with chiasmal lesion presenting with visual impairment.
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Graillon T, Passeri T, Boucekine M, Meyer M, Abritti R, Bernat AL, Labidi M, Dufour H, Froelich S. Chiasmapexy for secondary empty sella syndrome: diagnostic and therapeutic considerations. Pituitary 2021; 24:292-301. [PMID: 33136230 DOI: 10.1007/s11102-020-01104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Secondary empty sella syndrome (SESS) following pituitary surgery remains a diagnostic and therapeutic challenge. The aim of this study was to specify the diagnostic criteria, surgical indications and results of chiasmapexy in the SESS. METHODS Three cases from two experienced neurosurgical centers were collected and the available literature was reviewed. RESULTS The 3 patients were operated for a giant non-functioning pituitary adenoma, a cystic macroprolactinoma, and an arachnoid cyst respectively. Postoperative visual outcome was initially improved, and then worsened progressively. At the time of SESS diagnosis, visual field defect was severe in all cases with optic nerve (ON) atrophy in 2 cases. Patients were operated via an endoscopic endonasal extradural approach. One patient was re-operated because of early fat reabsorption. Visual outcome improved in 1 case and stabilized in 2 cases. Statistical analyses performed on 24 cases from the literature review highlighted that patient age and severity of the preoperative visual defect were respectively significant and nearly significant prognostic factors for visual outcome, unlike the surgical technique. CONCLUSION T2-weighted or CISS/FIESTA sequence MRI is mandatory to visualize adhesions, ON kinking and neurovascular conflict. TS approach is the most commonly used approach. The literature review could not conclude on the need for an intra or extradural approach suggesting case by case adapted strategy. Intrasellar packing with non-absorbable material such as bone should be considered. Severity of the visual loss clearly decreases the visual outcome suggesting early chiasmapexy. In case of severe and long standing symptoms before surgery, benefits and surgical risks should be carefully balanced.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France.
| | - Thibault Passeri
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Mohamed Boucekine
- EA 3279 CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille Univ, School of Medicine - La Timone Medical Campus, |27 bd Jean Moulin Cedex 05, 13385, Marseille, France
| | - Mikael Meyer
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Rosaria Abritti
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Anne-Laure Bernat
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Moujahed Labidi
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Sébastien Froelich
- Neurosurgery Department, Hôpital Lariboisiere, APHP, Université Paris Diderot, Paris, France
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Iqbal M, Irfan S, Goyal JL, Singh D, Singh H, Dutta G. An Analysis of Retinal Nerve Fiber Layer Thickness before and after Pituitary Adenoma Surgery and its Correlation with Visual Acuity. Neurol India 2021; 68:346-351. [PMID: 32189695 DOI: 10.4103/0028-3886.280634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Pituitary adenomas comprise approximately 10% of all intracranial tumors. Initially, subtle changes occur in the field of vision, which are difficult to assess clinically. It has been seen that following surgery of pituitary macroadenoma, total recovery of normal vision occurs in 35% of the patients, improvement of vision occurs in 60%, and in the rest there is no change in vision. Retinal nerve fiber layer thickness (RNFLT) undergoes retrograde degeneration following compression of optic apparatus by pituitary tumor. We planned a study to evaluate RNFLT before and after pituitary adenoma surgery and its correlation with visual acuity. Material and Methods Twenty patients (40 eyes) with diagnosed pituitary adenoma were included in the study. Preoperative visual acuity, fundus and RNFL thickness were calculated using spectral-domain OCT Optovue, Heidelberg Engineering, Heidelberg, Germany (RT 100 version 5.1), and postoperative measurement was done after 1 and 3 months. Four-quadrant mean of RNFLT was calculated. Results were tabulated and analyzed. Statistical Analysis Results of the study were analyzed using IBM SPSS Statistics version 19.0. Results There was no significant change in RNFLT after pituitary adenoma surgery, and it was found that patients with RNFLT within normal range preoperatively showed improvement in visual acuity after pituitary surgery. On the other hand, patients who had thinned-out RNFLT preoperatively showed no improvement in visual acuity. It was also found that once optic disc pallor sets due to chronic compression, then chances of its reversion to normal depend on its grading: only mild pallor disc has some chance to revert to normal, whereas moderate and severe pallor do not revert to normal. Conclusion RNFLT and optic disc can be used as prognostic factors for evaluation of visual outcome in pituitary adenoma surgery.
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Affiliation(s)
- Mohd Iqbal
- Department of Pathology, Era Medical College, Lucknow, Uttar Pradesh, India
| | - Sumaiya Irfan
- Department of Ophthalmology, Era Medical College, Lucknow, Uttar Pradesh, India
| | - Jawahar L Goyal
- Department of Ophthalmology, Guru Nanak Eye Hospital, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Hukum Singh
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Gautam Dutta
- Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Chung YS, Na M, Yoo J, Kim W, Jung IH, Moon JH, Lee J, Kim SH, Kim EH. Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study. Neurosurgery 2021; 88:106-112. [PMID: 32735666 DOI: 10.1093/neuros/nyaa318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. OBJECTIVE To analyze visual parameters and their association based on long-term follow-up. METHODS Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. RESULTS Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, -12.9 ± 7.3 dB to -6.3 ± 5.9 dB). CONCLUSION Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.
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Affiliation(s)
- Young Soo Chung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyun Na
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woohyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea.,Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junwon Lee
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Ho Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Neurosurgery, Ewha Woman's University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.,Pituitary Tumor Center, Severance Hospital, Seoul, Republic of Korea.,Yonsei Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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