1
|
Gonzalez R, Massman L, Ho S, Luna S, Cheok S, Liang B, Mrachek K, Coss D, Ioachimescu AG, Zwagerman N, Olivier-Van Stichelen S. The diverging role of O-GlcNAc transferase in corticotroph and somatotroph adenomas. Pituitary 2024:10.1007/s11102-024-01431-x. [PMID: 39066842 DOI: 10.1007/s11102-024-01431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Molecular mechanisms involved in the pathogenesis and tumor progression of pituitary adenomas (PA) remain incompletely understood. Corticotroph and somatotroph PA are associated with a high clinical burden, and despite improved surgical outcomes and medical treatment options, they sometimes require multiple surgeries and radiation. Preliminary data suggested a role for O-GlcNAc Transferase (OGT), the enzyme responsible for the O-GlcNAcylation of proteins. O-GlcNAcylation and OGT have been found elevated in other types of tumors. METHODS We evaluated 60 functioning and nonfunctioning PA (NFPA) from operated patients and postmortem normal and tumoral pituitary tissue by immunohistochemistry. We performed transcriptomic analyses to explore the relevance of the O-GlcNAc Transferase (OGT) in PAs. We detected OGT in immunobiological analysis and define its level in PA tissue in patients. RESULTS OGT was strongly associated with PA hormone secretory capacity in functioning PA and with tumor growth in NFPAs. In NFPAs, OGT was positively associated with tumor size but not with cavernous sinus invasion (Knosp grading). In GH-secreting PA, OGT expression was negatively correlated with circulating Insulin-like Growth Factor 1 level. In adrenocorticotropic hormone (ACTH)-secreting PA, OGT expression was positively associated with circulating ACTH levels. OGT did not correlate with tumor size in secreting PAs. OGT levels were higher in gonadotroph PA compared to normal glands. CONCLUSION O-GlcNAcylation can be downregulated in non-cancerous tumors such as GH-secreting adenomas. Future studies are warranted to elucidate the role of OGT in the pathogenesis of PAs.
Collapse
Affiliation(s)
- Roel Gonzalez
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Logan Massman
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Sophia Ho
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Sarai Luna
- Department of Biochemistry, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Stephanie Cheok
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Brandon Liang
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Kelly Mrachek
- Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Dylan Coss
- Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Adriana G Ioachimescu
- Department of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Nathan Zwagerman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | |
Collapse
|
2
|
Pawar PR, Booth J, Neely A, McIlwaine G, Lueck CJ. Nerve fibre organisation in the human optic nerve and chiasm: what do we really know? Eye (Lond) 2024:10.1038/s41433-024-03137-7. [PMID: 38849598 DOI: 10.1038/s41433-024-03137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
A recent anatomical study of the human optic chiasm cast doubt on the widespread assumption that nerve fibres travelling in the human optic nerve and chiasm are arranged retinotopically. Accordingly, a scoping literature review was performed to determine what is known about the nerve fibre arrangement in these structures. Meta-analysis suggested that the average number of fibres in each optic nerve was 1.023 million with an inter-individual range of approximately 50% of the mean. Loss of nerve fibres with age (approximately 3,400 fibres/year) could not account for this variability. The review suggested that there might be a retinotopic arrangement of nerve fibres in the orbital portion of the optic nerve but that this arrangement is most likely to be lost posteriorly with a more random distribution of nerve fibres at the chiasm. Limited studies have looked at nerve fibre arrangement in the chiasm. In summary, the chiasm is more 'H-shaped' than 'X-shaped': nerve fibre crossings occur paracentrally with nerves in the centre of the chiasm travelling coronally and in parallel. There is interaction between crossed and uncrossed fibres which are widely distributed. The review supports the non-existence of Wilbrand's knee. Considerable further work is required to provide more precise anatomical information, but this review suggests that the assumed preservation of retinotopy in the human optic nerve and chiasm is probably not correct.
Collapse
Affiliation(s)
- Pratap R Pawar
- School of Engineering and Technology, University of New South Wales, Canberra, NSW, Australia
| | - Joshua Booth
- School of Medicine and Psychology, Australian National University, Canberra, NSW, Australia
| | - Andrew Neely
- School of Engineering and Technology, University of New South Wales, Canberra, NSW, Australia
| | - Gawn McIlwaine
- Department of Ophthalmology, Mater Hospital, Belfast, Northern, Ireland
| | - Christian J Lueck
- School of Medicine and Psychology, Australian National University, Canberra, NSW, Australia.
| |
Collapse
|
3
|
Gesslein B, Naumovska M, Neumann O, Bizios D, Bengtsson B, Siesjö P, Uvelius E, Hammar B, Sheikh R. Comparison of perimetric 24-2 and 30-2 test patterns in detecting visual field defects in patients with tumours in the pituitary region. Acta Ophthalmol 2024; 102:326-333. [PMID: 37452447 DOI: 10.1111/aos.15731] [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: 11/01/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Automated perimetry provides a standardized method of measuring the visual field. The Humphrey Field Analyser (HFA) uses the 24-2 test pattern to cover 24 degrees centrally or the 30-2 test pattern to cover a slightly broader region of 30 degrees. The aim of this study was to determine whether the 24-2 test pattern provides comparable information to the 30-2 test pattern in detecting visual field defects in patients with tumours in the pituitary region. METHODS A retrospective cohort study was carried out on patients with tumours in the pituitary region and radiologically confirmed compression of the visual pathway. Included patients (79 of 133) had been examined using the Humphrey 30-2 visual field test, after which the 30-2 test patterns were reduced into corresponding 24-2 test patterns. The location of visual field defects, visual acuity and the perimetric parameters mean deviation (MD) and visual field index (VFI) were also recorded. RESULTS No patient was classified differently when evaluated with the 24-2 test pattern, compared to the 30-2 test pattern. Interestingly, although the majority of patients had visual field defects located in the temporal visual field of each eye, a significant minority did not. In addition, it was found that a large proportion of patients had normal visual acuity (≥0.8). CONCLUSIONS The use of the HFA 24-2 test pattern reliably detected visual field defects in patients with tumours in the pituitary region. The present study indicates that MD and VFI are not reliable parameters for evaluating visual field defects due to compression.
Collapse
Affiliation(s)
- Bodil Gesslein
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Magdalena Naumovska
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Olof Neumann
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dimitrios Bizios
- Department of Ophthalmology, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Boel Bengtsson
- Department of Ophthalmology, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter Siesjö
- Department of Neurosurgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Erik Uvelius
- Department of Neurosurgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Björn Hammar
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Rafi Sheikh
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
4
|
Gomez D, Cheok S, Feng JJ, Chung R, Pangal DJ, Ruzevick JJ, Gokoffski KK, Shiroishi MS, Wrobel BB, Carmichael JD, Zada G. Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas in Patients Presenting With Monocular Blindness. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01118. [PMID: 38869495 DOI: 10.1227/ons.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Suprasellar tumors, particularly pituitary adenomas (PAs), commonly present with visual decline, and the endoscopic endonasal transsphenoidal approach (EETA) is the primary management for optic apparatus decompression. Patients presenting with complete preoperative monocular blindness comprise a high-risk subgroup, given concern for complete blindness. This retrospective cohort study evaluates outcomes after EETA for patients with PA presenting with monocular blindness. METHODS Retrospective analysis of all EETA cases at our institution from June 2012 to August 2023 was performed. Inclusion criteria included adults with confirmed PA and complete monocular blindness, defined as no light perception, and a relative afferent pupillary defect secondary to tumor mass effect. RESULTS Our cohort includes 15 patients (9 males, 6 females), comprising 2.4% of the overall PA cohort screened. The mean tumor diameter was 3.8 cm, with 6 being giant PAs (>4 cm). The mean duration of preoperative monocular blindness was 568 days. Additional symptoms included contralateral visual field defects (n = 11) and headaches (n = 10). Two patients presented with subacute PA apoplexy. Gross total resection was achieved in 46% of patients, reflecting tumor size and invasiveness. Postoperatively, 2 patients experienced improvement in their effectively blind eye and 2 had improved visual fields of the contralateral eye. Those with improvements were operated within 10 days of presentation, and no patients experienced worsened vision. CONCLUSION This is the first series of EETA outcomes in patients with higher-risk PA with monocular blindness on presentation. In these extensive lesions, vision remained stable for most without further decline and improvement from monocular blindness was observed in a small subset of patients with no light perception and relative afferent pupillary defect. Timing from vision loss to surgical intervention seemed to be associated with improvement. From a surgical perspective, caution is warranted to protect remaining vision and we conclude that EETA is safe in the management of these patients.
Collapse
Affiliation(s)
- David Gomez
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Stephanie Cheok
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jeffrey J Feng
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Ryan Chung
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jacob J Ruzevick
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kimberly K Gokoffski
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, California, USA
| | - Mark S Shiroishi
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Bozena B Wrobel
- USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - John D Carmichael
- Department of Endocrinology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, USC Brain Tumor Center, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Dhoot AS, Ahmed Y, Tsang DS, Micieli JA. Rapid Onset Bitemporal Hemianopia as the Presenting Sign of Metastatic Adenocarcinoma of the Lung. J Neuroophthalmol 2024; 44:e184-e186. [PMID: 36542546 DOI: 10.1097/wno.0000000000001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine (ASD), University of Toronto, Toronto, Canada; Institute of Biomedical Engineering (ASD), Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada; Department of Family Medicine (YA), Dalhousie University, Halifax, Canada; Radiation Medicine Program (DST), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; and Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada
| | | | | | | |
Collapse
|
7
|
Świerczyńska M, Sedlak L, Tronina A, Winder M. Complete Binasal Hemianopia-Associated With Pituitary Microadenoma or Idiopathic?-A Case Report. J Neuroophthalmol 2024:00041327-990000000-00542. [PMID: 38170595 DOI: 10.1097/wno.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Marta Świerczyńska
- Departments of Ophthalmology (MS), Faculty of Medical Sciences in Katowice, Department of Ophthalmology (MS), Kornel Gibinski University Clinical Center, Department of Pediatric Ophthalmology (AT), Faculty of Medical Sciences in Katowice, Department of Pediatric Ophthalmology (AT), Kornel Gibinski University Clinical Center, Department of Radiology and Nuclear Medicine (MW), Medical University of Silesia, Katowice, Poland; and Department of Ophthalmology (LS), Euromedic Hospital, Katowice, Poland
| | | | | | | |
Collapse
|
8
|
Horton JC, Dilbeck MD, Economides JR. Decussating axons segregate within the anterior core of the primate optic chiasm. Br J Ophthalmol 2023; 107:447-452. [PMID: 36575620 PMCID: PMC10038861 DOI: 10.1136/bjo-2022-322235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The axons of ganglion cells in the nasal retina decussate at the optic chiasm. It is unclear why tumours cause more injury to crossing nasal fibres, thereby giving rise to temporal visual field loss in each eye. To address this issue, the course of fibres through the optic chiasm was examined following injection of a different fluorescent tracer into each eye of a monkey. METHODS Under general anaesthesia, cholera toxin subunit B-Alexa Fluor 488 was injected into the right eye and cholera toxin subunit B-Alexa Fluor 594 was injected into the left eye of a single normal adult male rhesus monkey. After a week's survival for anterograde transport, serial coronal sections through the primary optic pathway were examined. RESULTS A zone within the core of the anterior and mid portions of the optic chiasm was comprised entirely of crossing fibres. This zone of decussation was delineated by segregated, interwoven sheets of green (right eye) and red (left eye) fibres. It expanded steadily to fill more of the optic chiasm as fibres coursed posteriorly towards the optic tracts. Eventually, crossed fibres became completely intermingled with uncrossed fibres, so that ocular separation was lost. CONCLUSIONS A distinct, central compartment located within the anterior two-thirds of the optic chiasm contains only crossing fibres. Sellar tumours focus their compressive force on this portion of the structure, explaining why they so often produce visual field loss in the temporal fields.
Collapse
Affiliation(s)
- Jonathan C Horton
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Mikayla D Dilbeck
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - John R Economides
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
9
|
Jefferis JM, Innes WA, Hickman SJ. The presenting visual symptoms of optic chiasmal disease. Eur J Ophthalmol 2023; 33:9-20. [PMID: 36147020 DOI: 10.1177/11206721221125264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recognising optic chiasmal disease early is important in order to avoid irreversible visual loss and the potential risk of mortality for patients. Yet, there is frequently a delay in the initial diagnosis. Whilst the signs of optic chiasmal disease, particularly the perimetric findings, are well documented in the recent literature, the symptoms have been less well reported. Whilst some patients with optic chiasmal disease will be asymptomatic, many will complain of visual symptoms including symptomatic field defects, problems with central vision, difficulty with near tasks, binocular visual disturbances, colour vision disturbances, photophobia, phosphenes, glare, and rarely, oscillopsia and visual hallucinations. Others may have headache or the severe and sudden visual symptoms associated with pituitary apoplexy. The visual symptoms may be vague or non-specific, even when there are significant bitemporal visual field defects. We aim in this review to describe the presenting visual symptoms of optic chiasmal disease, and to illustrate these with selected qualitative descriptions from the literature. Our hope is that this will aid clinicians in eliciting a careful history of the sometimes subtle symptoms that may be present.
Collapse
Affiliation(s)
- Joanna M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK.,7315The University of Sheffield, Sheffield, UK.,Department of neuro-ophthalmology, 105552Manchester Royal Eye Hospital, Manchester, UK
| | - William A Innes
- Newcastle Eye Centre, The Royal Victoria Infirmary, Newcastle Upon Tyne, UK.,Augenklinik Wettingen, Wettingen, Switzerland.,University Hospital, Zürich, Switzerland.,Newcastle University, Newcastle Upon Tyne, UK
| | - Simon J Hickman
- 7315The University of Sheffield, Sheffield, UK.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
10
|
Raghib MF, Salim A, Angez M, Ghazi SM, Hashmi S, Tariq MB, Hashmi F, Anis SB, Shamim MS, Tanwir A, Enam SA. Prognostic implication of size on outcomes of pituitary macroadenoma: a comparative analysis of giant adenoma with non-giant macroadenoma. J Neurooncol 2022; 160:491-496. [DOI: 10.1007/s11060-022-04168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
|
11
|
Kohno S, Tabuchi H, Fukushima A. A Case of Immunoglobulin G4-Related Ophthalmic Disease With Unilateral Visual Field Impairment. Cureus 2022; 14:e27495. [PMID: 36060322 PMCID: PMC9424796 DOI: 10.7759/cureus.27495] [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] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
A 76-year-old man receiving maintenance therapy with oral steroids for immunoglobulin G4 (IgG4)-related disease presented to our hospital with the chief complaint of visual disturbance. His best corrected visual acuities of the right and left eye were 1.2 and 0.7, respectively. Humphrey visual field test revealed inferior auriculotemporal one-quarter blindness in the left eye. After detailed history-taking for IgG4-related disease, clinical diagnosis based on imaging revealed the marked pituitary/pituitary stalk enlargement with associated optic chiasm compression. Based on the history and initial evaluation findings, a diagnosis of IgG4-related ophthalmic disease was made. Intensified steroid therapy was performed, which led to symptom resolution. IgG4-related diseases are considered in the differential diagnosis when bilateral hemianopsia is observed. When unilateral visual acuity and visual field defects are present, IgG4-related diseases and other organ disorders should be considered.
Collapse
|
12
|
Agosti E, Alexander AY, Pinheiro-Neto CD, Link MJ, Meyer FB, Peris-Celda M. Letter: Visual Field Defects in the Setting of Suprasellar Lesions: Could Vascularization Patterns of the Optic Chiasm Play a Role? Neurosurgery 2022; 91:e102-e103. [DOI: 10.1227/neu.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022] Open
|
13
|
Analysis of visual field disturbance in patients with sellar and suprasellar lesions: relationship with magnetic resonance imaging findings and sagittal bending of the optic nerve. Acta Neurol Belg 2022; 122:1031-1041. [PMID: 35716312 DOI: 10.1007/s13760-022-01956-7] [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: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Visual dysfunction due to sellar and suprasellar lesions is thought to be caused by chiasmatic compression and bending of the optic nerve at the entrance of the optic canal. We examined the relationship between visual field impairment and magnetic resonance (MR) imaging. METHODS This study reviewed 122 consecutive patients with sellar and suprasellar tumors. We have newly devised a simple visual field impairment score (SVFIS) that was divided into 12 areas. SVFIS is classified into four grades as mild (0-3 points), moderate (4-6 points), severe (7-9 points), and most severe (10-12 points) for each eye. We investigated the relationship between SVFIS grades and MR imaging, including the recently reported optic nerve-canal bending angle (ONCBA) and visual acuity. RESULTS Ipsilateral visual acuity tended to deteriorate with increased SVFIS grade. Larger ONCBA was associated with increased SVFIS grades. Bitemporal hemianopia occurred in the early stage (mild case), but the central visual field within 30° was particularly likely to be impaired. The visual field disturbance progressed clockwise (counterclockwise on the left side) from the upper temporal side. Disorders of the central visual field within 5° were associated with ipsilateral large ONCBA. CONCLUSIONS The newly developed SVFIS grades are closely associated with indicators of visual pathway impairment on MR imaging, and are useful as indicators of the severity and progression of visual field impairment due to sellar and suprasellar lesions. Disorders of the central visual field within 5° were found to be associated with ipsilateral large ONCBA.
Collapse
|
14
|
Tran L, Papasavvas I, Herbort CP. Pituitary Macroadenoma: Fooling the Ophthalmologist before Giving Him the Role of the Whistle-Blower. Klin Monbl Augenheilkd 2022; 239:468-475. [PMID: 35472789 DOI: 10.1055/a-1778-3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe cases diagnosed with pituitary macroadenoma during the follow-up of their primary ocular pathologies. METHODS Charts of patients followed in the Centre for Ophthalmic Specialized Care for diverse pathologies and who had subsequently developed a pituitary macroadenoma were retrieved. The primary pathologies were noted. The delay of the diagnosis after sufficiently compatible perimetric signs became available was calculated and the evolution after the neurosurgical intervention was reported. RESULTS In total, from 2003 to 2020, 16/14 966 (0.1%) pituitary macroadenoma patients were recorded. In 10 patients, the disease was noted in their history. In 6 patients (2 females, 4 males; 0.04%), macroadenoma occurred during the follow-up for their primary ocular pathologies. Mean age at first presentation was 65.16 ± 8.52 years. Primary pathologies included amblyopia (1), glaucoma (2), cataract (4), and uveitis (2). Mean duration of symptoms was 18.17 ± 13.11 months. Mean delay from first suspicious visual field signs to diagnosis was 125 ± 207.93 days. All patients underwent one surgical treatment with or without radiotherapy except one where a second intervention was required. All patients have seen their visual field improve after surgical intervention. Mean preoperative Mean defect (MD) was 13.43 ± 8.68 dB OD and 13.4 ± 5.07 dB OS. Mean postoperative MD was 8.2 ± 10.27 dB OD and 5.42 ± 4.12 dB OS. CONCLUSION Pituitary macroadenomas are prone to be missed or diagnosed with delay when ophthalmic patients are already followed for another pathology that prevents the clinician from diligently evoking the diagnosis. Despite profound visual field loss, visual recovery was almost complete in 4/6 patients, indicating that even diagnostic delay did not preclude recovery in our series.
Collapse
Affiliation(s)
- Lara Tran
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
| | - Ioannis Papasavvas
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
| | - Carl P Herbort
- Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialized Care, Lausanne, Switzerland
| |
Collapse
|
15
|
Leong YY, Vasseneix C, Finkelstein MT, Milea D, Najjar RP. Artificial Intelligence Meets Neuro-Ophthalmology. Asia Pac J Ophthalmol (Phila) 2022; 11:111-125. [PMID: 35533331 DOI: 10.1097/apo.0000000000000512] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT Recent advances in artificial intelligence have provided ophthalmologists with fast, accurate, and automated means for diagnosing and treating ocular conditions, paving the way to a modern and scalable eye care system. Compared to other ophthalmic disciplines, neuro-ophthalmology has, until recently, not benefitted from significant advances in the area of artificial intelligence. In this narrative review, we summarize and discuss recent advancements utilizing artificial intelligence for the detection of structural and functional optic nerve head abnormalities, and ocular movement disorders in neuro-ophthalmology.
Collapse
Affiliation(s)
| | - Caroline Vasseneix
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Dan Milea
- Singapore National Eye Center, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
16
|
Donaldson LC, Eshtiaghi A, Sacco S, Micieli JA, Margolin EA. Junctional Scotoma and Patterns of Visual Field Defects Produced by Lesions Involving the Optic Chiasm. J Neuroophthalmol 2022; 42:e203-e208. [PMID: 34417771 DOI: 10.1097/wno.0000000000001394] [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 Lesions of the optic chiasm (OC) typically produce bitemporal hemianopia (BTH) on visual field (VF) testing, whereas lesions located at the nasal optic nerve-chiasmal (ON-OC) junction have been proposed to produce junctional scotoma (JXS), a central defect in the ipsilateral eye with temporal field loss in the contralateral eye. In this study, we investigated whether the pattern of VF loss in patients with chiasmal compression predicted the appearance of the causative lesion on neuroimaging and described the clinical presentation of these patients with different types of VF defect. METHODS Retrospective chart review of patients seen in tertiary neuro-ophthalmology practice over 6 consecutive years with lesions abutting or displacing the OC was performed. Lesion size and location relative to the OC on neuroimaging was determined and correlated with VF defects as well as optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer and macular ganglion cell complex (GCC). RESULTS Fifty-three patients were enrolled. VFs demonstrated JXS (n = 18), BTH (n = 14), monocular VF defect (n = 4), and no VF defect (n = 17); 64.7% of cases with normal VFs had radiologic OC compression. Lesion volume was highest in the JXS group, and these patients also had the poorest presenting visual acuity. All patients with JXS showed involvement of the ON-OC junction; however, not all cases showed compression of the OC from the nasal direction (15 of 18), and 17 of 18 also showed compression of one or both prechiasmatic ONs. Compression of the ON-OC junction was also seen in 79% of BTH, 100% of monocular VF defect, and 59% of no VF defect cases. Fifty percent of patients with normal VFs already had thinning of the GCC on OCT. GCC thinning was most pronounced nasally in the BTH group, but diffuse bilateral thinning was found in 38% of cases compared with 60% of JXS. VFs improved in 6 of 6 patients with BTH but only in 5 of 8 JXS cases after treatment. CONCLUSIONS JXS is more often seen with larger lesions and when there is compression of both the prechiasmatic ON and ON-OC junction. These patients have worse presenting visual acuity and poorer outcomes. Not all patients with radiologic compression had VF defects, although 50% of patients with normal VFs had evidence of compression on the macular GCC analysis, emphasizing the importance of macular OCT in the evaluation of patients with lesions involving the OC.
Collapse
Affiliation(s)
- Laura C Donaldson
- Department of Ophthalmology and Vision Sciences (LD, JM, EM), University of Toronto, Toronto, Canada; Faculty of Medicine (AE), University of Toronto, Toronto, Canada; Department of Medical Imaging (SS), University of Toronto, Toronto, Canada; and Department of Medicine (JM, EM), Division of Neurology, University of Toronto, Toronto, Canada
| | | | | | | | | |
Collapse
|
17
|
White A, Junior de Andrade E, Kshettry VR, Sindwani R, Recinos PF. Preoperative Workup for Patients with Pituitary Lesions. Otolaryngol Clin North Am 2022; 55:233-246. [DOI: 10.1016/j.otc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
18
|
Suh H, Choi H, Jeon H. The Radiologic Characteristics and Retinal Thickness Are Correlated With Visual Field Defect in Patients With a Pituitary Mass. J Neuroophthalmol 2021; 41:e541-e547. [PMID: 34788245 DOI: 10.1097/wno.0000000000001011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Investigation of visual field defects (VFDs) is important to decide the treatment and to predict the prognosis in patients with a pituitary mass. The aim of this study was to evaluate the correlation among 2 diagnostic modalities-MRI and optical coherence tomography (OCT)-and VFDs. METHODS Consecutive patients who showed the presence of a pituitary mass on MRI and in whom ophthalmic examinations were performed were recruited. Height and volume of the mass, sagittal and coronal displacement of optic chiasm, and the direction of mass expansion were measured. Patients were divided into 2 groups according to the presence (VFD group) or absence of VFDs (no VFDs group [NVFD]). The correlation among MRI parameters, OCT parameters, and VFDs were examined, and the diagnostic values of MRI and OCT and the combined value of the 2 modalities were analyzed. RESULTS Forty-one patients were included. The greatest coefficients of determination were observed between the sagittal displacement and pattern standard deviation (PSD) (R2 = 0.3661, P < 0.001) and between the inferonasal ganglion cell-inner plexiform layer (GCIPL) and PSD (R2 = 0.4079, P < 0.001). The height and the size of the mass in the VFD group were significantly greater as 57% and 148%, respectively, and the VFD group had more severe chiasmal displacement both in the sagittal (165%) and in the coronal (178%) plane (large effect in all). All macular GCIPLs were thinner in the NVFD group (range 9%-26%, large effect), whereas only temporal (25%) and average (11%) values were among peripapillary retinal nerve fiber layers. CONCLUSIONS The highest correlations with the degree of the VFD were seen in the sagittal displacement of optic chiasm and the inferonasal GCIPL, and these parameters were correlated concurrently. Both modalities showed a good diagnostic value for discriminating VFDs.
Collapse
Affiliation(s)
- Hiebum Suh
- Department of Radiology (HBS), Pusan National University School of Medicine, Busan, South Korea ; Department of Ophthalmology (HC, HJ), Pusan National University Hospital, Busan, South Korea ; and Biomedical Research Institute (HC, HJ), Pusan National University Hospital, Busan, South Korea
| | | | | |
Collapse
|
19
|
Donaldson L, Margolin E. Visual fields and optical coherence tomography (OCT) in neuro-ophthalmology: Structure-function correlation. J Neurol Sci 2021; 429:118064. [PMID: 34488042 DOI: 10.1016/j.jns.2021.118064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Visual field (VF) testing is an essential component of the neurological examination. The differential diagnosis of VF defects depends on relating this measure of afferent visual function to the structure of the visual pathway and optical coherence tomography (OCT) is an invaluable tool for detailed structural evaluation of the optic nerve and retina. This review describes the ways in which interpretation of VF and OCT can be used together to increase the accuracy of the localization of lesions along the visual pathway. Lesions of the anterior visual pathway (originating in ganglion cells or nerve fibre layer of the retina or optic nerve) will typically produce defects that respect the horizontal midline, reflecting the arcuate path of the ganglion cell axons as they travel to the optic nerve. OCT of peripapillary retinal nerve fibre layer and ganglion cell complex (GCC) will typically demonstrate irreversible thinning in compressive and demyelinating lesions affecting anterior visual pathway. Chiasmal lesions produce highly localizable VF defects (junctional scotoma and bitemporal hemianopia) which correspond to the thinning of nasal portion of GCC. Lesions of the optic tract result in incongruous homonymous hemianopia on VF with corresponding hemianopic thinning on GCC developing within months. Lesions affecting optic radiations usually produce more congruous homonymous VF defects and can also produce homonymous thinning on GCC, however, this takes much longer to develop as trans-synaptic degeneration at the lateral geniculate body must occur.
Collapse
Affiliation(s)
- Laura Donaldson
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada
| | - Edward Margolin
- University of Toronto, Faculty of Medicine, Department of Medicine, Division of Neurology, Toronto, Ontario, Canada.
| |
Collapse
|
20
|
Bosler NSI, Ashton D, Neely AJ, Lueck CJ. Variation in the Anatomy of the Normal Human Optic Chiasm: An MRI Study. J Neuroophthalmol 2021; 41:194-199. [PMID: 32141976 DOI: 10.1097/wno.0000000000000907] [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 Compression of the optic chiasm typically leads to bitemporal hemianopia. This implies that decussating nasal fibers are selectively affected, but the precise mechanism is unclear. Stress on nasal fibers has been investigated using finite element modeling but requires accurate anatomical data to generate a meaningful output. The precise shape of the chiasm is unclear: A recent photomicrographic study suggested that nasal fibers decussate paracentrally and run parallel to each other in the central arm of an "H." This study aimed to determine the population variation in chiasmal shape to inform future models. METHODS Sequential MRI scans of 68 healthy individuals were selected. 2D images of each chiasm were created and analyzed to determine the angle of elevation of the chiasm, the width of the chiasm, and the offset between the points of intersection of lines drawn down the centers of the optic nerves and contralateral optic tracts. RESULTS The mean width of the chiasm was 12.0 ± 1.5 mm (SD), and the mean offset was 4.7 ± 1.4 mm generating a mean offset:width ratio of 0.38 ± 0.09. No chiasm had an offset of zero. The mean incident angle of optic nerves was 56 ± 7°, and for optic tracts, it was 51 ± 7°. CONCLUSIONS The human optic chiasm is "H" shaped, not "X" shaped. The findings are consistent with nasal fibers decussating an average of 2.4 mm lateral to the midline before travelling in parallel across the midline. This information will inform future models of chiasmal compression.
Collapse
Affiliation(s)
- Nicholas S I Bosler
- Australian National University Medical School (NSIB, DA, CJL), Canberra, Australia ; Departments of Neurology (NSIB, CJL) and Radiology (DA), The Canberra Hospital, Canberra, Australia; and School of Engineering and Information Technology (AJN), University of New South Wales, Canberra, Australia
| | | | | | | |
Collapse
|
21
|
Liang L, Lin H, Lin F, Yang J, Zhang H, Zeng L, Hu Y, Lan W, Zhong H, Zhang H, Luo S, Mo Y, Li W, Lei Y. Quantitative visual pathway abnormalities predict visual field defects in patients with pituitary adenomas: a diffusion spectrum imaging study. Eur Radiol 2021; 31:8187-8196. [PMID: 33893857 DOI: 10.1007/s00330-021-07878-x] [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: 10/06/2020] [Revised: 01/18/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study was to investigate clinical applicability of diffusion spectrum imaging (DSI) for quantitative detection of visual pathway abnormalities to predict the degree of visual field defects (VFD) in patients with pituitary adenomas. METHODS Sixty-five patients with pituitary adenomas and 33 healthy controls underwent conventional MRI and DSI scanning that allowed high-angular-resolution fiber tracking. Optic chiasmal compression and VFD were confirmed in all patients via radiological and neuro-ophthalmological examinations. Quantitative assessments of chiasmal lift, VFD, and DSI parameters from the optic nerve, optic tract, and optic radiation were performed. Group comparisons and correlation analyses were conducted in patients and controls. Using the 5-fold cross-validation method, the support vector machine classifiers were constructed to predict the degree of visual defects. RESULTS The mean values of quantitative anisotropy and generalized fractional anisotropy in optic nerve and optic tract showed significant differences between patients and controls (p < 0.05). These parameters were also significantly correlated with the chiasmal lift distance and degree of visual defects (p < 0.05). All patients were divided into mild (n = 42) and severe (n = 23) VFD groups, using the mean deviation value of -8 dB as the threshold. The classifiers achieved an accuracy of 0.83, sensitivity of 0.78, and specificity of 0.86 to discriminate patients with mild and severe visual defects. CONCLUSIONS Using high-angular-resolution fiber tracking, DSI may provide quantitative information to detect visual pathway abnormalities and be a potential diagnostic tool for determining the degree of visual field defects in pituitary adenomas. KEY POINTS • Abnormal QA and GFA values of optic nerve and optic tract in adenoma patients • Close relationship between DSI parameters and VFD degree in adenoma patients • The classifiers achieved an accuracy of 0.83, sensitivity of 0.78, and specificity of 0.86 to discriminate patients with mild and severe VFD.
Collapse
Affiliation(s)
- Lihong Liang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hai Lin
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.,Department of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China
| | - Fan Lin
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China. .,Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
| | - Jihu Yang
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.,Department of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China
| | - Hanwen Zhang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Liang Zeng
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yaqiong Hu
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Weiwu Lan
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hua Zhong
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hong Zhang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Siping Luo
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yongqian Mo
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Weihua Li
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yi Lei
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China. .,Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
| |
Collapse
|
22
|
Vu DM, Swaminathan SS. Progressive Vision Loss in a 62-Year-Old Woman. JAMA Ophthalmol 2020; 138:1207-1208. [PMID: 32910149 DOI: 10.1001/jamaophthalmol.2020.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel M Vu
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida
| | - Swarup S Swaminathan
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida
| |
Collapse
|
23
|
Chapman PR, Singhal A, Gaddamanugu S, Prattipati V. Neuroimaging of the Pituitary Gland: Practical Anatomy and Pathology. Radiol Clin North Am 2020; 58:1115-1133. [PMID: 33040852 DOI: 10.1016/j.rcl.2020.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.
Collapse
Affiliation(s)
- Philip R Chapman
- Department of Radiology, School of Medicine, University of Alabama Birmingham, 619 19th Street South, JT N419, Birmingham, AL 35249-6830, USA.
| | - Aparna Singhal
- Department of Radiology, School of Medicine, University of Alabama Birmingham, 619 19th Street South, JT N419, Birmingham, AL 35249-6830, USA
| | - Siddhartha Gaddamanugu
- Department of Radiology, School of Medicine, University of Alabama Birmingham, 619 19th Street South, JT N419, Birmingham, AL 35249-6830, USA
| | - Veeranjaneyulu Prattipati
- Department of Radiology, School of Medicine, University of Alabama Birmingham, 619 19th Street South, JT N419, Birmingham, AL 35249-6830, USA
| |
Collapse
|
24
|
|
25
|
Al-Hasani H, Khan NW, Branham KH, Heckenlively JR, Sullivan SE, De Lott LB, Fahim AT. Rapid visual field constriction in a patient with retinitis pigmentosa and pituitary adenoma. Am J Ophthalmol Case Rep 2020; 19:100762. [PMID: 32566799 PMCID: PMC7296332 DOI: 10.1016/j.ajoc.2020.100762] [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: 12/04/2019] [Revised: 05/08/2020] [Accepted: 05/31/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report a case of pituitary adenoma in a patient with retinitis pigmentosa (RP) and consequent rapid constriction of the visual field in each eye, which is atypical for either of these pathologies. OBSERVATIONS A 45-year old male, with a long-standing history of RP, presented with rapid vision loss over 3 months. Examination revealed a severe drop in visual acuity and significant progression of concentric visual field constriction in each eye compared to 3 months prior. MRI revealed a pituitary macroadenoma compressing the optic chiasm. The patient underwent endoscopic trans-sphenoidal resection of the tumor and experienced partial recovery of visual acuity but not visual field. CONCLUSIONS AND IMPORTANCE The visual field deficit in this patient was atypical for pituitary adenoma or optic neuropathy. The pattern was most consistent with RP, but the rate of progression was not. In a patient with chiasmal pathology in the setting of pre-existing retinopathy, visual field progression may not be limited exclusively to the bitemporal regions. Rapid constriction of the visual field in a patient with RP should prompt a work-up for alternative etiologies which includes neuro-imaging.
Collapse
Affiliation(s)
- Hayder Al-Hasani
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Naheed W. Khan
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Kari H. Branham
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - John R. Heckenlively
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Stephen E. Sullivan
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive SPC 5338, Ann Arbor, MI, 48109-5338, USA
| | - Lindsey B. De Lott
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Abigail T. Fahim
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| |
Collapse
|
26
|
Gandhi GY, Fung R, Natter PE, Makary R, Balaji KC. Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature. Case Rep Endocrinol 2020; 2020:8883864. [PMID: 32908722 PMCID: PMC7450332 DOI: 10.1155/2020/8883864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Metastasis to the pituitary gland is extremely rare (∼2% of sellar masses). Clinical, biochemical, and radiologic characteristics of pituitary metastasis are poorly defined and can be difficult to diagnose before surgery. We present an unusual case with pituitary metastasis as the first manifestation of renal cell carcinoma (RCC). A 70-year-old male presented with acute onset of weakness, dizziness, diplopia, and progressively worsening headache. The initial CT head revealed a heterogeneous sellar mass measuring 2.8 × 1.9 × 1.7 cm. A follow-up MRI showed the sellar mass invading the right cavernous sinus. The presumptive diagnosis was a pituitary macroadenoma. Physical examination revealed bilateral 6th cranial nerve palsy and episodes of intermittent binocular horizontal diplopia. Hormonal testing noted possible secondary adrenal insufficiency (AM serum cortisol: 3.3 mcg/dL, ACTH: 8 pg/mL), secondary hypothyroidism (TSH: <0.01 mIU/L, FT4: 0.7 ng/dL), secondary hypogonadism (testosterone: 47 ng/dL, LH: 1.3 mIU/mL, and FSH: 2.3 mIU/mL), and elevated serum prolactin (prolactin: 56.8 ng/ml, normal: 4.0-15.2 ng/ml). IGF-1 level was normal at 110 ng/mL (47-192 ng/mL). The patient was discharged on levothyroxine and hydrocortisone therapy with plans for close surveillance. However, his condition worsened over the next three months, and he was subsequently readmitted with nausea, vomiting, and hypernatremia secondary to diabetes insipidus. Repeat MRI pituitary showed an interval increase in the size of the sellar mass with suprasellar extension and a new mass effect on the optic chiasm. The sellar mass was urgently resected via a trans-sphenoidal approach. The tumor was negative for neuroendocrine markers and pituitary hormone panel, ruling out the diagnosis of pituitary adenoma and triggered workup for metastatic renal cell carcinoma, clear cell type. The diagnosis of renal cell carcinoma was confirmed by the diffuse and strong staining for renal cell carcinoma markers (Pax-8, RCC-1, and CD10). A follow-up CT scan noted large right renal mass measuring 11 × 10 × 11 cm. The patient underwent a cytoreductive robotic right radical nephrectomy for WHO/ISUP histologic grade II clear cell RCC, stage pT2b pNX pM1. He subsequently received fractionated stereotactic radiotherapy to the pituitary gland. He is presently stable with no radiological evidence of progression or new intracranial disease on subsequent imaging. Pituitary metastasis most commonly occurs from breast, lung, or gastrointestinal tumors but also rarely from renal cell carcinoma. Biochemical findings such as panhypopituitarism, acute clinical signs such as headache, visual symptoms, and diabetes insipidus and interval increase in sellar mass in a short time interval should raise suspicion for sellar metastasis.
Collapse
Affiliation(s)
- Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick E. Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Raafat Makary
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - K. C. Balaji
- Department of Urology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| |
Collapse
|
27
|
Raviv N, Amin A, Kenning TJ, Pinheiro-Neto CD, Jones D, Sharma V, Peris-Celda M. Pituitary hyperplasia causing complete bitemporal hemianopia with resolution following surgical decompression: case report. J Neurosurg 2020; 135:147-151. [PMID: 32796150 DOI: 10.3171/2020.5.jns20448] [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: 02/12/2020] [Accepted: 05/11/2020] [Indexed: 11/06/2022]
Abstract
In this report, the authors demonstrated that idiopathic pituitary hyperplasia (PH) can cause complete bitemporal hemianopia and amenorrhea, even in the setting of mild anatomical compression of the optic chiasm and normal pituitary function. Furthermore, complete resolution of symptoms can be achieved with surgical decompression. PH can occur in the setting of pregnancy or end-organ insufficiency, as well as with medications such as oral contraceptives and antipsychotics, or it can be idiopathic. It is often found incidentally, and surgical intervention is usually unnecessary, as the disorder rarely progresses and can be managed by treating the underlying etiology. Here, the authors present the case of a 24-year-old woman with no significant prior medical history, who presented with bitemporal hemianopia and amenorrhea. Imaging revealed an enlarged pituitary gland that was contacting, but not compressing, the optic chiasm, and pituitary hormone tests were all within normal limits. The patient underwent surgical decompression of the sella turcica and exploration of the gland through an endoscopic endonasal transsphenoidal approach. Pathology results demonstrated PH. A postoperative visual field examination revealed complete resolution of the bitemporal hemianopia, and menstruation resumed 3 days later. The patient remains asymptomatic with no hormonal deficits.
Collapse
|
28
|
Avraham E, Azriel A, Melamed I, Alguayn F, Al Gawad Siag A, Aloni E, Sufaro Y. The Chiasmal Compression Index: An Integrative Assessment Tool for Visual Disturbances in Patients with Pituitary Macroadenomas. World Neurosurg 2020; 143:e44-e50. [PMID: 32562903 DOI: 10.1016/j.wneu.2020.06.086] [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: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Visual status is routinely evaluated by neuro-ophthalmologic examination and computerized visual field (VF) tests in patients with chiasmal compression secondary to pituitary macroadenoma. Currently, no relevant data exists to accurately quantify the extent of optic apparatus compromise to further guide clinical decision-making. We aimed to assess for a possible quantitative correlation between optic chiasm geometric properties on magnetic resonance imaging (MRI) and VF deficits. METHODS Visual assessments and concurrent MRI scans were retrospectively reviewed from patients treated for pituitary macroadenoma in a single medical institution. Chiasm width, chiasm minimal and maximal height, and chiasm angle were measured on MRI coronal plane images by 3 independent reviewers (for the sake of variability analysis). VF numerical summary parameters were also retrieved. RESULTS A total of 30 patients were included in the final analysis. Average VF index was 70% (±30), and averaged mean deviation was 10.0 db (±9). Chiasm angle and width (which together represents the bending and stretching of the chiasm by the upward directed compression; both of which demonstrated high inter- and intraobserver agreement) showed strong correlation with VF loss. Chiasmal compression index derived from those parameters showed even stronger correlation. CONCLUSIONS The strong correlation demonstrated by our results of this relatively simple radiologic measurement with VF status, despite the relatively small cohort, calls for further investigation in this promising direction, and may facilitate with basic assessment and clinical decision-making for patients with equivocal neuro-ophthalmologic evaluation, as well as with poor compliance.
Collapse
Affiliation(s)
- Elad Avraham
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Amit Azriel
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Farouq Alguayn
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Abed Al Gawad Siag
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Aloni
- Ophthalmology Department, Barzilai Medical Center, Ashkelon, Israel
| | - Yuval Sufaro
- Department of Neurosurgery, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
29
|
Ophthalmic and orbital considerations in the evaluation of skull base malignancies. J Neurooncol 2020; 150:483-491. [PMID: 32361865 DOI: 10.1007/s11060-020-03516-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system. METHODS We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base. RESULTS AND CONCLUSION Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.
Collapse
|
30
|
Kotoda Y, Kotoda M, Ogiwara M, Kinouchi H, Iijima H. Left-Right and Upper-Lower Light Sensitivity Asymmetry in Visual Field Defects Caused by Pituitary Adenoma: A Retrospective Observational Study. Clin Ophthalmol 2020; 14:317-324. [PMID: 32099316 PMCID: PMC6999783 DOI: 10.2147/opth.s234422] [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: 10/18/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to quantitatively investigate light sensitivity asymmetry both between left and right eyes and between upper and lower quadrant in the 30-degree visual field of patients with visual field defects caused by pituitary adenoma. Patients and Methods Preoperative Humphrey 30–2 perimetry results were reviewed retrospectively using the charts of 28 pituitary adenoma patients who underwent surgery. Inter-eye light sensitivity comparisons of the temporal and nasal hemifields between the left and right eyes were conducted in each patient to study left-right asymmetry. Upper-lower asymmetry was investigated by comparing the frequency of severe scotoma (light sensitivity 5 dB or less) in the upper and lower visual field quadrants in the temporal and nasal hemifields. Results Left-right asymmetry was demonstrated in 61% of cases in the temporal hemifield and in 57% of cases in the nasal hemifield. Severe scotoma test points were investigated in the worse eye of each patient and were more frequent in the superotemporal quadrant of the visual field compared with the inferotemporal quadrant (P = 0.00029) and in the inferonasal quadrant compared to the superonasal quadrant (P = 0.00268). Conclusion Asymmetric visual field defects between left and right eyes are common in patients with pituitary adenoma. Severe scotoma is more frequent in the upper quadrant of the temporal hemifield and in the lower quadrant of the nasal hemifield.
Collapse
Affiliation(s)
- Yumi Kotoda
- Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masakazu Kotoda
- Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masakazu Ogiwara
- Department of Neurosurgery, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Iijima
- Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| |
Collapse
|
31
|
van Essen MJ, Muskens IS, Lamba N, Belunek SFJ, van der Boog ATJ, Amelink GJ, Gosselaar PH, van Doormaal TPC, Stades AME, Verhoeff JJC, van Genderen MM, Eenhorst CAE, Broekman MLD. Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience. J Neurol Surg B Skull Base 2020; 82:e79-e87. [PMID: 34306920 DOI: 10.1055/s-0039-3402020] [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: 03/20/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022] Open
Abstract
Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes. Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al. Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively ( p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort ( p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD ( p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04). Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.
Collapse
Affiliation(s)
- Max J van Essen
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo S Muskens
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, California, United States
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stephan F J Belunek
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur T J van der Boog
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Johan Amelink
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter H Gosselaar
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Aline M E Stades
- Department of Internal medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria M van Genderen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christine A E Eenhorst
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marike L D Broekman
- Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States.,Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
32
|
Almazrouei R, Qayum A, Hope D, Hatfield E. Unusual visual field defect with giant pituitary adenoma. QJM 2020; 113:59-60. [PMID: 31106815 DOI: 10.1093/qjmed/hcz115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R Almazrouei
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 9th Floor, East Wing, Fulham Palace Road, London, UK
| | - A Qayum
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 9th Floor, East Wing, Fulham Palace Road, London, UK
| | - D Hope
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 9th Floor, East Wing, Fulham Palace Road, London, UK
| | - E Hatfield
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, 9th Floor, East Wing, Fulham Palace Road, London, UK
| |
Collapse
|
33
|
Yamaguchi R, Tosaka M, Miyagishima T, Osawa T, Horiguchi K, Honda F, Yoshimoto Y. Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions. J Neurosurg 2019; 134:180-188. [PMID: 31835251 DOI: 10.3171/2019.9.jns191365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Visual acuity impairment due to sellar and suprasellar tumors is not fully understood. The relationship between these tumors and disturbance of visual function was examined using preoperative MRI. METHODS This study reviewed 93 consecutive patients with sellar and suprasellar tumors. Best-corrected visual acuity (BCVA) and visual impairment score (VIS) were used for estimation of visual impairments. Preoperative MR images were examined to obtain several values for estimation of chiasmatic compression. Additionally, the optic nerve-canal bending angle (ONCBA) was newly defined as the external angle formed by the optic nerve in the optic canal and the optic nerve in the intracranial subarachnoid space at the junction, using preoperative sagittal T2-weighted MR images. RESULTS The mean ONCBA was about the same on the right (44° ± 25°) and the left (44° ± 24°). Sagittal ONCBA was defined as large (> 45°) and moderate (≤ 45°) on each side. Preoperative VIS was found to be significantly worse if the right or left ONCBA (or both) was large (right side: ONCBA large [median 20, IQR 8-30] > ONCBA moderate [median 10, IQR 3-17], p = 0.003, Mann-Whitney U-test; left side: ONCBA large [median 22, IQR 9-30] > ONCBA moderate [median 10, IQR 2-16], p = 0.001). A large ONCBA showed a significant relationship with unfavorable ipsilateral BCVA (> logMAR, 0; right side, p = 0.001, left side, p = 0.001, chi-square test). The ONCBA had a positive correlation with ipsilateral BCVA (right: r = 0.297, p = 0.031; left: r = 0.451, p = 0.000, Pearson's correlation coefficient). Preoperative BCVA was significantly lower on the same side in the large ONCBA group compared with the moderate ONCBA group (right side: large ONCBA 0.169 ± 0.333 [logMAR, mean ± standard deviation] vs moderate ONCBA 0.045 ± 0.359, p = 0.026, Student t-test; left side: large ONCBA 0.245 ± 0.346 vs moderate ONCBA 0.025 ± 0.333, p = 0.000). This visual acuity impairment improved after resection of the tumors. CONCLUSIONS Sagittal bending of the optic nerve at the entrance from the intracranial subarachnoid space to the optic canal may be related to ipsilateral deterioration of visual acuity in sellar and suprasellar lesions. Sagittal T2-weighted MRI is recommended for preoperative estimation of the optic nerve bending.
Collapse
|
34
|
Esposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, Johannsson G. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary 2019; 22:422-434. [PMID: 31011999 PMCID: PMC6647426 DOI: 10.1007/s11102-019-00960-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Non-functioning pituitary adenomas (NFPAs) are associated with impaired well-being, increased comorbidities, and reduced long-term survival. Data on optimal management of NFPAs around surgical treatment are scarce, and postoperative treatment and follow-up strategies have not been evaluated in prospective trials. Here, we review the preoperative, perioperative, and early postoperative management of patients with NFPAs. METHODS We searched Medline and the Cochrane Library for articles published in English with the following items "Pituitary neoplasms AND Surgery" and "Surgery AND Hypopituitarism". Studies containing detailed analyses of the management of NFPAs in adult patients, including pituitary surgery, endocrine care, imaging, ophthalmologic assessment and long-term outcome were reviewed. RESULTS Treatment options for NFPAs include active surveillance, surgical resection, and radiotherapy. Pituitary surgery is currently recommended as first-line treatment in patients with visual impairment due to adenomas compressing the optic nerves or chiasma. Radiotherapy is reserved for large tumor remnants or tumor recurrence following one or more surgical attempts. There is no consensus of optimal pre-, peri-, and postoperative management such as timing, frequency, and duration of endocrine, radiologic, and ophthalmologic assessments as well as management of smaller tumor remnants or tumor recurrence. CONCLUSIONS In clinical practice, there is a great variation in the treatment and follow-up of patients with NFPAs. We have, based on available data, suggested an optimal management strategy for patients with NFPAs in relation to pituitary surgery. Prospective trials oriented at drawing up strategies for the management of NFPAs are needed.
Collapse
Affiliation(s)
- Daniela Esposito
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden.
| | - Daniel S Olsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlange, Germany
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| |
Collapse
|
35
|
Thomas PBM, Chan T, Nixon T, Muthusamy B, White A. Feasibility of simple machine learning approaches to support detection of non-glaucomatous visual fields in future automated glaucoma clinics. Eye (Lond) 2019; 33:1133-1139. [PMID: 30833668 DOI: 10.1038/s41433-019-0386-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/13/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the performance of feed-forward back-propagation artificial neural networks (ANNs) in detecting field defects caused by pituitary disease from among a glaucomatous population. METHODS 24-2 Humphrey Visual Field reports were gathered from 121 pituitary patients and 907 glaucomatous patients. Optical character recognition was used to extract the threshold values from PDF reports. Left and right eye visual fields were coupled for each patient in an array to create bilateral field representations. ANNs were created to detect chiasmal field defects. We also assessed the ability of ANNs to identify a single pituitary field among 907 glaucomatous distractors. RESULTS Mean field thresholds across all locations were lower for pituitary patients (20.3 dB, SD = 5.2 dB) than for glaucoma patients (24.4 dB, SD = 5.0 dB) indicating a greater degree of field loss (p < 0.0001) in the pituitary group. However, substantial overlap between the groups meant that mean bilateral field loss was not a reliable indicator of aetiology. Representative ANNs showed good performance in the discrimination task with sensitivity and specificity routinely above 95%. Where a single pituitary field was hidden among 907 glaucomatous fields, it had one of the five highest indexes of suspicion on 91% of 2420 ANNs. CONCLUSIONS Traditional artificial neural networks perform well at detecting chiasmal field defects among a glaucoma cohort by inspecting bilateral field representations. Increasing automation of care means we will need robust methods of automatically diagnosing and managing disease. This work shows that machine learning can perform a useful role in diagnostic oversight in highly automated glaucoma clinics, enhancing patient safety.
Collapse
Affiliation(s)
- Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, EC1V 9EL, UK.
| | - Thomas Chan
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
| | - Thomas Nixon
- Department of Ophthalmology, Faculty of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Brinda Muthusamy
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew White
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia.,PersonalEYES, Sydney, NSW, Australia
| |
Collapse
|
36
|
Correlation of MRI Findings With Patterns of Visual Field Loss in Patients With Pituitary Tumors. J Neuroophthalmol 2019; 39:333-338. [PMID: 30807381 DOI: 10.1097/wno.0000000000000763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compression of the optic chiasm by pituitary tumors typically results in bitemporal hemianopia, implying that nasal retinal fibers are preferentially damaged. The reason for this is not clear. One theory suggests that nasal fibers are selectively vulnerable simply because they cross each other. This study investigated the "crossing theory" by correlating visual field (VF) loss with chiasmal elevation and with the degree of eccentric compression on MRI scans. METHODS Our hospital database was searched to identify patients with a) chiasmal compression by a pituitary tumor; b) documented preoperative evidence of VF loss; and c) preoperative MRI scan performed within 1 month of VF testing. Temporality and bitemporality indices were derived from pattern deviation VF plots. Elevations of the central and peripheral parts of the chiasm were obtained from MRI scans, from which the eccentricity of compression was calculated. Temporality indices and hemifield loss were compared with central chiasmal elevation, and nasal hemifield loss in each eye was plotted against eccentricity. RESULTS Eleven patients were suitable for analysis. The degree of bitemporal VF involvement was significantly correlated with elevation of the central chiasm (P = 0.004). However, there was minimal involvement of nasal VFs, and no demonstrable increase in nasal field loss with increasing eccentricity of compression. CONCLUSIONS This study provides support for the crossing theory. These findings will inform further finite element models of chiasmal compression. A larger, prospective study is planned.
Collapse
|
37
|
Feng R, Schwartz J, Loewenstern J, Kohli K, Lenina S, Ultakan S, Iloreta AM, Govindaraj S, Bederson J, Banik R, Shrivastava R. The Predictive Role of Intraoperative Visual Evoked Potentials in Visual Improvement After Endoscopic Pituitary Tumor Resection in Large and Complex Tumors: Description and Validation of a Method. World Neurosurg 2019; 126:e136-e143. [PMID: 30794978 DOI: 10.1016/j.wneu.2019.01.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND With the advent of extensive endoscopic approaches for pituitary tumors, there has also been an increase in surgery for larger and more complex tumors. Intraoperative manipulation during endoscopic resection of sellar tumors poses potential risk in postoperative visual function in this tumor population. This study proposes a method of accurate intraoperative monitoring of visual evoked potentials (VEPs) and its role in predicting visual function outcomes. METHODS Intraoperative VEPs were monitored for 42 resections from a single surgical team, with average tumor size of 2.84 cm. Changes in VEP amplitude and latency in excess of 50% were considered significant. Preoperative and postoperative visual information was obtained from ophthalmology and hospital records, along with patient demographics, comorbidities, and tumor characteristics. RESULTS Patients were stratified as experiencing deteriorations in VEPs that did not restore to baseline (n = 4), deteriorations in VEPs that did restore to baseline (n = 6), no change in VEPs (n = 31), and improvement in VEPs (n = 1). Correlation between VEP changes and postoperative visual fields was measured through univariate ordered logistic regression. Improved intraoperative VEP measurements were associated with odds ratio (OR) of visual field improvement of 3.15 (95% confidence interval, 1.15-8.59). Specifically, changes in VEP amplitude were positively associated with visual field improvement with OR of 4.35 (OR, 1.29-14.7). No association was observed between VEPs and other patient or tumor characteristics. CONCLUSION Changes in VEP amplitude during endoscopic sellar tumor resection correlate with postoperative visual function. Intraoperative VEP monitoring can serve an important role in preventing postoperative visual field loss.
Collapse
Affiliation(s)
- Rui Feng
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Jeffrey Schwartz
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karan Kohli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Svetlana Lenina
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sedat Ultakan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alfred-Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
38
|
MRI findings in Parinaud’s syndrome: a closer look at pineal masses. Neuroradiology 2019; 61:507-514. [DOI: 10.1007/s00234-019-02166-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/09/2019] [Indexed: 11/25/2022]
|
39
|
Habib SN, Lin Z, Puvanachandra N. Ocular hypertension secondary to high endogenous steroid load in Cushing's disease. BMJ Case Rep 2019; 12:12/1/bcr-2018-226738. [PMID: 30635306 DOI: 10.1136/bcr-2018-226738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case report describes a 35-year-old Caucasian man who was referred to the glaucoma clinic with high intraocular pressure (IOP) after routine optometrist assessment. He was diagnosed with ocular hypertension (OHT) and the management plan was for monitoring without treatment. Three months later, he presented to the endocrine clinic with symptoms of Cushing's disease and was diagnosed with an adrenocorticotropic hormone secreting pituitary microadenoma. His symptoms preceded his presentation at both departments by 5 years. He underwent definitive surgical treatment of his adenoma via transsphenoidal resection. At 1-year follow-up in glaucoma clinic, it was noted that his IOP had normalised. Due to his high endogenous cortisol level at diagnosis, long disease duration, the pattern of IOP rise and subsequent normalisation after treatment, it is suggestive that his OHT is secondary to his Cushing's disease. There are infrequent reports of this association in published literature.
Collapse
Affiliation(s)
- Sofia Noor Habib
- Ophthalmology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Zhiheng Lin
- Ophthalmology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Narman Puvanachandra
- Ophthalmology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| |
Collapse
|
40
|
Takahashi M, Goseki T, Ishikawa H, Hiroyasu G, Hirasawa K, Shoji N. Compressive Lesions of the Optic Chiasm: Subjective Symptoms and Visual Field Diagnostic Criteria. NEURO-OPHTHALMOLOGY (AEOLUS PRESS) 2018; 42:343-348. [PMID: 30524487 DOI: 10.1080/01658107.2018.1438477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 09/30/2022]
Abstract
We investigated the diagnostic ability of a new criterion (simple temporal depression) for compressive lesions of the optic chiasm. The subjects were 124 eyes with compressive lesions of the optic chiasm. The controls were 84 eyes. The Humphrey (Carl Zeiss) visual field test was used for visual field testing. The simple temporal depression index was calculated as the ratio of the sums of the thresholds for one line on the nasal side and temporal side of the vertical meridian. The result of new index was 87% sensitivity and 99% specificity. This result suggested that our new criterion will assist the diagnosis in the future.
Collapse
Affiliation(s)
- Mikiko Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| | - Hitoshi Ishikawa
- Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan.,Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Goukon Hiroyasu
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| |
Collapse
|
41
|
Jørstad ØK, Wigers AR, Marthinsen PB, Moe MC, Evang JA. Loss of horizontal macular ganglion cell complex asymmetry: an optical coherence tomography indicator of chiasmal compression. BMJ Open Ophthalmol 2018; 3:e000195. [PMID: 30519642 PMCID: PMC6243475 DOI: 10.1136/bmjophth-2018-000195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To estimate the macular ganglion cell complex (GCC) asymmetry in patients with suprasellar tumours, to compare its diagnostic performance to the nasal GCC thickness and visual field (VF) and to investigate how the parameters correlate with magnetic resonance imaging (MRI) findings. Methods and analysis Cross-sectional study of patients with suprasellar tumours affecting the optic chiasm. Macular optical coherence tomography (OCT) scans were evaluated for nasal GCC sector thinning and loss of normal GCC asymmetry between corresponding nasal-temporal sectors. Equivalently, VFs were analysed for defects compatible with chiasm dysfunction. The relationship between optic chiasm and tumour was measured on MRI. Results Thirty-three eyes of 33 patients were included. There were OCT findings in 14 eyes. Nasal GCC thinning was found in 9 eyes and loss of GCC asymmetry in 12 eyes; the two parameters were not significantly different with respect to number of positive findings (p=0.45). Loss of GCC asymmetry, however, occurred in 5 eyes among 24 without GCC thinning (proportion 0.21; 95% confidence interval 0.071 to 0.42). In 8 eyes, VF indicated pathology; of these, 7 had concurring OCT findings. The prevalence of OCT and VF findings increased significantly with suprasellar tumour extension on MRI. Conclusion The diagnostic capabilities of nasal GCC thinning and loss of GCC asymmetry were comparable, whilst their complementary performances increased the proportion of eyes in which OCT suggested compression. The prevalence of both OCT and VF findings grew with suprasellar tumour extension. In several cases, however, structural findings on OCT preceded detectable VF deficits.
Collapse
Affiliation(s)
| | - Andreas Reidar Wigers
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | | | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Johan Arild Evang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
42
|
Castle-Kirszbaum M, Goldschlager T, Ho B, Wang YY, King J. Twelve cases of pituitary metastasis: a case series and review of the literature. Pituitary 2018; 21:463-473. [PMID: 29974330 DOI: 10.1007/s11102-018-0899-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The pituitary gland is an unusual site for metastatic spread, but as patients with metastatic malignancy are living longer, it may become more prevalent. Compression of important anatomy adjacent to the sella may produce disabling symptoms and endocrine derangement, leading to significant morbidity. METHODS An ambispective review of patient records between 2013 and 2017 from three neurosurgical centres was performed. After identifying cases, further investigation was performed to evaluate patient demographic, symptoms at presentation, radiological and histological findings, management, and outcome. RESULTS Our investigation identified 12 patients with pituitary metastasis. The average age of the cases was 63.4 years, with breast (n = 4) and lung (n = 4) being the most common primary cancers. In half the cases there was a history of metastatic disease, while in one-quarter of cases, pituitary symptoms were the first sign of malignancy. Adenohypophyseal dysfunction (83%), diabetes insipidus (DI) (75%), headache (67%) and visual field defects (67%) were the most common findings at presentation. Glucocorticoid replacement increased the sensitivity for diagnosis of DI. All cases were contrast enhancing on MRI and the endoscopic trans-sphenoidal approach was preferred for biopsy and debulking. CONCLUSIONS The pituitary should not be overlooked as a site of metastasis and sellar symptoms may be the first presentation of neoplastic disease. Any biochemical or clinical sign of pituitary pathology in a patient with known cancer should raise suspicion for sellar metastasis. Moreover, the development of DI or ophthalmoplegia from any pituitary lesion is suggestive of metastatic disease even in patients with no known primary.
Collapse
Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Benjamin Ho
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| |
Collapse
|
43
|
Gan L, Ma J, Feng F, Wang Y, Cui J, Guo X, Zhang X, You H, Wang Z, Yin Z, Zhong Y, Xing B. The Predictive Value of Suprasellar Extension for Visual Function Evaluation in Chinese Patients with Nonfunctioning Pituitary Adenoma with Optic Chiasm Compression. World Neurosurg 2018; 116:e960-e967. [PMID: 29857216 DOI: 10.1016/j.wneu.2018.05.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the quantitative relationship between suprasellar extension (SSE) and visual function impairment in Chinese patients with nonfunctioning pituitary adenoma (NFPA) with optic chiasm compression. METHODS We retrospectively reviewed 117 patients with NFPA and optic chiasm compression treated at our hospital between January 2013 and December 2016. The quantitative relationships between SSE detected on sagittal and coronal magnetic resonance imaging (MRI) sections and visual function, including visual acuity (VA) and visual fields (VFs), were analyzed. The cutoff value of SSE to predict a VF defect (VFD) was calculated using a receiver operating characteristic curve. The mean deviation (MD) value was used to quantitatively analyze the VFs, and multiple linear regression analysis was performed to investigate risk factors of VFD. RESULTS Among 117 patients with NFPA, 77 (65.8%) had VFD, and the mean VA was 0.42 ± 0.38 logMAR. The cutoff value of the sagittal SSE was 14.0 mm, with 77.9% sensitivity and 80.0% specificity, and the cutoff value of the coronal SSE was 15.8 mm, with 81.8% sensitivity and 85.0% specificity. The values of SSE on 2 MRI sections were correlated with VA (P < 0.001) and the MD (P < 0.001). Multiple linear regression analysis demonstrated that SSE on sagittal views (P < 0.001), SSE on coronal views (P < 0.001), duration of the disease (P = 0.027), and apoplexy (P = 0.036) were related to the degree of VF damage. CONCLUSIONS VFD in patients with NFPA with chiasm compression can be predicted by SSE on MRI. There is a linear correlation between SSE and the MD value.
Collapse
Affiliation(s)
- Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiantao Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenming Yin
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
44
|
Abstract
PURPOSE Non-functioning pituitary adenomas (NFPAs) are benign pituitary neoplasms that do not cause a hormonal hypersecretory syndrome. An improved understanding of their epidemiology, clinical presentation and diagnosis is needed. METHOD A literature review was performed using Pubmed to identify research reports and clinical case series on NFPAs. RESULTS They account for 14-54% of pituitary adenomas and have a prevalence of 7-41.3/100,000 population. Their standardized incidence rate is 0.65-2.34/100,000 and the peak occurence is from the fourth to the eighth decade. The clinical spectrum of NFPAs varies from being completely asymptomatic to causing significant hypothalamic/pituitary dysfunction and visual field compromise due to their large size. Most patients present with symptoms of mass effect, such as headaches, visual field defects, ophthalmoplegias, and hypopituitarism but also hyperprolactinaemia due to pituitary stalk deviation and less frequently pituitary apoplexy. Non-functioning pituitary incidentalomas are found on brain imaging performed for an unrelated reason. Diagnostic approach includes magnetic resonance imaging of the sellar region, laboratory evaluations, screening for hormone hypersecretion and for hypopituitarism, and a visual field examination if the lesion abuts the optic nerves or chiasm. CONCLUSION This article reviews the epidemiology, clinical behaviour and diagnostic approach of non-functioning pituitary adenomas.
Collapse
Affiliation(s)
- Georgia Ntali
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
| | - John A Wass
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| |
Collapse
|
45
|
Anik I, Anik Y, Cabuk B, Caklili M, Pirhan D, Ozturk O, Cirak M, Ceylan S. Visual Outcome of an Endoscopic Endonasal Transsphenoidal Approach in Pituitary Macroadenomas: Quantitative Assessment with Diffusion Tensor Imaging Early and Long-Term Results. World Neurosurg 2018; 112:e691-e701. [DOI: 10.1016/j.wneu.2018.01.134] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
|
46
|
Sriram PR, Sellamuthu P, Ghani ARI. Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study. Malays J Med Sci 2018; 24:58-67. [PMID: 29379387 DOI: 10.21315/mjms2017.24.6.7] [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: 05/05/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022] Open
Abstract
Background Despite the broad category of differentials for sellar region, most of them present with similar clinical signs and symptoms. Headache and visual disturbance are among the frequently seen as presenting symptom. Visual field (VF) assessment is one of the crucial component of neuroophtalmologic assessment and mean deviation (MD) value from automated perimetry allows quantification of the visual field defect. We formulated a study to look into the factors that affect the visual field outcome after surgery. Methods All patients with sellar region tumor who has underwent surgery in Queen Elizabeth Hospital from July 2010 to July 2016 were retrospectively analysed through hospital notes. VF assessment via Humphrey visual assessment for these patient pre and post-surgery were reviewed for MD value. Results Eighty four patients were recruited and out of them, 151 eyes were taken into analysis after excluding eyes with missing data. Mean age of patients were 45.4 years with 70.2% of them were male. Visual disturbance is the commonest presenting symptom with mean duration of symptom prior to surgery is 9.7 months. Majority of them were pituitary adenomas (75%) followed by sellar meningioma (19%), craniopharyngioma (4.8%), and rathke cleft cyst (1.2%). 70.9% of patients showed improvement in VF based on MD outcome. Mean MD for pre surgery and post-surgery were -14.0 dB and -12.4 dB, respectively. Univariate analysis reveals younger age, female sex, shorter duration of symptom, pituitary adenoma, transsphenoidal approach, and transcranial approach favours improvement in VF. Multivariate analysis shows only shorter symptom duration, transphenoidal approach, and transcranial approach are significant for favourable VF outcome when other factors adjusted. Conclusion Symptom duration and surgical approach were independent factors that affects the visual field after surgery in patients with sellar region tumors.
Collapse
Affiliation(s)
- Prabu Rau Sriram
- Department of Neurosurgery, Queen Elizabeth Hospital, 88200 Kota Kinabalu, Sabah, Malaysia.,Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Center for Neuroscience Services and Research, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Puliventhan Sellamuthu
- Department of Neurosurgery, Queen Elizabeth Hospital, 88200 Kota Kinabalu, Sabah, Malaysia
| | - Abdul Rahman Izani Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
47
|
Hisanaga S, Kakeda S, Yamamoto J, Watanabe K, Moriya J, Nagata T, Fujino Y, Kondo H, Nishizawa S, Korogi Y. Pituitary Macroadenoma and Visual Impairment: Postoperative Outcome Prediction with Contrast-Enhanced FIESTA. AJNR Am J Neuroradiol 2017; 38:2067-2072. [PMID: 28912278 DOI: 10.3174/ajnr.a5394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced FIESTA can depict anterior optic pathways in patients with large suprasellar tumors. We assessed whether the degree of kink in the optic nerve at the optic canal orifice on contrast-enhanced FIESTA correlates with the postoperative improvement of visual impairment in patients with pituitary macroadenoma. MATERIALS AND METHODS Thirty-one patients with pituitary macroadenoma who underwent preoperative MR imaging and an operation were evaluated. We measured the optic nerve kinking angle on sagittal oblique contrast-enhanced FIESTA parallel to the optic nerve; the optic nerve kinking angle was defined as the angle between a line parallel to the planum sphenoidale and a line parallel to the intracranial optic nerve at the optic canal orifice. We used logistic regression analyses to determine whether the clinical (sex, age, and duration of symptoms) and imaging (tumor height, chiasmal compression severity, hyperintense optic nerve on T2WI, and optic nerve kinking angle) characteristics were associated with the postoperative improvement (good-versus-little improvement) of visual acuity disturbance and visual field defect. RESULTS There were 53 impaired sides before the operation: 2 sides with visual acuity disturbance alone, 25 with visual field defect alone, and 26 with both. After the operation, good improvement was found in 17 of the 28 sides with visual acuity disturbance and in 32 of the 51 sides with visual field defects. Only the optic nerve kinking angle was significantly associated with good improvement of the visual acuity disturbance (P = .011) and visual field defect (P = .002). CONCLUSIONS The degree of the optic nerve kinking angle was an independent predictor of postoperative improvement, indicating that irreversible damage to the optic nerve may be associated with its kinking at the optic canal orifice.
Collapse
Affiliation(s)
- S Hisanaga
- From the Departments of Radiology (S.H., S.K., K.W., J.M., Y.K.)
| | - S Kakeda
- From the Departments of Radiology (S.H., S.K., K.W., J.M., Y.K.)
| | | | - K Watanabe
- From the Departments of Radiology (S.H., S.K., K.W., J.M., Y.K.)
| | - J Moriya
- From the Departments of Radiology (S.H., S.K., K.W., J.M., Y.K.)
| | | | - Y Fujino
- Preventive Medicine and Community (Y.F.), University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | | | | | - Y Korogi
- From the Departments of Radiology (S.H., S.K., K.W., J.M., Y.K.)
| |
Collapse
|
48
|
Boland MV, Lee IH, Zan E, Yousem DM, Miller NR. Quantitative Analysis of the Displacement of the Anterior Visual Pathway by Pituitary Lesions and the Associated Visual Field Loss. Invest Ophthalmol Vis Sci 2017; 57:3576-80. [PMID: 27388050 PMCID: PMC4942251 DOI: 10.1167/iovs.16-19410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate quantitatively the relationship between the displacement of anterior visual pathway structures by pituitary tumors and visual field damage with the goal of improving diagnosis and management. Methods Subjects had pituitary macroadenomas and both magnetic resonance imaging (MRI) and static perimetry. Neuroradiologists measured the displacement of anterior visual pathway structures and right–left tumor asymmetry. To quantify the degree and laterality of visual field loss, we used algorithms from the neurologic hemifield test to analyze each right–left pair of visual fields with respect to temporal asymmetry, the proportion of loss that was temporal, total asymmetry, and total damage. We compared these metrics with the displacement of anterior visual pathway structures and tumor asymmetry. Results Of 114 subjects, 64 (56%) were male and the median age was 57 years (range, 14–88). The summation of vision loss in both eyes and the proportion of temporal loss were statistically significantly related to the maximum displacement of the anterior visual pathway (both P < 0.001 for fit of linear regression). The relationship between the asymmetry of visual field loss in the two eyes and the subjective assignment of tumor asymmetry on MRI did not achieve statistical significance (P = 0.06 by analysis of variance). Conclusions Displacement of the anterior visual pathway by pituitary tumors is associated with both the total amount of visual field loss and the proportion of temporal visual field loss. Although there was right–left asymmetry of vision loss in some subjects, it was not related to the subjective assessment of tumor asymmetry.
Collapse
Affiliation(s)
- Michael V Boland
- Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, Maryland, United States 2Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - In Ho Lee
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States 4Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Elcin Zan
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - David M Yousem
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Neil R Miller
- Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| |
Collapse
|