Spectrum of Visual Deficits Associated with Pituitary Adenoma and Factors Determining Visual Outcome in More Than 2,000 Eyes

Object Clinoidal meningiomas remain a major neurosurgical challenge. Surgery-related outcome has been less than desirable in the past, and little attention has been directed toward improving visual deficits. The authors advocate a skull base technique for the removal of these difficult tumors and describe its advantages in terms of improving extent of resection and enhancing overall outcome, particularly visual function. Methods A retrospective analysis was performed on data obtained in 26 consecutive patients with clinoidal meningiomas (including one patient with hemangiopericytoma) who underwent resection between June 1995 and January 2003. In 24 cases the skull base procedure involved extradural anterior clinoidectomy, optic canal unroofing, and optic sheath opening; in two cases a standard pterional craniotomy was performed. Fourteen of the 26 patients suffered significant preoperative visual deficits. All patients underwent thorough pre- and postoperative ophthalmological evaluations. The follow-up period ranged from 3 to 91 months (mean 42.3 months). Total resection was achieved in 20 patients (77%), and the majority (76.9%) of patients with preoperative visual impairment experienced significant improvement. Conclusions With the use of the skull base technique, total resection and excellent visual outcome may be achieved with minimal morbidity in most patients with clinoidal meningiomas.

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Endoscopic endonasal pituitary adenoma surgery: our surgical experience in 116 patients

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204626 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2029

Author(s):

Krishna Vikas Potdukhe ◽

Kalpesh Patel ◽

Rajesh Vishwakarma

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome ◽

Primary Objective ◽

Partial Resection ◽

High Rate ◽

Endocrine Function ◽

Gross Total Resection ◽

Imaging Data ◽

Total Resection ◽

Endoscopic Endonasal

Background: The primary objective of this study was to evaluate the outcome of excision in terms of gross and partial resection rates compared to the grades of pituitary adenoma (based on Hardy-Vezina classification). We also evaluated the post-operative complications and the effect of resection on visual outcomes and endocrinological remission.Methods: We retrospectively analysed 116 patients who underwent surgical resection of pituitary adenoma via endonasal trans-sphenoidal approach at Civil Hospital (Ahmedabad) between March 2013 and March 2019 and collected pre-operative and post-operative data in terms of imaging, endocrine function and vision. Results: According to the postoperative imaging data and endocrine examination results, gross-total resection (GTR) was achieved in 79.3% (92 patients), and partial (PR) in 20.6% (24 patients) which was significant (p<0.05). Improvement in vision was seen in 62% (40 patients out of 64 patients). Out of 44 patients having endocrine dysfunction, endocrinological remission was achieved in 32 patients with functional adenomas (72.7%). Sinusitis followed by headache was the most common minor complication seen in the study.Conclusions: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for patients having grade 3 or lower pituitary adenomas, which leads to gross total resection in comparison to patients having grade 4 adenoma. It also results in high rate of surgical decompression and better visual outcome. Partial resection may result in endocrinological response in functional tumors.

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Visual outcome after surgery in patients with suprasellar tumors and preoperative blindness

Journal of Neurosurgery ◽

10.3171/jns/2008/108/01/0019 ◽

2008 ◽

Vol 108 (1) ◽

pp. 19-25 ◽

Cited By ~ 18

Author(s):

Ashish Suri ◽

Karanjit Singh Narang ◽

Bhawani Shankar Sharma ◽

Ashok Kumar Mahapatra

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome ◽

Bivariate Analysis ◽

Factors Affecting ◽

Visual Improvement ◽

History Of ◽

Sellar Tumor ◽

Tumor Consistency ◽

Age Range

Object The purpose of this paper was to study the visual outcome after surgery in patients with suprasellar tumors who experienced preoperative blindness in 1 or both eyes. Methods All patients with suprasellar tumors and no perception of light in 1 or both eyes and who underwent surgery between May 2002 and May 2006 were included in this retrospective study. Outcome was analyzed at discharge from the hospital and at follow-up. There were a total of 79 patients (51 males and 28 females, age range 5–70 years). There were 37 cases of pituitary adenomas, 19 craniopharyngiomas, 18 meningiomas, and 5 other tumors. Preoperatively 61 patients had uniocular blindness and 18 patients had binocular blindness. Of all 158 eyes, 97 (61.4%) were blind at admission and these eyes were analyzed. Sixty-three patients (79.7%) presented with headache and 14 (17.7%) with hypothalamic symptoms. Nearly one fourth (24%) of patients with a pituitary adenoma had a history of apoplexy. The duration of visual decline ranged from 3 days to 7 years, and the duration of blindness ranged from 1 day to 3 years. Patients underwent either transcranial or transsphenoidal tumor decompression. Results At discharge from the hospital visual improvement was exhibited in 23 (29%) of 79 patients and 27 (27.8%) of 97 eyes. Improvement to serviceable vision occurred in 7 (8.9%) of 79 patients and in 8 (8.2%) of 97 eyes with pre-operative blindness. After surgery, visual improvement was noted in 15 (24.6%) of 61 patients with uniocular blindness and 8 (44.4%) of 18 patients with binocular blindness. However, serviceable vision was restored in 5 (8.2%) of 61 patients with uniocular and 2 (11.1%) of 18 patients with binocular blindness. Bivariate analysis revealed male sex, shorter duration of blindness, presence of apoplexy, sellar tumor extension, soft tumor consistency, operative evidence of hemorrhage in tumor, and tumor histopathology (pituitary adenoma) to have significant impact on the outcome. Multivariate analysis revealed duration of blindness for > 12 weeks, apoplexy, and sellar extension to have a significant impact on visual outcome. Conclusions The present study is the largest in the existing medical literature to evaluate the factors affecting visual outcome after surgery of suprasellar tumors with preoperative blindness.

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Fluid-fluid level in pituitary tumors: analysis of management of 106 cases

Journal of Neurosurgery ◽

10.3171/2009.11.jns091083 ◽

2010 ◽

Vol 112 (6) ◽

pp. 1341-1346 ◽

Cited By ~ 14

Author(s):

Atul Goel ◽

Abhidha Shah ◽

Sukhdeep Singh Jhawar ◽

Naina K. Goel

Keyword(s):

Pituitary Tumors ◽

Visual Outcome ◽

Fluid Level ◽

Recurrence Rates ◽

Maximum Dimension ◽

Visual Deficits ◽

Time Of Presentation ◽

Symptom Progression ◽

Fluid Levels

Object The management issues of 106 cases of pituitary tumors with a fluid level within the fluid content of the cystic part of the tumor (a “fluid-fluid” level) were reviewed. Methods Between 2000 and March 2009, 1660 pituitary tumors were treated neurosurgically at K.E.M. Hospital. Investigations of 106 of these cases revealed a fluid-fluid level within the tumor. All patients underwent surgery via a transsphenoidal route. The mean follow-up duration was 46 months. Results The tumors varied in size: 31 were between 1 and 3 cm, and 75 were larger than 3 cm in maximum dimension (mean maximum dimension 3.4 cm). Fifty-two tumors had 1 fluid level, 11 had 2, and 43 had multiple fluid levels (≥ 3). The onset of symptoms was acute in 8 cases and insidious in 98 cases. In 16 cases, there was evidence of acute exacerbation of symptoms during the course of symptom progression. The symptoms were progressive in all cases. Ninety-seven percent of patients had visual deficits at the time of presentation. The solid portion of the tumor was relatively friable and vascular in most cases, and the fluid varied in color and in consistency, from a thin yellow to dark red liquid. Visual outcome was extremely gratifying in the majority of cases; of those presenting with visual dysfunction, 94% reported visual recovery in the immediate postoperative period. During the follow-up period, there was tumor recurrence in 21 cases; in 12 of these cases, the authors documented a fluid-fluid level. The histological features did not indicate malignancy in any case. Conclusions A fluid level within a fluid cavity in pituitary tumors is rarely reported but is not uncommon in large/giant tumors. The presence of such a feature suggests that surgery in these cases can be relatively straightforward despite the lesion's large size, and the visual outcome is gratifying. However, recurrence rates are relatively higher in such cases than in other pituitary tumors.

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Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v28i2.17182 ◽

2013 ◽

Vol 28 (2) ◽

pp. 108-115

Author(s):

Md Rezaul Amin ◽

Haradhon Deb Nath ◽

M Afzal Hossain ◽

Kanak Kanti Barua

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Visual Function ◽

Tumor Resection ◽

Visual Outcome ◽

Visual Field Defects ◽

Bivariate Analysis ◽

P Value ◽

Duration Of Symptoms ◽

Visual Status

Background: Pituitary adenoma, which accounts for 17.4% of all brain tumors, is the third most frequently diagnosed brain tumor, following intracranial glioma and meningioma. The visual disturbance in pituitary adenoma ranged from blurring of vision with or without headache to total loss of vision. In patients with visual field defects, bitemporal hemianopia was the commonest visual field defect. Early improvement of visual function is one of the major indication surgery. Objective: The purpose of this study was to comparison between the pre and post-operative visual parameters and to find out the value in assessment of the prognosis of early postoperative visual function and also to find out the factor which influence the early post-operative visual outcome. Methods: A prospective study was done from September 2010 to April 2012 in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, 30 cases of pituitary adenoma had been included in this study of those who were presented with visual symptoms. Visual assessment was done before the operation and outcome was analyzed at discharged from hospital. Results: Within 60 eyes, 13 (43.3%) patients presented with blindness of one or both eyes. 10 (33.3%) presented with uniocular and 3 (10.0%) presented with binocular blindness. Duration of the symptoms ranged from 2 months to 48 months. Patients underwent either transcranial or transsphenoidal tumor decompression. At discharge out of 30 patients, 23 (76.7%) showed improvement, 2 (6.6%) patients were deteriorated post-operatively. P value was <0.001, in z test, Z=91.5, which was highly significant. Post-operative visual status was analyzed with age, sex, duration of symptoms, suprasellar extension, and methods of surgery and extent of tumor resection to find out that any other factor influenced the visual outcome. In bivariate analysis it was shown that only duration of the symptoms only other factor that influenced the visual outcome (statistically significant, p value 0.017). Conclusion: With this study it was statistically proved that pre-operative visual status is the main factor for improvement of early post-operative visual outcome in pituitary adenoma and duration of symptoms had also influence the early post-operative visual outcome. Duration less than 12 months had a favorable outcome. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17182 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 108-115

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Visual outcome after pituitary adenoma surgery

Neurology India ◽

10.4103/0028-3886.193770 ◽

2016 ◽

Vol 64 (6) ◽

pp. 1254 ◽

Cited By ~ 1

Author(s):

SacitB Omay ◽

TheodoreH Schwartz

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome

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Influence of surgical or endovascular treatment on visual symptoms caused by intracranial aneurysms: single-center series and systematic review

Journal of Neurosurgery ◽

10.3171/2011.5.jns101983 ◽

2011 ◽

Vol 115 (4) ◽

pp. 694-699 ◽

Cited By ~ 27

Author(s):

Patrick Schuss ◽

Erdem Güresir ◽

Joachim Berkefeld ◽

Volker Seifert ◽

Hartmut Vatter

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Visual Outcome ◽

Surgical Clipping ◽

Visual Dysfunction ◽

Visual Symptoms ◽

Visual Deficits ◽

Unruptured Intracranial Aneurysms ◽

Number Of Patients

Object Intracranial aneurysms of the anterior circulation might become symptomatic by causing visual deficits. The influence of treatment modality on improvement is still unclear. The objective of this study was to analyze the recovery of visual deficits caused by the mass effect of intracranial aneurysms after surgical clipping or endovascular treatment. Methods Between June 1999 and December 2009, 20 patients with unruptured intracranial aneurysms causing visual dysfunction due to compression of the optical nerve were treated at the authors' institution. Visual deficits were recorded at admission and at follow-up. To evaluate a larger number of patients, MEDLINE was searched for published studies involving visual disturbance caused by an aneurysm. A multivariate analysis was performed to find independent predictors for favorable visual outcome. Results Nine (75%) of 12 patients treated surgically achieved improvement of visual symptoms, compared with 3 (38%) of 8 patients treated endovascularly. A literature review, including the current series, revealed a total of 165 patients with UIAs causing visual dysfunction. Surgical treatment was associated with a significantly higher rate of visual improvement (p = 0.002) compared with endovascular treatment. According to the multivariate analysis, surgical clipping was the only variable significantly associated with improvement of visual outcome (p = 0.02). Conclusions Aneurysm-related visual dysfunction developed from direct mechanical compression may improve after surgical clipping and endovascular coiling. However, based on the present series combined with pooled analysis of data from the literature, the only factor significantly associated with improvement of visual dysfunction was surgical clipping.

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