Fronto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term visual outcome

ObjectVarious surgical approaches, such as uni- and bifrontal, frontolateral, and pterional approaches, have been advocated for tuberculum sellae meningiomas. The authors retrospectively reviewed the effectiveness of a bilateral subfrontal approach for tuberculum sellae meningiomas with special attention to ophthalmological outcomes and complications.MethodsBetween 1993 and 2009, 34 patients underwent surgery for removal of tuberculum sellae meningiomas at Osaka City University. Tumor size ranged from 14 to 45 mm. Thirty-two of 34 patients presented with visual disturbances before the surgery. The visual functions in all patients were assessed using a visual impairment score (VIS) before and after surgery. Postoperative visual examination was performed 2 weeks after surgery. Long-term follow-up examinations were conducted 1 year after surgery.ResultsRadical resection (Simpson Grades I and II) was accomplished in 27 patients, and subtotal or partial resection (Simpson Grades III and IV) was achieved in 7. There was no deterioration in postoperative visual outcome. Twenty-nine (90.6%) of 32 patients showed improved VIS compared with preoperative VIS. The average VIS was 38.1 preoperatively, 23.5 in the short-term postoperative period, and 21.8 in the long-term postoperative period. In the short-term postoperative period, the visual function in 6 patients normalized, and visual problems persisted in the remaining 26. Six (23%) of 26 patients showed further improvement in VIS during the long-term follow-up period, and no patient exhibited a worsened VIS during this time. One patient complained of hyposmia after surgery, but there was no indication of related complications such as CSF leakage or frontal brain contusion.ConclusionsThe bilateral subfrontal approach was previously avoided because of the relatively high rate of complications in earlier surgical series of tuberculum sellae meningiomas. However, after developments in microsurgical techniques in recent years, the bilateral subfrontal approach can now provide satisfactory visual outcomes with minimal postoperative complications. Careful preservation of the blood supply to optic apparatus and early unroofing of the optic canal using a bilateral subfrontal approach led to further improvement in long-term postoperative visual outcome.

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Anterior Interhemispheric Approach for Tuberculum Sellae Meningioma

Operative Neurosurgery ◽

10.1227/neu.0b013e31820781e1 ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons84-ons89 ◽

Cited By ~ 6

Author(s):

Shunsuke Terasaka ◽

Katsuyuki Asaoka ◽

Hiroyuki Kobayashi ◽

Shigeru Yamaguchi

Keyword(s):

Visual Outcome ◽

Visual Field Defects ◽

Preoperative Period ◽

Tuberculum Sellae Meningioma ◽

Interhemispheric Approach ◽

Visual Status ◽

Number Of Patients ◽

Impairment Score ◽

Anterior Interhemispheric Approach ◽

Tuberculum Sellae

Abstract BACKGROUND: The tuberculum sellae meningioma (TSM) arises from the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale. OBJECTIVE: To retrospectively analyze patients with TSM who underwent surgery via an anterior interhemispheric approach, with special attention to visual outcomes. METHODS: Nine consecutive patients between April 2004 and December 2009 were examined. Visual impairment score (VIS) was used to analyze the visual status of the patients. A VIS is the sum of the scores in specific tables for visual acuity and visual field defects. Visual status was sequentially evaluated in the preoperative period and within 2 weeks of the operation. Any change in the VIS was considered an improvement or deterioration of visual function. All tumors were removed via an anterior interhemispheric approach. Following the wide dissection of the interhemispheric fissure, the tumor was first detached from its origin and debulked with the ultrasonic aspirator starting at the midline. The debulking continued until the arachnoid plane separating the nerve and tumor was visualized. RESULTS: Gross total resection (Simpson I + II) was achieved in all 9 patients. The average VIS was 56.1 in the preoperative period and 26.3 in the postoperative period. Among 9 patients, 8 patients had an improvement of the VIS after surgery. VIS was unchanged in 1 patient, and no patients experienced visual deterioration. Other nonvisual complications, such as rhinoliquorrhea, venous infarction, and permanent anosmia, occurred in 3 patients. CONCLUSION: Despite the small number of patients, a high resection rate and favorable visual outcome support the suitability of this approach for resection of TSM.

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Surgically Treated Tuberculum Sellae and Diaphragm Sellae Meningiomas

Neurosurgery ◽

10.1227/01.neu.0000223341.08402.c5 ◽

2006 ◽

Vol 59 (2) ◽

pp. 238-243 ◽

Cited By ~ 70

Author(s):

Chul-Kee Park ◽

Hee-Won Jung ◽

Seung-Yeob Yang ◽

Ho Jun Seol ◽

Sun Ha Paek ◽

...

Keyword(s):

Visual Impairment ◽

Visual Function ◽

Visual Outcome ◽

Significant Prognostic Factor ◽

Tumor Diameter ◽

Short Term ◽

Short And Long Term ◽

Tuberculum Sellae ◽

Diaphragm Sellae

Abstract OBJECTIVE: The visual outcome in patients with tuberculum and diaphragm sellae meningiomas treated with microsurgery was evaluated. Prognostic and diagnostic values of short- and long-term postoperative visual outcome and etiology for postoperative visual deterioration are discussed with special attention. METHODS: Clinical data for 30 surgically treated patients with tuberculum and diaphragm sellae meningiomas were reviewed retrospectively. The mean duration of the follow-up period was 75.9 months (range, 12–151 mo). Mean tumor diameter and volume was 25.9 mm (range, 16.3–63.3 mm) and 12.4 cm3 (range, 2.3–125.6 cm3). A visual impairment score was used to assess the short-term (≤2 wk after surgery) and the long-term (>6 mo after surgery) postoperative visual outcome. Various predictive factors for visual outcome were tested statistically. RESULTS: Complete resection was achieved in 23 out of 30 (76.7%) patients. Average preoperative, short- and long-term visual impairment scores were 48.2, 43.4, and 40.9, respectively. Favorable visual outcome was achieved in 80% of patients in the short term and 70% in the long term. Short-term postoperative aggravation of visual function was an ominous sign of further aggravation or at least of little hope for recovery, whereas there was a tendency to improve in the long term if short-term postoperative visual function showed favorable outcome. Recurrence or regrowth of tumor fully was responsible for late deterioration of visual function. No significant prognostic factor for visual outcome could be found. CONCLUSION: Short-term postoperative visual outcome was a strong indicator of permanent visual outcome after surgery for tuberculum sellae and diaphragm sellae meningiomas.

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Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

Journal of Neurosurgery ◽

10.3171/2012.5.jns112102 ◽

2012 ◽

Vol 117 (2) ◽

pp. 295-301 ◽

Cited By ~ 10

Author(s):

Juri Kivelev ◽

Elina Koskela ◽

Kirsi Setälä ◽

Mika Niemelä ◽

Juha Hernesniemi

Keyword(s):

Visual Field ◽

Visual Fields ◽

Visual Field Loss ◽

Occipital Lobe ◽

Visual Outcome ◽

Surgical Removal ◽

Long Term Outcome ◽

Visual Field Deficit

Object Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome. Methods Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years). Results All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up. Conclusions Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

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Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome

Journal of Neurosurgery ◽

10.3171/jns.1988.69.4.0523 ◽

1988 ◽

Vol 69 (4) ◽

pp. 523-528 ◽

Cited By ~ 120

Author(s):

Brian T. Andrews ◽

Charles B. Wilson

Keyword(s):

Visual Loss ◽

Visual Outcome ◽

Tumor Location ◽

Postoperative Recovery ◽

Optic Canal ◽

Visual Disability ◽

Content Type ◽

Tuberculum Sellae ◽

Diaphragma Sellae ◽

Planum Sphenoidale

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.

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Influences of Central Bouquet Alterations on the Visual Outcome in Eyes Receiving Epiretinal Membrane Surgery

Applied Sciences ◽

10.3390/app11030926 ◽

2021 ◽

Vol 11 (3) ◽

pp. 926

Author(s):

Max Philipp Brinkmann ◽

Stephan Michels ◽

Carolin Brinkmann ◽

Mario Damiano Toro ◽

Nicole Graf Johansen ◽

...

Keyword(s):

Visual Outcome ◽

Functional Results ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Epiretinal Membranes ◽

Staging Systems ◽

Before And After ◽

Pars Plana

Background: Previous studies have shown that epiretinal membranes (ERMs) may be associated with abnormal outer retinal anatomy. However, long-term morphological and functional results of pars plana vitrectomy (PPV) with ERM and internal limiting membrane (ILM) peeling in eyes with central bouquet (CB) alterations have not yet been investigated. Methods: In a retrospective, consecutive study all patients underwent best corrected visual acuity (BCVA) testing and spectral domain optical coherence tomography (SD-OCT) before and after a mean of 20 months (range 3–70 months) postoperatively. CB abnormalities and ERMs were classified according to Govetto’s staging systems. Results: Of the 67 eyes, 22 (34%) showed CB abnormalities at baseline. The mean BCVA increased from 0.42 at baseline to 0.20 LogMAR at final follow-up (p < 0.001). Neither ERM stage (p = 0.06) nor CB stage (p = 0.939) at baseline were significant predictors of vision improvement following surgery. Conclusions: Our results show that baseline BCVA, but not classification of CB changes and ERM at baseline, seems to be a useful predictor for functional outcomes following PPV with ERM and ILM peeling in the long-term.

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Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study

Neurosurgery ◽

10.1093/neuros/nyaa318_s064 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S64-S64

Author(s):

Young Soo Chung ◽

Minkyun Na ◽

Jihwan Yoo ◽

Woohyun Kim ◽

In-Ho Jung ◽

...

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome ◽

Optical Coherent Tomography ◽

Follow Up Study

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LONG-TERM VISUAL OUTCOME FOLLOWING CHEMOREDUCTION FOR RETINOBLASTOMA

Evidence-Based Ophthalmology ◽

10.1097/01.ieb.0000209779.95400.f6 ◽

2006 ◽

Vol 7 (2) ◽

pp. 91-92

Author(s):

Jose Pulido

Keyword(s):

Visual Outcome

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Predictors of long-term visual outcome following retinal hemorrhage from abusive head trauma

Journal of American Association for Pediatric Ophthalmology and Strabismus ◽

10.1016/j.jaapos.2021.08.167 ◽

2021 ◽

Vol 25 (4) ◽

pp. e43-e44

Author(s):

Julia E. Reid ◽

Hilliary E. Inger ◽

Catherine O. Jordan ◽

Nishanth Uli ◽

Lauren A. Tomlinson ◽

...

Keyword(s):

Head Trauma ◽

Visual Outcome ◽

Abusive Head Trauma ◽

Retinal Hemorrhage

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Safety and efficacy of posterior iris claw intraocular lens fixation in aphakic patients

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v16i2.368 ◽

2018 ◽

Vol 16 (2) ◽

pp. 124-133

Author(s):

Rosemary Tomy ◽

Rajkumar Maheshwari ◽

Ansa Parveen Kunhu Muhammed ◽

Venkataramana Kalikivayi ◽

Sajeev Cherian Jacob

Keyword(s):

Intraocular Lens ◽

Anterior Segment ◽

Case Series ◽

Visual Outcome ◽

Applanation Tonometry ◽

Long Term Results ◽

Retrospective Case ◽

Case Series Study ◽

Wide Range

Purpose: To assess the indications and visual outcome of eyes undergoing posterior iris fixated intraocular lens (IFIOL) implantation for aphakia, to identify reasons for poor visual outcome, and report occurrence of complications. Methods: In this retrospective case series study, all cases of posterior IFIOL fixation performed over a 30-month period were identified retrospectively. Preoperative and postoperative evaluations comprised objective and subjective refraction, best corrected visual acuity (BCVA), slit lamp biomicroscopy, applanation tonometry, and dilated fundus examination. Results: Fifty-six eyes of 56 patients were analyzed. Mean age was 60.55 ± 17.2 years. The most common indication for IFIOL implantation was surgical aphakia following complicated cataract surgery (n = 33; 58.9%) followed by trauma (n = 10; 17.9%), dropped nucleus/IOL during primary surgery (n = 6; 10.7%), and subluxated/dislocated lens-induced glaucomas (n = 5; 8.9%). BCVA better than or equal to their preoperative BCVA was achieved in 96.43% patients. The surgical aphakia and paediatric/adolescent groups had the best visual results while the dropped nucleus/IOL group and subluxated lens-induced glaucoma groups fared poorly. On the long-term follow-up visit, the most common complication noted was pigment dusting on the corneal endothelium (65.7%). Conclusion: The long-term results suggest that posterior IFIOL implantation is a safe and effective method for correction of aphakia and can be used for a wide range of indications in eyes without adequate capsule support. It may be considered an easier and faster alternative with minimal manipulation to anterior segment structures in paediatric and post-traumatic aphakic eyes.

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