Visual outcomes after endoscopic pituitary adenomas surgery: our experience

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.

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Visual Outcomes After Treatment of Pituitary Adenomas

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2012.06.004 ◽

2012 ◽

Vol 23 (4) ◽

pp. 607-619 ◽

Cited By ~ 11

Author(s):

Clare Louise Fraser ◽

Valérie Biousse ◽

Nancy J. Newman

Keyword(s):

Pituitary Adenomas ◽

Visual Outcomes

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Ultrastructural Investigation of Spontaneous Pituitary Adenomas in Aging Sprague-Dawley Rats

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100053747 ◽

1982 ◽

Vol 40 ◽

pp. 216-217

Author(s):

D. J. McComb ◽

J. Beri ◽

F. Zak ◽

K. Kovacs

Keyword(s):

Microscopic Study ◽

Pituitary Adenomas ◽

Wistar Rats ◽

Microscopic Level ◽

Sprague Dawley ◽

Prolactin Cells ◽

Light Microscopic Level ◽

Ultrastructural Investigation ◽

Sprague Dawley Rats ◽

Long Evans

Investigation of the spontaneous pituitary adenomas in rat have been limited mainly to light microscopic study. Furth et al. (1973) described them as chromophobic, secreting prolactin. Kovacs et al. (1977) in an ul trastructural investigation of adenomas of old female Long-Evans rats, found that they were composed of prolactin cells. Berkvens et al. (1980) using immunocytochemistry at the light microscopic level, demonstrated that some spontaneous tumors of old Wistar rats could contain GH, TSH or ACTH as well as PRL.

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Ultrastructural comparison of prolactin adenomas of pituitary in men and women

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100103796 ◽

1988 ◽

Vol 46 ◽

pp. 346-347

Author(s):

R.C. Caughey ◽

U.P. Kalyan-Raman

Keyword(s):

Endoplasmic Reticulum ◽

Electron Microscope ◽

Phosphate Buffer ◽

Pituitary Adenomas ◽

Osmium Tetroxide ◽

Secretory Granules ◽

Uranyl Acetate ◽

En Bloc ◽

Men And Women ◽

Transmission Electron

Prolactin producing pituitary adenomas are ultrastructurally characterized by secretory granules varying in size (150-300nm), abundance of endoplasmic reticulum, and misplaced exocytosis. They are also subclassified as sparsely or densely granulated according to the amount of granules present. The hormone levels in men and women vary, being higher in men; so also the symptoms vary between both sexes. In order to understand this variation, we studied 21 prolactin producing pituitary adenomas by transmission electron microscope. This was out of a total of 80 pituitary adenomas. There were 6 men and 15 women in this group of 21 prolactinomas.All of the pituitary adenomas were fixed in 2.5% glutaraldehyde, rinsed in Millonig's phosphate buffer, and post fixed with 1% osmium tetroxide. They were then en bloc stained with 0.5% uranyl acetate, rinsed with Walpole's non-phosphate buffer, dehydrated with graded series of ethanols and embedded with Epon 812 epoxy resin.

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Fine Structural Classification of Chromophobe Adenomas of the Human Pituitary Gland

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100115511 ◽

1975 ◽

Vol 33 ◽

pp. 378-379

Author(s):

K. Kovacs ◽

E. Horvath

Keyword(s):

Pituitary Adenomas ◽

Secretory Activity ◽

Microscopic Investigation ◽

Uranyl Acetate ◽

Electron Microscopic Investigation ◽

Electron Microscopic ◽

Human Pituitary ◽

Cytoplasmic Staining ◽

Human Pituitary Gland ◽

Microscopic Features

Chromophobe pituitary adenomas arise from adenohypophysial cells and fail to exhibit cytoplasmic staining with conventional acid or basic dyes by light microscopy. The aim of the present work was to study the electron microscopic features of these tumors, to separate them into distinct entities and to correlate their fine structural appearances with secretory activity.Among 48 surgically removed various pituitary adenomas 30 tumors were found which, based on the tinctorial characteristics of the cytoplasm, corresponded to chromophobe adenomas. For electron microscopic investigation pieces of these tumors were fixed in 2.5 per cent glutaraldehyde in Sorensen's buffer, post fixed in 1 per cent osmium tetroxide in Millonig's buffer, dehydrated in graded ethanol and embedded in Epon 812. Ultrathin sections were stained with uranyl acetate and lead citrate.By electron microscopy it was possible to separate chromophobe adenomas into 3 distinct entities: 1) adenomas consisting of sparsely granulated growth hormone cells (7 cases).

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Ultrastructural Immunocytochemistry of Five Rat Pituitary Adenomas

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s1431927600003147 ◽

1980 ◽

Vol 38 ◽

pp. 724-725

Author(s):

D. J. McComb ◽

N. Ryan ◽

E. Horvath ◽

K. Kovacs ◽

E. Nagy ◽

...

Keyword(s):

Pituitary Adenomas ◽

Pituitary Tumors ◽

Electron Microscopic ◽

Electron Microscopic Immunocytochemistry ◽

Transmission Electron ◽

Rat Pituitary ◽

Radiation Induced ◽

Group 5 ◽

Group 2 ◽

Microscopic Techniques

Conventional light and electron microscopic techniques failed to clarify the cellular composition and derivation of spontaneous and induced, intrasellar and transplanted pituitary adenomas in rats (1). In the present work, electron microscopic immunocytochemistry was applied to evaluate five adenohypo-physial tumors using a technique described by Moriarty and Garner (2). Spontaneously occurring pituitary adenomas (group 1) were harvested from aging female Long-Evans rats. R-Amsterdam rats were treated with 2 x 1.0 mg estrone acetate (HogivaI) s.c. weekly for 6 months. Pituitary adenomas in excess of 30 mg were removed from these animals to make up the tumors of group 2. Groups 3 and 4 consisted of estrogen-induced autonomous transplan¬ted pituitary tumors MtT.WlO and MtT.F4. Group 5 was a radiation-induced transplanted autonomous pituitary tumor MtT.W5. The tumors of groups 3,4 and 5 were allowed to proliferate in host rats 6-8 weeks prior to removal for processing. Tissue was processed for transmission electron microscopy (glutaraldehyde fixation, OsO4 postfixation and epoxy resin embedding), and electron microscopic immunocytochemistry (3% paraformaldehyde fixation and Araldite embedding).

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