Prognostic Utility of Optical Coherence Tomography for Visual Outcome After Extended Endoscopic Endonasal Surgery for Adult Craniopharyngiomas

Abstract Optical coherence tomography (OCT) serving as a novel high resolution imaging technique can assess the retinal morphology. At present, a few studies are reported with limited evidence on the predictive value of OCT for visual outcome after optic nerve decompression. This study aims to utilize the largest series of adult craniopharyngiomas to evaluate the association between OCT parameters and visual outcome following the extended endoscopic endonasal surgery (EEES). From October 2018 to October 2020, one hundred and seventy eyes in 88 adult patients with craniopharyngiomas were retrospectively reviewed. Gross total resection was performed in 82 (93.2%) patients. The median follow-up time was 10.9 months. Our study showed that increased temporal circumpapillary retinal nerve fiber layer (cpRNFL) thickness was associated with higher odds of visual acuity (VA) improvement and maintenance (OR=1.070; P=0.035), and greater inferior cpRNFL thickness was significantly associated with visual field (VF) improvement and maintenance (OR=1.034; P=0.046). Tight adhesion was demonstrated as an independent adverse factor for either postoperative VA or VF (P=0.048, P=0.030, respectively). Receiver operating characteristic (ROC) analysis further verified the robustness of the prediction model either in VA (AUC=0.842; P<0.001) or VF (AUC=0.849; P<0.001). Preoperative OCT can effectively predict visual outcome after EEES for adult craniopharyngiomas. It can also serve as a reliable alternative to evaluate preoperative visual filed defects, especially for patients with lower compliance. Tight adhesion was confirmed as an independent risk factor for postoperative visual outcome. The OCT-based multivariable prediction models developed in present study may contribute to patient counseling on visual prognosis.

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Prognostic Utility of Optical Coherence Tomography for Visual Outcome After Extended Endoscopic Endonasal Surgery for Adult Craniopharyngiomas

Frontiers in Oncology ◽

10.3389/fonc.2021.764582 ◽

2022 ◽

Vol 11 ◽

Author(s):

Ning Qiao ◽

Chuzhong Li ◽

Jing Xu ◽

Guofo Ma ◽

Jie Kang ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Field ◽

Visual Outcome ◽

Adult Patients ◽

Optical Coherence ◽

Patient Counseling ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Prognostic Utility

IntroductionOwing to the close vicinity of the optic chiasma, visual dysfunction is known as one of the most common surgical indications and postoperative complications in adult patients with craniopharyngiomas, probably leading to poor quality of life. Historically, very few consistent predictive factors associated with the visual outcome are identified, which may not be helpful for patient counseling and preoperative decision making. Recently, optical coherence tomography (OCT) serving as a novel high-resolution imaging technique can assess the retinal morphology by measuring the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex thickness. However, few studies have examined the prognostic utility of OCT parameters for visual outcome after surgery for craniopharyngiomas. This study aims to use the largest series to evaluate the association between OCT parameters and visual outcome after extended endoscopic endonasal surgery (EEES) for primary craniopharyngiomas in adults.Material and MethodsFrom October 2018 to October 2020, one hundred and seventy eyes in 88 adult patients with newly confirmed craniopharyngiomas were retrospectively reviewed and pertinent prognostic factors were analyzed.ResultsGross total resection was performed in 82 (93.2%) patients. The median postoperative follow-up time was 10.9 months. Multiple logistic regression analysis showed that increased temporal cpRNFL thickness was associated with higher odds of visual acuity (VA) improvement and maintenance (OR = 1.070; 95% CI, 1.005–1.140; p = 0.035), and greater inferior cpRNFL thickness was significantly associated with visual field (VF) improvement and maintenance (OR = 1.034; 95% CI, 1.001–1.068; p = 0.046). Furthermore, tight adhesion between optic nerves and craniopharyngiomas was demonstrated as an independent adverse factor for either postoperative VA or VF (p = 0.048, p = 0.030, respectively). The ROC results further verified the robustness of the prediction model either in VA (AUC = 0.843; 95% CI, 0.734–0.952; p < 0.001) or VF (AUC = 0.849; 95% CI, 0.741–0.958; p < 0.001).ConclusionPreoperative OCT can effectively predict visual outcome after EEES for adult craniopharyngiomas. It can also serve as a reliable alternative to evaluate preoperative visual field defects, especially for patients with lower compliance. Tight adhesion was confirmed as an independent risk factor for postoperative visual outcome. The OCT-based multivariable prediction models developed in the present study may contribute to patient counseling on visual prognosis.

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Clinical Efficacy of Optical Coherence Tomography to Predict the Visual Outcome After Endoscopic Endonasal Surgery for Suprasellar Tumors

World Neurosurgery ◽

10.1016/j.wneu.2019.08.031 ◽

2019 ◽

Vol 132 ◽

pp. e722-e731 ◽

Cited By ~ 3

Author(s):

Chiman Jeon ◽

Kyung-Ah Park ◽

Sang Duk Hong ◽

Jung Won Choi ◽

Ho Jun Seol ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Clinical Efficacy ◽

Visual Outcome ◽

Optical Coherence ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal

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Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1713108 ◽

2020 ◽

Author(s):

Arad Iranmehr ◽

Mostafa Esmaeilnia ◽

Khashayar Afshari ◽

Seyed Mousa Sadrehosseini ◽

Azin Tabari ◽

...

Keyword(s):

Tumor Resection ◽

Visual Outcome ◽

Extent Of Resection ◽

Csf Leak ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Pituitary Dysfunction ◽

Before And After

Abstract Background Recently the endoscopic endonasal surgery (EES) has been introduced as a modality for the treatment of patients with craniopharyngiomas. In this study, we describe our initial experience in treatment of 29 patients with craniopharyngiomas using this approach. Methods Twenty-nine consecutive patients with craniopharyngiomas who had undergone EES in a 5-year period were studied retrospectively. Patients underwent preoperative and postoperative endocrinologic and ophthalmologic evaluations. Radiologic characteristics of tumors and extent of resection were determined. The recurrence and complications were evaluated. Results Pituitary and visual dysfunction were observed preoperatively in 89.7 and 86% of patients, respectively. After EES, visual outcome either showed an improvement or else remained unchanged in 92.3% of the cases; however, pituitary function remained unchanged and even got worsened in 34.6% of the cases. Prevalence of diabetes insipidus before and after surgery was 58.6 and 69.2%. The rate of gross total resection was 62%. Moreover, 86.2% of the tumors were almost totally resected (more than 95% of the tumor size resected). After surgery, cerebrospinal fluid (CSF) leak and meningitis occurred in four (13.8%) and two (6.9%) patients, respectively. Perioperative mortality was seen in two of the cases (6.9%). The mean follow-up was 25 months and tumor recurrence was discovered in four patients (15.3%). Conclusion The EES with the goal of maximal and safe tumor resection could be used for the treatment of most craniopharyngiomas. Although the rates of visual improvement and gross tumor resection are high, CSF leak, pituitary dysfunction, and meningitis are serious concerns.

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Inner Retinal Layer and Outer Retinal Layer Findings after Macular Hole Surgery Assessed by means of Optical Coherence Tomography

Journal of Ophthalmology ◽

10.1155/2019/3821479 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Maria Vittoria Cicinelli ◽

Alessandro Marchese ◽

Francesco Bandello ◽

Michele Coppola

Keyword(s):

Optical Coherence Tomography ◽

Macular Hole ◽

Visual Outcome ◽

Clinical Findings ◽

Foveal Avascular Zone ◽

Retinal Layer ◽

Optical Coherence ◽

Fiber Layer ◽

Retinal Layers ◽

Retinal Thinning

Aim. To summarize the spectrum of optical coherence tomography (OCT) and OCT angiography (OCTA) features after full-thickness macular hole (MH) repair surgery. Methods. A PubMed engine search was carried out using the terms “Macular Hole,” “Optical Coherence Tomography,” and “Optical Coherence Tomography Angiography.” All reports published in English up to October 2018, irrespective of their publication status, were included. Tomographic signs analyzed were divided according to the involved portion of the retina in “inner retinal layers” and “external retinal layers.” Despite predominantly involving the inner retinal layers, cystoid macular edema (CME) has been treated as a separate entity. Finally, report on vessel density (VD) changes and the foveal avascular zone (FAZ) area modifications have been included. Results. Different clinical findings can be observed on OCT of patients who underwent MH repair surgery. There is general consent that retinal thinning involving primarily the retinal nerve fiber layer and the ganglion cell layer takes place after surgery. In the postoperative period, the outermost retinal layers get progressively restored. Persistent defects in the ellipsoid zone or in the external limiting membrane correlate with worse postoperative visual outcome. OCTA has globally demonstrated that eyes after MH closure show a reduction in macular and paramacular VD and smaller FAZ areas, compared with control or fellow eyes. Conclusion. Clinicians should be aware of the most common tomographic findings to properly manage each condition. In addition, significant advantages for the postoperative application of OCT and OCTA include noninvasiveness, rapid and simple execution, repeatability, and precise measurements.

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Use of optical coherence tomography to predict visual outcome in parachiasmal meningioma

Journal of Neurosurgery ◽

10.3171/2014.12.jns141549 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1489-1499 ◽

Cited By ~ 15

Author(s):

Hun Ho Park ◽

Min Chul Oh ◽

Eui Hyun Kim ◽

Chan Yun Kim ◽

Sun Ho Kim ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Outcome ◽

Mean Deviation ◽

Separate Analysis ◽

Optical Coherence ◽

Visual Recovery ◽

Fiber Layer ◽

Rnfl Thickness ◽

The Mean ◽

One Year

OBJECT The authors investigated the value of retinal nerve fiber layer (RNFL) thickness in predicting visual outcome after surgery for parachiasmal meningioma. METHODS Forty-nine eyes of 25 patients who underwent craniotomy and resection of a parachiasmal meningioma were analyzed retrospectively. Visual parameters including visual field (VF) (recorded as the mean deviation [MD]), visual acuity (VA), and RNFL thickness (via optical coherence tomography) were measured before and 1 week, 6 months, and 1 year after surgery. Postoperative visual outcome was compared among the patients with a thin or normal RNFL. A separate analysis of data pertaining to 22 eyes of 13 patients with severe VF defects (MD ≤ −10 dB) was performed to compare visual outcome for those with a thin or normal RNFL. RESULTS Of the 23 eyes that showed VF improvement, 22 (95.7%) had normal RNFL thickness. The positive predictive value of normal RNFL thickness for VF improvement was 78.6%. The VF of patients with normal RNFL thickness improved in 6 months and continued improving 1 year after surgery (MD −5.9 dB before surgery, −5.5 dB 1 week after surgery, −2.8 dB 6 months after surgery [p < 0.01], and −1.1 dB 1 year after surgery [p < 0.01]). In contrast, those with a thin preoperative RNFL showed deterioration at first and then slower, worse visual recovery after surgery (MD −18.1 dB before surgery, −22.4 dB 1 week after surgery, −21.2 dB 6 months after surgery, and −19.1 dB 1 year after surgery). VA also showed significant progress 6 months after surgery in patients with normal RNFL thickness (0.6 before surgery, 0.7 one week after surgery, 0.9 six months after surgery [p = 0.025], and 0.9 one year after surgery [p = 0.050]) compared to those with a thin RNFL (0.3 before surgery, 0.2 one week after surgery, 0.3 six months after surgery, and 0.4 one year after surgery). Preoperative differences in VF MD and VA were noted between the 2 groups (p < 0.01). Even patients with severe VF defects and normal RNFL thickness improved by 11.1 dB by 1 year after surgery compared with patients with a thin RNFL (−0.01 dB) (p < 0.01). Patients with normal RNFL thickness also did better in VA improvement (from 0.7 to 1.1) than those with a thin RNFL (from 0.2 to 0.3), but these results were not statistically significant. CONCLUSIONS RNFL thickness measured by optical coherence tomography has significant value as a prognostic factor of postoperative visual recovery for parachiasmal meningioma. Patients with normal RNFL thickness before surgery are more likely to have visual improvement after surgery than patients with a thin RNFL.

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Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients

Journal of Neurosurgery ◽

10.3171/2014.2.jns13767 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1326-1339 ◽

Cited By ~ 81

Author(s):

Maria Koutourousiou ◽

Juan C. Fernandez-Miranda ◽

S. Tonya Stefko ◽

Eric W. Wang ◽

Carl H. Snyderman ◽

...

Keyword(s):

Medical Center ◽

Tumor Resection ◽

Visual Outcome ◽

Tumor Location ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Pituitary Fossa ◽

Endoscopic Endonasal ◽

Primary Tumors ◽

Csf Leaks

Object Following the introduction of the neurosurgical microscope, the outcomes in suprasellar meningioma surgery were dramatically improved. More recently, the neurosurgical endoscope has been introduced as a visualization option during removal of skull base tumors, both transcranially and endonasally. The authors retrospectively reviewed the effectiveness of endoscopic endonasal surgery (EES) in the management of suprasellar meningiomas. Methods Between 2002 and 2011, 75 patients (81.3% female) with suprasellar meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, visual outcome, and complications. Results Seventy-one patients presented with primary tumors, whereas 4 were previously treated elsewhere. Their mean age was 57.3 years (range 36–88 years), and most patients presented with visual loss (81.3%). Tumors occupied the tuberculum sellae (86.7%) and planum sphenoidale (50.7%), with extension into the optic canals in 26.7% (unilateral in 21.3% and bilateral in 5.3%) and the pituitary fossa (9.3%). Gross-total tumor resection (Simpson Grade I) was achieved in 76% of the cases in the whole cohort and in 81.4% of the patients in whom it was the goal of surgery. Tumor location and extension into the optic canals was not a limitation for total resection. Tumor size, configuration, and vascular encasement were significant factors that influenced the degree of resection (p < 0.0001). Vision was improved or normalized in 85.7% of the cases. Visual deterioration following EES occurred in 2 patients (3.6%). Complications included postoperative CSF leaks (25.3% overall, 16.1% in recent years) resulting in meningitis in 4 cases. One patient had an intraoperative injury of the artery of Heubner resulting in associated neurological deficit. Another elderly patient died within 1 month after EES due to cerebral vasospasm and multisystem impairment. No patient developed postoperative cerebral contusions, hemorrhage, or seizures. During a mean follow-up period of 29 months (range 1–98 months), 4 patients have shown recurrence, but only 1 required repeat EES. Conclusions With the goal of gross-total tumor resection and visual improvement, EES can achieve very good results, (comparable to microscopic approaches) for the treatment of suprasellar meningiomas. Avoidance of brain and optic nerve retraction, preservation of the vascularization of the optic apparatus, and wide decompression of the optic canals are the main advantages of EES for the treatment of suprasellar meningiomas, while CSF leaks remain a disadvantage.

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