scholarly journals PITUITARY MACROADENOMAS

2010 ◽  
Vol 17 (04) ◽  
pp. 623-627
Author(s):  
KHALID FAROOQ ◽  
TAYYABA GUL MALIK ◽  
ANJUM RASHID
Keyword(s):  
Motor Nerve ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Sphenoidal Sinus ◽  
Optic Chiasma ◽  
Female Ratio ◽  
Cavernous Sinus Invasion ◽  
Tumour Extension ◽  
Visual Disturbances ◽  
Pituitary Macroadenomas

Objectives: To describe the demographic profile, patterns of visual disturbance and imaging studies of patients with Macroadenoma. Design: Retrospectively. Reviewed the clinical charts and neuroradiologic imaging of 125 patients who were diagnosed as cases of Macroadenoma. Duration: 2000 to 2009. Subjects and Methods: 100 patients were selected who had visual disturbances along with Macroadenomas. Age, sex, visual symptoms and other associated systemic problems of these patients were reviewed. The Neuroimaging data (Magnetic Resonance Imaging) was correlated with the clinical picture. The data was analysed using Statistical package for social sciences (SPSS). The Descriptive Statistics were calculated for age and MR findings. Results: The age ranged from 9 to 85 years (mean 42.92). Male to female ratio was 1.4: 1. 90% patients had visual disturbances including visual field defects and 10% had ocular motor nerve palsies. Tumour extension on MR studies showed optic chiasma compression in 69% patients, cavernous sinus invasion in 57% and Sphenoidal sinus invasion in 14%. Haemorrhagic foci were seen in 8% and intra tumour necrosis was found in 9% patients. Conclusions: The most common path for the extension of pituitary macroadenomas is towards the optic chiasma. Hence majority of these patients present with visual disturbances. MRI is an excellent aid to see the extent and invasion of Macroadenomas to the surrounding structures.

Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

2021 ◽  
pp. 1-11
Author(s):  
Visish M. Srinivasan ◽  
Phiroz E. Tarapore ◽  
Stefan W. Koester ◽  
Joshua S. Catapano ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Visual Fields ◽  
Optic Tract ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Subtotal Resection

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

scholarly journals Safety and efficacy of mini doppler in recurrent pituitary tumours

2020 ◽  
pp. 336-342
Author(s):  
Moshiur Rahman ◽  
Ezequiel Garcia-Ballestas ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Cavernous Sinus ◽  
Surgical Excision ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Csf Leak ◽  
Surgical Removal ◽  
Pituitary Tumours ◽  
Female Ratio ◽  
Cavernous Sinus Invasion ◽  
Number Of Patients

Background: Pituitary surgery is the most common surgery used to remove pituitary tumours. The use of mini doppler in surgical removal of an endonasal pituitary tumour has shown good short-term clinical outcomes and few complications in patients. Cavernous sinus invasion limits the surgical excision and still a challenge of gross total resection.   Objective: The main objective of this study is to evaluate the outcome of surgical removal of an endonasal pituitary tumour using mini doppler.    Method: A total of 12 patients were studied retrospectively from 2012 to 2018 in a single institution (Private hospital) in Dhaka, Bangladesh. The male and female ratio was 7:5. Results: 92% of cases of the total number of patients had satisfactory removal/ neurological improvement/hormonal improvement. Among 12 cases, 8 cases had transient diabetes insipidus and one patient had CSF leak.    Conclusion: The intraoperative Doppler is a useful tool to localize the carotids, which provides safer resection of endonasal pituitary tumours. Thus, it is very safe and effective for laterosellar resection of recurrent pituitary tumours and for cavernous sinus invasions.

Visual Outcome after Microsurgical removal of Craniopharyngioma via Pterional Craniotomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Adnan Khaliq ◽  
Farooq Azam ◽  
Mumtaz Ali ◽  
Asadullah , ◽  
Akramullah , ◽  
...  
Keyword(s):  
Benign Tumor ◽  
Case Series ◽  
Visual Outcome ◽  
Bimodal Distribution ◽  
Visual Disturbance ◽  
Surgical Removal ◽  
Paired Data ◽  
Chi Square ◽  
Female Ratio ◽  
Number Of Patients

Background: Craniopharyngioma is a benign tumor of sellar & Suprasellar area with bimodal distribution. Visual disturbance isone of the common clinical presentation. Early surgical intervention results in favourable results.Objective: To analyze visual outcome after surgical removal of craniopharyngioma via pterional craniotomy.Material and Methods: This observational descriptive case series was conducted at department of neurosurgery,LRH/Peshawar. Duration of study was 18 months from Jan 2017 to June 2018. The study included patients withcraniopharyngioma, who underwent surgery in elective setup, newly diagnosed cases and patients operated via pterionalapproach. All those patients who presented in crisis like acute hydrocephalus, operated via other approaches and recurrent caseswere excluded from this study. The changes of visual function (visual acuity and field) of the patients were assessed preoperativelyand postoperatively, documented by a predesigned proforma and paired data of this change were compared. Visual assessmentwas done on follow up visits on 2 weeks,1 month,3 months and 6 months. Chi square test was applied as statistical test. Data wasanalysed through SPSS version 17.Results: Total number of patients were (30) with Male to female ratio was 1.5:1.Age of patients were Ranging from 4 year to 62years (mean 35 years).There were 23 Children (76.6%) and 7 Adults (23.3%).Out of 30 patients, 21 patients(70%) presented withvisual disturbance and 9 patients (30%) had non opthalmogical symptoms. Optic atrophy was seen in 6 patients (20%) preoperatively.Per operatively tumor was found in suprasellar area in 24 patients(80%) and in both supra+infrasellar area in 6patients(20%). Tumor size was less than 3cm in 19 patients(63.3%) and more than 3cm in 11 patients(36.6%). Morphology peroperatively was cystic in 19 patients(63.3%), solid in 5 patients(16.6%) and both solid and cystic in 6 patients(20%). Calcification intumor was seen in 16 patients(53.3%). Gross total resection(GTR) of tumor was done in only 21 patients(70%). Post-operativefollow up assessment of visual status showed that (50%) of patients improved.Conclusion: Craniopharyngioma is a benign tumor with malignant behaviour so timely intervention give favourable results.

scholarly journals Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

1998 ◽  
Vol 56 (1) ◽  
pp. 107-110 ◽  
Author(s):  
ARTHUR CUKIERT ◽  
MARIO ANDRIOLI ◽  
JAYME GOLDMAN ◽  
MARCIA NERY ◽  
LUIS SALGADO ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Gold Standard ◽  
Pituitary Tumors ◽  
Medial Wall ◽  
Cavernous Sinus Invasion ◽  
Mri Features ◽  
Pituitary Macroadenomas

The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transesphenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients.

Transcavernous surgery; an effective treatment for pituitary macroadenomas

1995 ◽  
Vol 133 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Akira Matsuno ◽  
Tomio Sasaki ◽  
Nobuhito Saito ◽  
Toshihiro Mochizuki ◽  
Takamitsu Fujimaki ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Elevated Serum ◽  
Serum Levels ◽  
Pituitary Hormones ◽  
Cavernous Sinus Invasion ◽  
Stimulation Tests ◽  
Sufficient Degree ◽  
Pituitary Macroadenomas

Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K. Transcavernous surgery; an effective treatment for pituitary macroadenomas. Eur J Endocrinol 1995:133:156–65. ISSN 0804–4643 The endocrinological outcome in four patients with pituitary macroadenomas laterally invading the cavernous sinus, who were treated surgically by the transcranial transcavernous approach, was compared with that in four patients with macroadenomas that had been removed transsphenoidally. The decrease in the elevated serum levels of anterior pituitary hormones after transcavernous surgery ranged from 58.4% to 90.1%, whereas after transsphenoidal surgery it ranged from 0% to 46.1%. The responsiveness of pituitary hormones to stimulation tests was restored and maintained after transcranial transcavernous surgery. Transsphenoidal surgery achieved neither sufficient tumor reduction nor produced a satisfactory endocrinological remission. When cavernous sinus invasion is suspected by magnetic resonance imaging, even if it cannot be confirmed with certainty, transcranial transcavernous surgery is recommended. It is a useful surgical procedure for obtaining a sufficient degree of tumor extirpation and satisfactory endocrinological improvement in patients with macro-adenomas laterally invading the cavernous sinus, particularly somatotroph or corticotroph macro-adenomas. Postoperatively, mild cranial nerve paresis may occur, but this may resolve in 1–4 months. Akira Matsuno, Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426-3 Anegasaki, Ichihara City, Chiba 299-01, Japan

Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas

1990 ◽  
Vol 72 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Stephen C. Rush ◽  
Mark J. Kupersmith ◽  
Irving Lerch ◽  
Paul Cooper ◽  
Joseph Ransohoff ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Radiation Therapy ◽  
Visual Field ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Radiation Treatment ◽  
Visual Field Defects ◽  
Content Type ◽  
Pituitary Macroadenomas

✓ Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p < 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p < 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

scholarly journals A Nonfunctioning Pituitary Macroadenoma Presenting as Cyclical Vomiting and Severe Hyponatremia in a Young Female

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Dinuka S. Warapitiya ◽  
Dimuthu Muthukuda ◽  
W. A. H. P. Sanjeewa ◽  
Kushalee Poornima Jayawickreme ◽  
Shyama Subasinghe
Keyword(s):  
Case Report ◽  
Hypogonadotropic Hypogonadism ◽  
Serum Osmolality ◽  
Normal System ◽  
Pituitary Hormone ◽  
Pituitary Macroadenoma ◽  
Severe Hyponatremia ◽  
Optic Chiasma ◽  
Secondary Hypoadrenalism ◽  
Pituitary Macroadenomas

Introduction. Recurrent vomiting is a commonly overlooked debilitating symptom which causes significant impact on the quality of life. There are several causes for vomiting, ranging from commonly known causes to rare causes. Nonfunctioning pituitary macroadenomas generally present with visual disturbances, headache, and symptoms due to anterior pituitary hormone deficiencies. This case report is about an atypical presentation of a nonfunctioning pituitary macroadenoma in which the patient presented with cyclical vomiting with severe hyponatremia. Case Report. A 23-year-old girl presented with four to five episodes of vomiting per day for two days duration. She had a history of similar episodes of vomiting since 2016, with each episode generally lasting for 4-5 days and occurring in every four to six months. All episodes exhibited similar symptomatology and she was free of symptoms in-between. Generalized body weakness, postural dizziness, reduced appetite, and secondary amenorrhea were other symptoms she has had since 2016. Examination findings showed a low body mass index (BMI) (16 kg/m2) with normal system examination. Investigations showed severe hyponatremia (110 mmol/L) with hypokalemia (3.2 mmol/L) and hypochloremia (74 mmol/L). Her urinary excretion of potassium, sodium, and serum osmolality was low. Urine osmolality was mildly elevated compared to serum osmolality. Blood urea was normal. Severe hyponatremia with minimal hyponatremic symptoms was suggestive of chronic hyponatremia, which was accentuated by ongoing vomiting and possible reduced intake of salt. Further investigations showed evidence of secondary hypoadrenalism, central hypothyroidism, hypogonadotropic hypogonadism, and mild hyperprolactinemia. Magnetic resonance imaging (MRI) revealed a pituitary macroadenoma with mass effect on the optic chiasma. Hydrocortisone and levothyroxine were started, and she underwent transsphenoidal resection of the pituitary tumor. She recovered from cyclical vomiting. Conclusion. There can be multiple overlapping aetiologies for every observed symptom, sign, and abnormal investigation finding. Therefore, aetiological diagnosis is challenging, especially in the presence of an atypical clinical presentation. Cyclical vomiting and severe hyponatremia are atypical presentations of nonfunctioning pituitary macroadenomas.

scholarly journals Transient Visual Disturbance is Associated with Disability and Suicidal Risk in Patients with Migraine Without Aura

2021 ◽  
Author(s):  
Yu Chien Tsao ◽  
Yen-Feng Wang ◽  
Jong-Ling Fuh ◽  
Wei-Ta Chen ◽  
Kuan-Lin Lai ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Migraine Without Aura ◽  
Rating Scale ◽  
Depression Scale ◽  
Visual Disturbance ◽  
Visual Aura ◽  
Visual Phenomenon ◽  
Headache Clinic ◽  
Headache Impact ◽  
Visual Disturbances

Abstract Background: Patients with migraine without aura frequently report transient visual disturbances (TVD) other than typical visual aura, but the clinical correlates are not determined. Method: Patients with migraine without aura (MO) that attended the headache clinic were enrolled. Structured questionnaires were self-administered by the patients including headache profiles, comorbidities, lifetime suicidal ideation and attempts, six-item Headache Impact Test, Migraine Photophobia Score, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Beck Depression Inventory, and Pittsburgh Sleep Quality Index. A semi-structured visual phenomenon questionnaire was also used to assess the characteristics of TVDs. TVD is defined as any zigzag flashes, flickering dots/lines, or blurred/foggy vision associated with headache and with a Visual Aura Rating Scale < 4. Headache specialists interviewed with the participants for the ascertainment of diagnosis and verified of the questionnaires.Result: MO patients (n = 7,200, female/male = 3.56, mean age: 40.1 ± 13.4 years) were divided into 2 subgroups based on the presence (n=2,488) or absence of TVDs (n= 4,712). Patients with TVD had higher headache-related disability, more psychiatric comorbidities and were more likely to be photophobic. Suicidal ideation and attempts were more common in patients with TVD than in those without (ideation: 31.9% vs. 18.1%, OR = 1.92 [95% CI: 1.71−2.15], p < 0.001; attempt: 8.2% vs. 3.5%, OR = 2.23 [95% CI: 1.80−2.75], p < 0.001). The associations remained after adjustment of confounding factors.Conclusion: Presence of transient visual disturbance may suggest a higher migraine-related disability, higher level of photophobia and higher suicidal ideation/attempts in MO patients.

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