Neuro-ophthalmic effects of stenting across the ophthalmic artery origin in the treatment of intracranial aneurysms

Object The benefits of treating intracranial aneurysms in the region of the anterior visual pathways are well understood. However, the adverse effects of endovascular stenting across the ophthalmic artery have received little attention. The authors reviewed their experience with patients who had stents deployed across the ophthalmic artery origin. Methods Patients' medical charts and imaging studies were reviewed to identify all patients with a non–flow diverting stent deployed over the ophthalmic artery origin for the treatment of intracranial aneurysms. All patients with neuro-ophthalmic complaints were referred for formal ophthalmological evaluation. Results A total of 104 consecutive patients with 106 aneurysms were identified to meet criteria for inclusion in the study cohort. Preoperatively, 30 patients (29%) described headache symptoms and 32 patients (31%) reported visual complaints. Of the patients with preoperative headaches, 15 (54%) of 28 patients for whom follow-up was available experienced improvement in their symptoms. Of the patients with preoperative visual complaints, improvement was noted in 11 (41%) of the 27 patients for whom follow-up was available, 9 (33%) of 27 patients reported no change in visual symptoms, and 7 (26%) of 27 patients reported progression of symptoms. Visual field defects developing posttreatment were noted to occur in 8 (7.7%) of 104 patients: 3 with immediate postoperative retinal infarcts, 1 with perioperative hemianopia that resolved by the time of discharge, 1 with a subjective visual field defect, 1 with subjective migratory visual field defects, and 2 with nonspecific visual symptoms. Compressive symptoms from aneurysm mass effect were noted in 6 patients preoperatively, with 4 of those patients experiencing persistent worsening, resolution in 1 case, and no change in 1 case. One patient developed a novel cranial nerve palsy from mass effect in the immediate postoperative period. Conclusions Deployment of stents across the ophthalmic artery origin for the treatment of intracranial aneurysms appears to be relatively safe with regard to visual outcomes. Neuro-ophthalmic complaint resolution rates were comparable to endovascular procedures that do not employ stents, with headache resolution rates comparable to coil-only aneurysm obliteration and low rates of retinal ischemic events. For patients presenting with mass effect, stent-assisted coiling appears to be less effective than microsurgery with decompression for relief of compressive symptoms.

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Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed

Acta Endocrinologica ◽

10.1530/eje-11-0142 ◽

2011 ◽

Vol 165 (1) ◽

pp. 33-37 ◽

Cited By ~ 18

Author(s):

R Trifanescu ◽

V Stavrinides ◽

P Plaha ◽

S Cudlip ◽

J V Byrne ◽

...

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Rathke's Cleft Cysts ◽

Long Term Monitoring ◽

Rathke's Cleft ◽

Term Monitoring ◽

Field Defects ◽

Tsh Deficiency

ObjectiveTo clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.Subjects and methodsThe records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.ResultsA total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.ConclusionsIn this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

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Twenty-Year Follow-up of Visual Field Defects in Primary Glaucoma Eyes

Japanese Journal of Ophthalmology ◽

10.1016/s0021-5155(99)00046-5 ◽

1999 ◽

Vol 43 (4) ◽

pp. 334-335

Author(s):

J Kozaki

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Primary Glaucoma ◽

Field Defects

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The Effects of Compensatory Scanning Training on Mobility in Patients with Homonymous Visual Field Defects: Further Support, Predictive Variables and Follow-Up

PLoS ONE ◽

10.1371/journal.pone.0166310 ◽

2016 ◽

Vol 11 (12) ◽

pp. e0166310 ◽

Cited By ~ 10

Author(s):

Gera A. de Haan ◽

Bart J. M. Melis-Dankers ◽

Wiebo H. Brouwer ◽

Oliver Tucha ◽

Joost Heutink

Keyword(s):

Visual Field ◽

Visual Field Defects ◽

Predictive Variables ◽

Field Defects

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Plurihormonal pituitary macroadenoma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02948-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ebtesam Allehaibi ◽

Mussa H. AlMalki ◽

Imad Brema

Keyword(s):

Growth Hormone ◽

Case Report ◽

Pituitary Adenoma ◽

Visual Field ◽

Pituitary Adenomas ◽

Mass Effect ◽

Pituitary Hormones ◽

Visual Field Defects ◽

Plurihormonal Pituitary Adenoma ◽

Field Defects

Abstract Background Plurihormonal pituitary adenomas are a unique type of pituitary adenomas that secrete two or more pituitary hormones normally associated with separate cell types that have different immunocytochemical and ultrastructural features. Although they represent 10–15% of all pituitary tumors, only a small fraction of plurihormonal pituitary adenomas clinically secrete multiple hormones. The most common hormone combinations secreted by plurihormonal pituitary adenomas are growth hormone, prolactin, and one or more glycoprotein hormones. The most common hormonal symptom is acromegaly (50%). The aim of this case report is to bring awareness about this rare type of pituitary adenomas and to describe the unique presentation of our patient, even though plurihormonal pituitary adenomas are known mostly as a clinically silent tumors. Case presentation Herein, we describe an unusual case of plurihormonal pituitary adenoma with triple-positive staining for adrenocorticotropic hormone, growth hormone, and prolactin. The patient is a 65-year-old Egyptian woman who presented with mass effect symptoms of the pituitary tumor, which primarily manifested as severe headache and visual field defects. She also presented with some cushingoid features, and further analysis confirmed Cushing’s disease; slightly high prolactin and normal growth hormone levels were observed. She underwent transsphenoidal surgery and has been in remission thus far. Only a few cases have been reported in the literature, but none has exhibited silent acromegaly or mass effect symptoms as the initial presentation. Conclusion This case highlights an unusual plurihormonal pituitary adenoma case with a rare combination of secreted hormones; mass effect symptoms were dominant, as were uncommon visual field defects. Our case further proves that immunohistochemical analyses of all pituitary hormones are needed to ensure correct diagnosis and to alert clinicians to the need for more rigorous follow-up due to the higher morbidity of these patients. Our case report approval number Federal Wide Assurance NIH, USA is FWA00018774 IRB registration number with OHRP/NIH is IRB00010471.

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The Pattern of Visual Impairment in Patients with Pituitary Adenoma

Journal of International Medical Research ◽

10.1177/147323000803600525 ◽

2008 ◽

Vol 36 (5) ◽

pp. 1064-1069 ◽

Cited By ~ 14

Author(s):

Hanbin Wang ◽

Wei Sun ◽

Zhuang Fu ◽

Zhichao Si ◽

Yufang Zhu ◽

...

Keyword(s):

Visual Acuity ◽

Pituitary Adenoma ◽

Visual Field ◽

Visual Impairment ◽

Visual Field Defects ◽

Visual Symptoms ◽

Tumour Pathology ◽

Acuity Score ◽

Suprasellar Extension ◽

Field Defects

This retrospective study aimed to identify the pattern of visual impairment in pituitary adenoma patients. Patients' eyes were categorized into four groups according to their visual acuity score. Trans-sphenoidal hypophysectomy was performed on all patients. Significant differences between groups were evaluated for visual field defects, visual symptoms duration, degree of suprasellar extension and tumour pathology. In the 201 patients (402 eyes) evaluated, 166 eyes had impaired visual acuity (45 eyes, < 4.0; 43 eyes, 4.0–4.4; and 78 eyes, 4.5–4.8), 236 eyes scored > 4.8 and were considered to be free of this disorder. A linear correlation was found between visual field defects and visual acuity score. Duration of visual symptoms between visual acuity groups was not significant. Suprasellar extension (measured by Hardy grades) was significant between visual acuity groups and may be the main cause of visual acuity loss in pituitary adenoma patients. Non-functional pituitary adenomas tended to affect visual acuity more than adenomas with other pathological diagnoses which are adrenocorticotropic hormone and prolactin. Further investigation is required to clarify visual loss cause in pituitary adenoma patients.

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The natural course of non-functioning pituitary macroadenomas

Acta Endocrinologica ◽

10.1530/eje.1.02334 ◽

2007 ◽

Vol 156 (2) ◽

pp. 217-224 ◽

Cited By ~ 108

Author(s):

O M Dekkers ◽

S Hammer ◽

R J W de Keizer ◽

F Roelfsema ◽

P J Schutte ◽

...

Keyword(s):

Visual Field ◽

Tumor Growth ◽

Transsphenoidal Surgery ◽

Tumor Volume ◽

Visual Fields ◽

Visual Field Defects ◽

Pituitary Insufficiency ◽

Field Defects ◽

Pituitary Macroadenomas

Objective: The natural history of non-functioning pituitary macroadenomas (NFMA) has not been completely elucidated. Therefore, we evaluated pituitary function, visual fields, and tumor size during long-term follow-up of non-operated patients with NFMA. Design: Follow-up study. Patients: Twenty-eight patients (age 55 ± 3 years) with NFMA, not operated after initial diagnosis, were included. Results: Initial presentation was pituitary insufficiency in 44%, visual field defects in 14%, apoplexy in 14%, and chronic headache in 7% of the patients. The duration of follow-up was 85 ± 13 months. Radiological evidence of tumor growth was observed in 14 out of 28 patients (50%) after duration of follow-up of 118 ± 24 months. Six patients (21%) were operated, because tumor growth was accompanied by visual field defects. Visual impairments improved in all the cases after transsphenoidal surgery. Spontaneous reduction in tumor volume was observed in eight patients (29%). No independent predictors for increase or decrease in tumor volume could be found by regression analysis. Conclusion: Observation alone is a safe alternative for transsphenoidal surgery in selected NFMA patients, without the risk of irreversibly compromising visual function.

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Follow-up of visual field defects with vascular damage of the geniculostriate visual pathway

Neuro-Ophthalmology ◽

10.3109/01658108709007458 ◽

1987 ◽

Vol 7 (4) ◽

pp. 231-242 ◽

Cited By ~ 11

Author(s):

Birgitta Messing ◽

Heinz Ganshirt

Keyword(s):

Visual Field ◽

Visual Pathway ◽

Vascular Damage ◽

Visual Field Defects ◽

Field Defects

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A longitudinal observation of a patient with normal tension glaucoma

African Vision and Eye Health ◽

10.4102/aveh.v76i1.408 ◽

2017 ◽

Vol 76 (1) ◽

Author(s):

Hlupheka L. Sithole

Keyword(s):

Intraocular Pressure ◽

Visual Field ◽

Normal Tension Glaucoma ◽

Field Analysis ◽

Visual Field Defects ◽

Due Diligence ◽

Longitudinal Observation ◽

Eye Examination ◽

Field Defects

Normal tension glaucoma (NTG) is a disease associated with normal intraocular pressure (10 mmHg – 21 mmHg) that may lead to irreversible blindness if misdiagnosed or left untreated over a period of time. The author observed a patient with NTG over a period of 5 years (from 2013 to 2017). The initial visual field analysis results (2014) showed mild visual field defects because of NTG at the start of the 5-year period. Although the patient was also diagnosed with hydrocephalus, a condition associated with optic nerve head damage, following years of noncompliance to treatment of NTG and follow-up eye examination schedules, the patient’s visual field defects were found to have progressed by the year 2017. It is therefore important for optometrists to apply due diligence when examining patients with NTG in order to expedite intervention and prevention of visual impairment and blindness.

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