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

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

10.21203/rs.3.rs-574460/v1 ◽

2021 ◽

Author(s):

Ning Qiao ◽

Chuzhong Li ◽

Jing Xu ◽

Guofo Ma ◽

Jie Kang ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Prediction Models ◽

Visual Outcome ◽

Optical Coherence ◽

Patient Counseling ◽

Endoscopic Endonasal Surgery ◽

Fiber Layer ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Prognostic Utility

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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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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Prognostic value of optical coherence tomography in chronic chiasmal compression

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh201028061g ◽

2021 ◽

pp. 61-61

Author(s):

Desanka Grkovic ◽

Sofija Davidovic ◽

Sava Barisic ◽

Nikola Babic ◽

Svetlana Pavin

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Visual Field ◽

Ganglion Cell ◽

Visual Outcome ◽

Optical Coherence ◽

Pituitary Macroadenoma ◽

Chiasmal Compression ◽

Average Value ◽

The Right

Introduction. Sellar and parasellar region lesions, such as pituitary adenoma often lead to the compression of the optic chiasm. Consequentialy, visual field (VF) defects and loss of visual acuity (VA), is a common complaint in these patients. The aim of this study is to evaluate if optical coherence tomography (OCT), measuring retinal nerve fibre layer (RNFL) and ganglion cell complex thickness (GCC), offers a reliable prediction of visual outcome in patients with chronic chiasmal compression from a pituitary macroadenoma. Case outline. We present a case of chronic chiasmal compression from a pituitary macroadenoma with an initial binocular visual field defect and low values of OCT parameters binocularly. The average value of RNFL on the right eye pre/postoperatively was 48/79 ?m, while on the left eye it was 56/63 ?m. The average value of GCC pre/postoperatively was 47/46 microns on the right and 45/46 microns on the left eye. Six weeks after surgical optochiasmal decompression macular GCC on both eyes and RNFL on the left eye remained largely unchanged, while RNFL of the right eye exhibits increases in thickness, as the postoperative consequence of the removal of conduction block. Neither visual field, nor visual acuity shows postoperative improvement. Conclusion. Irreversible damage of GCC and RNFL by longstanding compression results in poor visual outcome after surgery. Ganglion cell layer of the macula is a more accurate and reliable indicator of postoperative visual outcome.

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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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The predictive value of intraoperative visual evoked potential for visual outcome after extended endoscopic endonasal surgery for adult craniopharyngioma

Journal of Neurosurgery ◽

10.3171/2020.10.jns202779 ◽

2021 ◽

pp. 1-11

Author(s):

Ning Qiao ◽

Xiaocui Yang ◽

Chuzhong Li ◽

Guofo Ma ◽

Jie Kang ◽

...

Keyword(s):

Visual Impairment ◽

Real Time ◽

Visual Evoked Potential ◽

Evoked Potential ◽

Tumor Volume ◽

Visual Outcome ◽

Adult Patients ◽

Endoscopic Endonasal Surgery ◽

Clinical Value ◽

Endoscopic Endonasal

OBJECTIVE Due to the proximity of craniopharyngioma to the optic apparatus, one of the most common complications after surgery is visual deterioration. Intraoperative visual evoked potential (VEP), as a means of real-time visual function monitoring, has been integrated into transsphenoidal surgery for pituitary adenoma to predict postoperative visual outcome. Compared with pituitary tumor, craniopharyngioma often adheres to optic nerves, with increased risk of postoperative visual impairment. Furthermore, extended endoscopic endonasal surgery (EEES) can provide direct visualization of the surgical plane between the craniopharyngioma and the optic nerves, which contributes to analysis of the mechanism of real-time VEP changes during surgery. Therefore, VEP monitoring applied during EEES for craniopharyngioma may have more clinical value. However, only 9 patients who underwent EEES with VEP monitoring for craniopharyngioma have been sporadically reported to date. In this paper, the authors present the largest series to date analyzing the clinical value of VEP to predict postoperative visual outcome in adult patients with craniopharyngioma. METHODS Sixty-five adult patients who underwent EEES with intraoperative VEP monitoring for primary craniopharyngioma were retrospectively reviewed. The association between changes in VEP amplitude and postoperative visual outcome was determined. In addition, other potential prognostic factors with regard to postoperative visual outcomes were included in the analysis. RESULTS Gross-total resection was achieved in 59 patients (90.8%). Reproducible and stable VEP was recorded in 128 of 130 eyes (98.5%). During surgery, VEP remained stable in 108 eyes, 10 (9.3%) of which had new visual acuity (VA) and/or visual field (VF) defects after surgery. Transient VEP decrease was recorded in 15 eyes, 4 (26.7%) of which had visual deterioration. Of the 5 eyes with permanent VEP decrease, 3 (60%) experienced postoperative visual impairment. Permanent VEP decrease (OR 19.868, p = 0.007) and tight adhesion (OR 6.104, p = 0.040) were independent adverse factors for postoperative VA deterioration. Tight adhesion (OR 7.150, p = 0.002) and larger tumor volume (OR 1.066, p = 0.001) were significant risk factors for postoperative VF defects. CONCLUSIONS Intraoperative VEP monitoring can serve as a real-time warning to guide surgeons to avoid postoperative visual impairment. It effectively predicted VA changes in adult patients with craniopharyngioma after EEES. Tight adhesion and larger tumor volume were also strong predictors of postoperative visual impairment.

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