Visual outcome after pituitary adenoma surgery

Background: The primary objective of this study was to evaluate the outcome of excision in terms of gross and partial resection rates compared to the grades of pituitary adenoma (based on Hardy-Vezina classification). We also evaluated the post-operative complications and the effect of resection on visual outcomes and endocrinological remission.Methods: We retrospectively analysed 116 patients who underwent surgical resection of pituitary adenoma via endonasal trans-sphenoidal approach at Civil Hospital (Ahmedabad) between March 2013 and March 2019 and collected pre-operative and post-operative data in terms of imaging, endocrine function and vision. Results: According to the postoperative imaging data and endocrine examination results, gross-total resection (GTR) was achieved in 79.3% (92 patients), and partial (PR) in 20.6% (24 patients) which was significant (p<0.05). Improvement in vision was seen in 62% (40 patients out of 64 patients). Out of 44 patients having endocrine dysfunction, endocrinological remission was achieved in 32 patients with functional adenomas (72.7%). Sinusitis followed by headache was the most common minor complication seen in the study.Conclusions: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for patients having grade 3 or lower pituitary adenomas, which leads to gross total resection in comparison to patients having grade 4 adenoma. It also results in high rate of surgical decompression and better visual outcome. Partial resection may result in endocrinological response in functional tumors.

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Visual outcome after surgery in patients with suprasellar tumors and preoperative blindness

Journal of Neurosurgery ◽

10.3171/jns/2008/108/01/0019 ◽

2008 ◽

Vol 108 (1) ◽

pp. 19-25 ◽

Cited By ~ 18

Author(s):

Ashish Suri ◽

Karanjit Singh Narang ◽

Bhawani Shankar Sharma ◽

Ashok Kumar Mahapatra

Keyword(s):

Pituitary Adenoma ◽

Visual Outcome ◽

Bivariate Analysis ◽

Factors Affecting ◽

Visual Improvement ◽

History Of ◽

Sellar Tumor ◽

Tumor Consistency ◽

Age Range

Object The purpose of this paper was to study the visual outcome after surgery in patients with suprasellar tumors who experienced preoperative blindness in 1 or both eyes. Methods All patients with suprasellar tumors and no perception of light in 1 or both eyes and who underwent surgery between May 2002 and May 2006 were included in this retrospective study. Outcome was analyzed at discharge from the hospital and at follow-up. There were a total of 79 patients (51 males and 28 females, age range 5–70 years). There were 37 cases of pituitary adenomas, 19 craniopharyngiomas, 18 meningiomas, and 5 other tumors. Preoperatively 61 patients had uniocular blindness and 18 patients had binocular blindness. Of all 158 eyes, 97 (61.4%) were blind at admission and these eyes were analyzed. Sixty-three patients (79.7%) presented with headache and 14 (17.7%) with hypothalamic symptoms. Nearly one fourth (24%) of patients with a pituitary adenoma had a history of apoplexy. The duration of visual decline ranged from 3 days to 7 years, and the duration of blindness ranged from 1 day to 3 years. Patients underwent either transcranial or transsphenoidal tumor decompression. Results At discharge from the hospital visual improvement was exhibited in 23 (29%) of 79 patients and 27 (27.8%) of 97 eyes. Improvement to serviceable vision occurred in 7 (8.9%) of 79 patients and in 8 (8.2%) of 97 eyes with pre-operative blindness. After surgery, visual improvement was noted in 15 (24.6%) of 61 patients with uniocular blindness and 8 (44.4%) of 18 patients with binocular blindness. However, serviceable vision was restored in 5 (8.2%) of 61 patients with uniocular and 2 (11.1%) of 18 patients with binocular blindness. Bivariate analysis revealed male sex, shorter duration of blindness, presence of apoplexy, sellar tumor extension, soft tumor consistency, operative evidence of hemorrhage in tumor, and tumor histopathology (pituitary adenoma) to have significant impact on the outcome. Multivariate analysis revealed duration of blindness for > 12 weeks, apoplexy, and sellar extension to have a significant impact on visual outcome. Conclusions The present study is the largest in the existing medical literature to evaluate the factors affecting visual outcome after surgery of suprasellar tumors with preoperative blindness.

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Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v28i2.17182 ◽

2013 ◽

Vol 28 (2) ◽

pp. 108-115

Author(s):

Md Rezaul Amin ◽

Haradhon Deb Nath ◽

M Afzal Hossain ◽

Kanak Kanti Barua

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Visual Function ◽

Tumor Resection ◽

Visual Outcome ◽

Visual Field Defects ◽

Bivariate Analysis ◽

P Value ◽

Duration Of Symptoms ◽

Visual Status

Background: Pituitary adenoma, which accounts for 17.4% of all brain tumors, is the third most frequently diagnosed brain tumor, following intracranial glioma and meningioma. The visual disturbance in pituitary adenoma ranged from blurring of vision with or without headache to total loss of vision. In patients with visual field defects, bitemporal hemianopia was the commonest visual field defect. Early improvement of visual function is one of the major indication surgery. Objective: The purpose of this study was to comparison between the pre and post-operative visual parameters and to find out the value in assessment of the prognosis of early postoperative visual function and also to find out the factor which influence the early post-operative visual outcome. Methods: A prospective study was done from September 2010 to April 2012 in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, 30 cases of pituitary adenoma had been included in this study of those who were presented with visual symptoms. Visual assessment was done before the operation and outcome was analyzed at discharged from hospital. Results: Within 60 eyes, 13 (43.3%) patients presented with blindness of one or both eyes. 10 (33.3%) presented with uniocular and 3 (10.0%) presented with binocular blindness. Duration of the symptoms ranged from 2 months to 48 months. Patients underwent either transcranial or transsphenoidal tumor decompression. At discharge out of 30 patients, 23 (76.7%) showed improvement, 2 (6.6%) patients were deteriorated post-operatively. P value was <0.001, in z test, Z=91.5, which was highly significant. Post-operative visual status was analyzed with age, sex, duration of symptoms, suprasellar extension, and methods of surgery and extent of tumor resection to find out that any other factor influenced the visual outcome. In bivariate analysis it was shown that only duration of the symptoms only other factor that influenced the visual outcome (statistically significant, p value 0.017). Conclusion: With this study it was statistically proved that pre-operative visual status is the main factor for improvement of early post-operative visual outcome in pituitary adenoma and duration of symptoms had also influence the early post-operative visual outcome. Duration less than 12 months had a favorable outcome. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17182 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 108-115

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Visual Outcome of Patients with Pituitary Adenomas Following Surgery and Its Contributory Factors at a Tertiary Hospital in Ghana

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v29i1.11 ◽

1970 ◽

Vol 29 (1) ◽

Author(s):

Naa Naamuah Tagoe ◽

Vera Adobea Essuman ◽

Patrick Bankah ◽

Thomas Dakurah ◽

Vincent Kwaku Hewlett ◽

...

Keyword(s):

Pituitary Adenoma ◽

Teaching Hospital ◽

Visually Impaired ◽

Tumour Size ◽

Visual Outcome ◽

Tertiary Hospital ◽

Late Presentation ◽

Success Rates ◽

Local Data ◽

Duration Of Symptoms

BACKGROUND: Craniotomy and transphenoidal microsurgery are surgical options for treatment of pituitary adenoma at Korle Bu Teaching Hospital(KBTH). Despite major advances and reported success rates of transphenoidal resection globally, paucity of local data regarding visual outcome of either procedure exists. We evaluated the visual outcome of patient with pituitary adenoma following surgery in a tertiary hospital in Ghana.METHODS: This is a prospective study of 18 of 45 consecutive new patients with pituitary adenoma seen from November 2010 to July 2013 at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Sixteen (88.9%) of the 18 had surgery by transphenoidal route and 2(11.1%) by craniotomy. All patients had macroadenoma (tumour size >1cm) and histological confirmation of diagnosis. Pre-operative and post-operative visual acuity and its relationship to tumour size and duration of symptoms before diagnosis were evaluated.RESULTS: Data on 18 patients aged 33-60 years, mean (SD) 45.9±8.5, was analysed. Eleven (61.1%) were females.Visual blur, 15(83.3%), and headache,13(72.2%), were predominant presenting complaints.Common neuro-ophthalmic signs included unilateral or bilateral optic atrophy, 17(94.4%), Relative Afferent Pupillary Defect (RAPD) in 8(44.4%) and impaired colour vision in 32 of 36(88.9%) eyes. Preoperatively, 8(22.2%) and 13(36.1%) of 36 eyes were visually impaired or blind respectively. Postoperatively, 6(16.7%) eyes were visually impaired and 17(47.2%) eyes blind. Blindness was associated with late presentation (p<0.005) and larger tumour width (p<0.036).CONCLUSIONS: More than a third of eyes of patients with pituitary adenoma were blind before and after surgery. Blindness was associated with late presentation and larger tumours. Transphenoidal surgery may be beneficial following early diagnosis to avoid irreversible blindness/visual impairment.

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Factors Affecting the Visual Outcome of Pituitary Adenoma Patients Treated with Endoscopic Transsphenoidal Surgery

World Neurosurgery ◽

10.1016/j.wneu.2017.05.144 ◽

2017 ◽

Vol 105 ◽

pp. 422-431 ◽

Cited By ~ 6

Author(s):

Tuomas Luomaranta ◽

Antti Raappana ◽

Ville Saarela ◽

M. Johanna Liinamaa

Keyword(s):

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Visual Outcome ◽

Endoscopic Transsphenoidal Surgery ◽

Factors Affecting

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Association of pituitary adenoma with neuronal christoma: A TEM study

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010016889x ◽

1994 ◽

Vol 52 ◽

pp. 232-233

Author(s):

Eva Horvath ◽

Kalman Kovacs ◽

B. W. Scheithauer ◽

R. V. Lloyd ◽

H. S. Smyth

Keyword(s):

Growth Hormone ◽

Pituitary Adenoma ◽

Pituitary Tumor ◽

Nervous Tissue ◽

Alternative Explanation ◽

Growth Hormone Releasing Hormone ◽

Cell Hyperplasia ◽

Releasing Hormone ◽

Secretory Neurons

The association of a pituitary adenoma with nervous tissue consisting of neuron-like cells and neuropil is a rare abnormality. In the majority of cases, the pituitary tumor is a chromophobic adenoma, accompanied by acromegaly. Histology reveals widely variable proportions of endocrine and nervous tissue in alternating or intermingled patterns. The lesion is perceived as a composite one consisting of two histogenetically distinct parts. It has been suggested that the neuronal component, morphologically similar to secretory neurons of the hypothalamus, may initiate adenoma formation by releasing stimulatory substances. Immunoreactivity for growth hormone releasing hormone (GRH) in the neuronal component of some cases supported this view, whereas other findings such as consistent lack of growth hormone (GH) cell hyperplasia in the lesions called for alternative explanation.Fifteen tumors consisting of a pituitary adenoma and a neuronal component have been collected over a 20 yr. period. Acromegaly was present in 11 patients, was equivocal in one, and absent in 3.

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