Dynamics of visual improvement following chiasmal decompression. Quantitative pre‐ and postoperative observations

Jakobsson, Karl-Erik; Petruson, Björn; Lindblom, Bertil

doi:10.1034/j.1600-0420.2002.800510.x

Cited by 340 publications

(22 citation statements)

References 12 publications

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“…The majority of previous studies that investigated the role of OCT as a prognostic tool strictly limited their data to those from surgery via the transsphenoidal approach (TSA), from which there is little surgical trauma. 6,8,13,14,16,18 In this series, this potential limitation was overcome by using the data of only one neurosurgeon, who had > 10 years of experience in parachiasmal meningioma. A follow-up duration longer than that described in other OCT publications also made it possible to surpass the possible confounding effect of craniotomy (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…The utility of OCT as a predictive marker of axonal loss and visual recovery in chiasmal compression by tumors such as pituitary adenoma has already been well established by several publications. 6,10,14,16,24 In this study, we analyzed the usefulness of OCT as a tool for predicting visual recovery in patients with a parachiasmal meningioma compressing the anterior visual pathway.…”

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confidence: 99%

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

Park

Oh²,

Kim

et al. 2015

JNS

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R estoRing vision in patients who have lost visual field (VF) or visual acuity (VA) as a result of a tumor compressing the visual pathway has always been a matter of great concern. It is a well-known fact that tumor resection and decompression of the affected anterior visual pathway can lead to visual recovery, but in many cases such recovery is variable and unpredictable. 18Numerous studies have identified predictive factors such as symptom duration, preoperative visual deficit, preoperative tumor size, and intraoperative and radiographic abbreviatioNs MD = mean deviation; OCT = optical coherence tomography; RGC = retinal ganglion cell; RNFL = retinal nerve fiber layer; SAP = standard automated perimetry; TSA = transsphenoidal approach; VA = visual acuity; VF = visual field. 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 ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Park

Oh²,

Kim

et al. 2015

JNS

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“…Due to this anatomical relationship, visual impairment is the most common objective manifestation of such tumors. 10 The severity of visual loss (acuity, field, and color discrimination) depends on the tumor's characteristic. Large, firm, and capsular tumors appear to lead to more severe loss of vision.…”

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confidence: 99%

A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment

Hajiabadi

Samii

Fahlbusch

2016

JNS

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O ptic nerves, the optic chiasm, and optic tracts, which are located in the suprasellar region, can be damaged anatomically and functionally by tumors in this area. Due to this anatomical relationship, visual impairment is the most common objective manifestation of such tumors. 10 The severity of visual loss (acuity, field, and color discrimination) depends on the tumor's characteristic. Large, firm, and capsular tumors appear to lead to more severe loss of vision. 6 On the other hand, visual acuity and visual field examination reflect the degree of optic pathway compression. This examination requires the cooperation of the patient; therefore in some critical situations such as an intubated patient, a noncooperative state, and pediatric patients, decision making while considering the ophthalmological examination is not possible. Furthermore, there is a continuing interest to evaluate viabbreviatioNs DTI = diffusion tensor imaging; FA = fractional anisotropy; HARDI = high angular resolution diffusion imaging; MD = mean diffusivity; MFL = minimum fiber length; ROI = region of interest; TSSS = transsphenoidal sinus surgery; VIS = visual impairment score. methods This prospective study consisted of 25 patients with progressive visual impairment due to suprasellar mass lesions and 6 control patients with normal vision without such lesions. Visual acuity, visual field, and the optic fundus were examined preoperatively and repeated 1 week and 3 months after surgery. Visual pathway DTI tractography was performed preoperatively, intraoperatively immediately after tumor resection, and 1 week and 3 months after surgery. results In the control group, pre- and postoperative visual status were normal and visual pathway tractography revealed fibers crossing the optic chiasm without any alteration. In patients with suprasellar lesions, vision improved in 24 of 25. The mean distance between optic tracts in tractography decreased after tumor resection and detectable fibers crossing the optic chiasm increased from 12% preoperatively to 72% postoperatively 3 months after tumor resection, and undetectable fibers crossing the optic chiasm decreased from 88% preoperatively to 27% postoperatively 3 months after tumor resection. Visual improvement after tumor removal 1 week and 3 months after surgery was significantly correlated with the distance between optic tracts in intraoperative tractography (p < 0.01). coNclusioNs Visual pathway DTI tractography appears to be a promising adjunct to the standard clinical and paraclinical visual examinations in patients with suprasellar mass lesions. The intraoperative findings, in particular the distance between optic tract fibers, can predict visual outcome after tumor resection. Furthermore, postoperative application of this technique may be useful in following anterior optic pathway recovery.

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“…16,20 Visual recovery may be demonstrated a few days after surgery. [21][22][23] In a recent study by Losa and co-workers, visual function normalised in 110 (39.4%) and improved in 141 (50.6%) of the 279 patients with pre-operative impairment of visual function. 9 Resolution of oculomotor nerve palsy occurred in 18 of the 22 patients (81.8%) with diplopia at presentation.…”

Section: Early Results Of Surgerymentioning

confidence: 99%

Surgical Indications and Results for Non-functioning Pituitary Adenomas

Losa

Peretti

Mortini

2008

European Endocrinology

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Dynamics of visual improvement following chiasmal decompression. Quantitative pre‐ and postoperative observations

Cited by 340 publications

References 12 publications

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

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

A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment

Surgical Indications and Results for Non-functioning Pituitary Adenomas

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