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

Luomaranta, T.; Raappana, Antti; Saarela, Ville; Liinamaa, Johanna

doi:10.1016/j.wneu.2017.05.144

Cited by 32 publications

(25 citation statements)

References 31 publications

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“…8,31,32 One study found SSE greater than 9.5 mm to be associated with visual dysfunction which indicates that this association between tumor size and VFD is especially strong among tumors growing in a craniocaudal direction. 7 In our cohort, a similar trend was seen with higher Fujimoto grade independently being associated with an increased likelihood of VFD at presentation. A significant difference was also seen in average SSE between patients with preoperative VFD and those without VFD, with similar values to the abovementioned study.…”

Section: Presentationsupporting

confidence: 81%

“…Although existing literature suggests SSE to be predictive of VFD at presentation, most studies also indicate greater tumor size, frequently accompanied by SSE, to be associated with less postoperative improvement. 7,8,31,32,[36][37][38] The contrary can be seen in this study, where a higher Fujimoto grade was associated with a greater odds of postoperative VFD improvement. This inconsistency might come from differences in study population with some of these studies having a larger tumors, 31 a lower percentage of NFPA, 32 a higher percentage of preoperative VFD, 8 or a lower percentage of postoperative improvement.…”

Section: Postoperative Visual Outcomesmentioning

confidence: 54%

“…Suprasellar tumor extension (SSE) and chiasmal compression were graded following the grading system as formulated by Fujimoto et al 26,27 Additionally, the absolute size of SSE was measured from the planum sphenoidale upward. 7 Invasion of the cavernous sinus by PA was classified according to the scale devised by Knosp et al 28 Out of operative reports and medical charts, the following variables were collected: intraoperative cerebrospinal fluid (CSF) leakage, postoperative CSF leakage, use of a fat graft, and histopathological tumor characteristics. Ophthalmological parameters included preoperative and postoperative best-corrected VA, visual field tests (i.e., Humphrey field analysis, Octopus, Goldmann's perimetry), and assessment of ophthalmoplegia.…”

Section: Data Collectionmentioning

confidence: 99%

“…6 Similarly, depending on the location of the tumor, visual impairment can also be seen in a small proportion of microadenomas (adenomas <1 cm in size). 7,8 The development of these visual symptoms is secondary to PA growth that results in the compression of optic chiasm and damage to the optic nerve fibers. 3 These visual symptoms may present as visual field defects (VFD) and decreased visual acuity (VA) with reported prevalence rates ranging from 14 to 84% and 28 to 100%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Essen

Muskens

Lamba

et al. 2020

J Neurol Surg B Skull Base

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Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes. Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al. Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively (p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort (p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD (p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04). Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.

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Section: Presentationsupporting

confidence: 81%

Section: Postoperative Visual Outcomesmentioning

confidence: 54%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Essen

Muskens

Lamba

et al. 2020

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…After chiasmal decompression, retinal signals transmitted to the visual cortex could increase as the visual field improves. However, the local FC may still be unstable, as some studies have shown that visual acuity improvement lags behind that of the visual field [28][29][30][31], while others have shown that improvement of the visual field lags behind that of visual acuity [32,33]. One study on pituitary adenoma patients showed that visual function was significantly improved at 1 to 4 months after surgery, and only a few individuals regained normal vision at 1 week after surgery [3].…”

Section: Discussionmentioning

confidence: 99%

Increased resting-state functional connectivity in suprasellar tumor patients with postoperative visual improvement

Ying

Yuan

et al. 2019

Int. J. Med. Sci.

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Background and Objective: Large suprasellar tumors often compress the optic chiasm and give rise to visual impairment. Most patients have significantly improved visual function at 1 to 4 months after chiasmal decompression surgery, and only a few individuals regain normal vision at 1 week after surgery. How the recovery of visual function in these patients affects the visual cortex is not fully understood. In this study, we aimed to investigate alterations in brain functional connectivity (FC) in suprasellar tumor patients with visual improvement using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: This longitudinal study was conducted on 13 suprasellar tumor patients who had ophthalmological examinations and rs-fMRI at the following time points: within 1-week preoperation (Pre-op), 1-week postoperation (Post-1w) and 1-month postoperation (Post-1m). The visual impairment score (VIS), local functional correlation (LCOR) and FC values were subjected to one-way ANOVA. Pearson correlation coefficients between changes in the LCOR and clinical factors were calculated. Results: The VIS was significantly decreased at both Post-1w and Post-1m compared to that at Pre-op. Whole-brain analysis of LCOR values showed that the left V1 (primary occipital cortex) was increased significantly at Post-1m compared to that at Pre-op (p < 0.05, FDR corrected). ROI analysis exhibited a significant negative correlation between the LCOR and VIS changes at Post-1m compared to those at Pre-op (p < 0.05, r =-0.60). FC analysis within the visual network showed that the FC strengths were significantly increased between the left V5 and the left V4, right V3a, left V3, left V2d, and right V5 at Post-1m compared to those at Pre-op (p < 0.05, FDR corrected). Additionally, the FC strengths were significantly increased between the left V5 and the left V1, right orbital-frontal gyrus and left posterior supramarginal gyrus at the whole-brain network level at Post-1m compared to those at Pre-op (p < 0.05, FDR corrected). Conclusions: Postoperative visual improvement can be reflected by the increased FC of the visual cortex at Post-1w and Post-1m, especially at Post-1m. The LCOR value of the left V1 was associated with improved visual outcomes and may be used to objectively assess early visual recovery after chiasmal decompression at Post-1m.

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Analysis of factors affecting visual field recovery following surgery for pituitary adenoma

et al. 2021

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

Cited by 32 publications

References 31 publications

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Increased resting-state functional connectivity in suprasellar tumor patients with postoperative visual improvement

Analysis of factors affecting visual field recovery following surgery for pituitary adenoma

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