Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study

Sriram, Prabu Rau; Sellamuthu, Puliventhan; Ghani, Abdul Rahman Izani

doi:10.21315/mjms2017.24.6.7

Cited by 2 publications

(4 citation statements)

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“…Unroofing the optic canal, with or without clinoidectomy, was previously described. 1,3,7,18,25,26 Mahmoud et al pooled results of multiple optic canal decompression reports for tuberculum sellae meningiomas and found a compounded chance of visual preservation (92%), with possible improvement in 73% 1,3 (Figure 6). Early ON unroofing resulted in improved visual outcome vs delayed ON decompression.…”

Section: Discussion Anatomy and Surgical Techniquementioning

confidence: 99%

“…Tuberculum sellae meningiomas tend to present with visual symptoms at a smaller size vs pituitary adenomas. 1,3,25,34 Optic canal involvement in those tumors, while common, is not always the culprit. 1,3 Mechanical factors may explain patterns of visual defects seen in sellar and suprasellar tumors.…”

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

“…1,3,25,34 Optic canal involvement in those tumors, while common, is not always the culprit. 1,3 Mechanical factors may explain patterns of visual defects seen in sellar and suprasellar tumors. Trobe et al 37 found that most patients with adenomas had more pronounced unilateral visual deficits.…”

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

“…However, what is considered “visual outcomes” remains poorly understood. 1,2 Visual deficits may improve postresection of compressive lesions with consequent optic nerve (ON) decompression. 3-11 Several prognostic factors reportedly contribute to such outcomes: extent and duration of preoperative visual deterioration, patient age, lesion size, and optic canal involvement.…”

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Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study

Basma

Dacus

Kumar

et al. 2022

Operative Neurosurgery

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BACKGROUND:Questions remain regarding optic nerve (ON) physiology, mechanical compliance, and microvasculature, particularly surgical outcomes and atypical visual field defects associated with sellar/parasellar pathology (eg, tumors and aneurysms).OBJECTIVE:To study the microsurgical/histological anatomy of each ON segment and corresponding microvasculature, calculate area of optic-carotid space at each decompression stage, and measure ON tension before/after compression.METHODS:Five cadaveric heads (10 sides) underwent sequential dissection: (1) intradural (arachnoidal) ON dissection; (2) falciform ligament opening; (3) anterior clinoidectomy, optic canal decompression, and ON sheath release. At each step, we pulled the nerve superiorly/laterally with a force meter and measured maximal mobility/mechanical tension in each position.RESULTS:Cisternal ON microvasculature was more superficial and less dense vs the orbital segment. ON tension was significantly lower with higher mobility when manipulated superiorly vs lateromedially. Optic-carotid space significantly increased in size at each decompression stage and with ON mobilization both superiorly and laterally, but the increase was statistically significant in favor of upward mobilization. At decompression step, upward pull provided more space with less tension vs side pull. For upward pull, each step of decompression provided added space as did side pull.CONCLUSION:Opening the optic canal, falciform ligament, and arachnoid membrane decompresses the ON for safer manipulation and provided a wider optic-carotid surgical corridor to access sellar/parasellar pathology. When tailoring decompression, the ON should be manipulated superiorly rather than lateromedially, which may guide surgical technique, help prevent intraoperative visual deterioration, facilitate postoperative visual improvement, and help understand preoperative visual field deficits based on mechanical factors.

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Section: Discussion Anatomy and Surgical Techniquementioning

confidence: 99%

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

Section: Biomechanics and Pathophysiologymentioning

confidence: 99%

mentioning

confidence: 99%

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Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study

Basma

Dacus

Kumar

et al. 2022

Operative Neurosurgery

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Visual field improvement after endoscopic transsphenoidal surgery in patients with pituitary adenoma

Zhuang²,

Yang³

et al. 2023

Front. Oncol.

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PurposeTo analyze and predict the possibility of visual field (VF) recovery after endoscopic transsphenoidal surgery (ETSS) in patients with pituitary adenoma, we investigated the factors affecting the improvement of the visual field defect (VFD) and built a nomogram predictive model based on these risk factors. We further investigated specific recovery regions of VF associated with the improvement of VFD.MethodsThe clinical data of patients who underwent ETSS for pituitary adenomas at a single center between the January 2021 and April 2022 were retrospectively analyzed. Univariate and multivariate analyses were used to determine the predictive factors affecting the improvement in the VF defect and specific recovery regions in patients with pituitary adenomas after ETSS.ResultsWe enrolled 28 patients (56 eyes) who were hospitalized at our institution. Four clinical features, including compression of the optic chiasm, preoperative mean defect (MD), diffuse defect, and duration of the visual symptom, were chosen from the least absolute shrinkage and selection operator regression analysis to establish the predictive nomogram. The nomogram’s area under the curve (AUC) was 0.912, indicating a good degree of differentiation. A calibration plot was used to evaluate the predictive model’s calibration, and a decision curve was used to evaluate its clinical application value. The VF defects were improved in the 270–300° range (270–300: RR = 361.00, 95% CI: 21.01–6,202.41).ConclusionWe developed a predictive nomogram model based on significant visual field improvement-associated factors after ETSS in patients with pituitary adenoma. Postoperative visual field improvement is likely to begin at 270–300° in the inferior temporal quadrant. This improvement would enable personalized counselling for individual patients by precisely predicting the visual field recovery after surgery.

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Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study

Abstract: Symptom duration and surgical approach were independent factors that affects the visual field after surgery in patients with sellar region tumors.

Cited by 2 publications

References 36 publications

Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study

Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study

Visual field improvement after endoscopic transsphenoidal surgery in patients with pituitary adenoma

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