Optic Nerve Compression by Pituitary Adenomas

Fahlbusch, Rudolf; Marguth, F.

doi:10.1007/978-3-642-67980-3_19

Cited by 12 publications

(9 citation statements)

References 5 publications

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“…Fahlbusch et al [11] reported about normalization or recovery of impaired visual functions in 80% and 48%, respectively, comparing transsphenoidal surgery with transcranial surgery of pituitary adenomas. Visual acuity and visual fields deteriorated in 2% of cases in the transsphenoidal group in contrast to 22% in the craniotomy group.…”

Section: Results Of Transcranial Pituitary Surgerymentioning

confidence: 97%

“…Especially after resecting calcified tumors, e.g. craniopharyngiomas, visual deterioration is frequently seen depending on the adhesion of the calcified tumors to the optic chiasm, optic nerves and the suprasellar arachnoid [11,17,26]. Similar to the experience from patients surgically treated via transsphenoidal approaches, a few general factors which are associated with a higher risk of postoperative visual deterioration have been identified, namely prior radiotherapy, previous surgery, a long history of preoperative visual impairment and invasive tumor growth to the suprasellar arachnoid [1,3,9,11,24].…”

Section: Complicationsmentioning

confidence: 99%

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Transcranial surgery for pituitary adenomas

Buchfelder

Kreutzer

2008

Pituitary

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Following a century of evolution and refinements in standard surgical techniques, the vast majority of operations for pituitary adenoma to date are performed utilizing transsphenoidal approaches. From current large series one obtains the impression that certainly less than 10% of these tumors require craniotomies. However, still several tumors, which's volume is mainly localized outside of the sella require transcranial approaches, of which the pterional and subfrontal routes are the most widely used. The goal of surgical treatment is rapid eradication of the tumor mass, decompression of visual pathways and elimination of hormonal oversecretion whilst preserving the normal gland and avoiding potential surgical complications. Even with microsurgical techniques and standardized approaches, there is still some mortality associated with transcranial approaches and morbidity is undoubtly higher than with transsphenoidal operations. However, a selection bias must be considered, which shifts tumors with a larger size, less favourable prognosis and higher complication rate into the transcranial series. Moreover, with extended transsphenoidal approaches, lesions have become accessible for transsphenoidal surgery, which previously have been considered as contraindications. In this article current indications and limitations for transcranial surgery of pituitary adenomas, the preoperative workup, surgical techniques, results, and complications are briefly reviewed.

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Section: Results Of Transcranial Pituitary Surgerymentioning

confidence: 97%

Section: Complicationsmentioning

confidence: 99%

Transcranial surgery for pituitary adenomas

Buchfelder

Kreutzer

2008

Pituitary

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“…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.…”

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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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“…The ophthalmological results of a series of 76 suprasellar pituitary adenomas operated by the transsphenoidal approach had been documented (Fahlbusch and Marguth 1981). Vision is constituted by two parameters, visuaI acuity and visual field defects.…”

Section: Suprasellar Pituitary Adenomasmentioning

confidence: 99%

Surgical therapy of lesions within the hypothalamic region

Fahlbusch

Schrell

1985

Acta neurochir

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On one hand pituitary microadenomas with autonomous character and those, which had been influenced by hypothalamic disorders, are summarized and discussed. On the other hand, the neurosurgical management of tumours, adjacent to or involved with the hypothalamus, are described. Endocrinologically active pituitary adenomas are characterized by their hormone excess of ACTH, GH, and prolactin. In Cushing's disease endocrine and clinical remission occurred in 74%. 3 patients out of this group showed a reincrease of ACTH after a period of remission, indicating a possible hypothalamic influence. In acromegaly the hypothalamic influence is also discussed. One patient with an ectopic GRF-producing tumour showing a reincrease of GH levels after successful transsphenoidal adenomectomy has been described. In microprolactinomas, 7 patients out of 45 showed a reincrease of prolactin-levels after a period of normalization, we also discussed hypothalamic disorders. Tumours with suprasellar extension such as macroadenomas without endocrine activity and meningiomas are removed nowadays with minimal risk for the life of the patients. In craniopharyngiomas radical excision is accompanied by a high risk of hypothalamic defects caused by mechanical lesions and possible secondary vasospasm. Finally the excision of a hamartoma growing from the floor of the third ventricle into the interpeduncular cistern is discussed. Up to now the successful excision could be documented by endocrinological data, which give no sign of further growth of the hamartoma.

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Optic Nerve Compression by Pituitary Adenomas

Cited by 12 publications

References 5 publications

Transcranial surgery for pituitary adenomas

Transcranial surgery for pituitary adenomas

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

Surgical therapy of lesions within the hypothalamic region

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