Recovery of vision following transsphenoidal surgery for pituitary adenomas

Powell, Michael

doi:10.1080/02688699550041377

Cited by 88 publications

(45 citation statements)

References 3 publications

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“…We have previously reported visual improvement in 88% of patients and Arafah found endocrine improvement in two-thirds of patients operated. 10,11 Our series showed results compatible with these findings; all patients with a preoperative field defect or with impaired acuity improved.…”

Section: Discussionsupporting

confidence: 85%

A spectrum of behaviour in silent corticotroph pituitary adenomas

Baldeweg

Pollock

Powell

et al. 2005

British Journal of Neurosurgery

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Silent corticotroph adenomas (SCA) are pituitary tumours positive on immunohistochemical staining for ACTH but without clinical evidence of Cushing's disease in the patient. Previous reports suggest that these tumours may behave in a more aggressive way then other pituitary adenomas. We have followed the natural history of SCA and assessed whether histopathological indices predict tumour behaviour. We identified 22 patients in whom trans-sphenoidal surgery was performed for a non-functioning adenoma (NFA) with positive immunostaining for ACTH between 1990 and 2000 and examined the history of their disease. Patients were followed up for a mean of 4.8 years. A total of 86.7% of patients had documented visual deficits at presentation. In four cases hypercortisolaemia was observed later in the course of the disease. Two patients died as a result of their SCA and 33.3% of tumours recurred. Recurrence was more frequent in patients treated with adjuvant radiotherapy. Pathological indices (increased mitotic range and Ki-67) did not predict recurrence or malignant transformation. We suggest that certain 'silent' corticotroph tumours may have the potential for ACTH secretion leading to hypercortisolaemia at a later stage in the disease. The possibility of transformation to a more aggressive tumour needs to be considered in all SCA.

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Section: Discussionsupporting

confidence: 85%

A spectrum of behaviour in silent corticotroph pituitary adenomas

Baldeweg

Pollock

Powell

et al. 2005

British Journal of Neurosurgery

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“…We achieved a complete recovery of the visual field after surgery in 48.9% of eyes and an improvement, without reaching normality, in 46.8%. Our series compare favourably with the previously reported results [19,20]. Many preoperative factors have been advocated to influence the postoperative visual outcome.…”

Section: Discussionsupporting

confidence: 82%

“…In the present study, no patient experienced postoperative deterioration in the visual function. In the literature, including our previously published large series, the reported visual worsening ranged from 0% to 5% [7,8,13,17,20]. This wide range of published series may be explained considering that the follow-up, the visual parameters that were studied and the method of evaluation used were different.…”

Section: Discussionmentioning

confidence: 62%

Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method

et al. 2011

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The objective of the study was to evaluate the preoperative visual field defect, the postoperative outcome and the possible prognostic factors in patients with pituitary macroadenoma, using a quantitative method (the mean deviation = MD), and to review the literature. A total of 73 patients, operated trough trans-sphenoidal approach, were selected, and data in single eyes were analysed by calculating the frequency and the degree of postoperative improvement (relative improvement). The visual field defect improved in 95.7% of eyes: The recovery was complete in 48.9% and partial in 46.8%. Multivariate logistic regression showed that factors, independently predictive for complete recovery, were as follows: low preoperative MD absolute value (p = 0.008), low cranio-caudal diameter of tumour (p = 0.02) and young age (p = 0.0001). The mean relative improvement in visual field defect (dMD%) was correlated with the preoperative visual acuity (p = 0.0001) and inversely related with the preoperative MD (p = 0.007) and the age (p = 0.017). The relative improvement was higher in tumours with a smaller cranio-caudal diameter (p = 0.0185). In conclusion, using a quantitative method, we can measure the degree of the postoperative visual field defect improvement. Predictive factors for a complete recovery were good preoperative visual function, young age and low cranio-caudal tumour.

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“…La mayoría de las series quirúrgicas publicadas, no obstante, han evaluado resultados visuales en macroadenomas no funcionantes. Estos estudios reportan mejoría visual en hasta 75-95% de los pacientes sometidos a cirugía trans-esfenoidal o trans-cranial [33][34][35][36][37][38] . En el caso de macroprolactinomas, la mejoría visual se obtiene en 64 a 69% de los casos 39,40 .…”

Section: Discussionunclassified

“…Se ha citado a la duración de los síntomas, severidad de la pérdida visual, presencia o ausencia de atrofia óptica, edad y tamaño del tumor, entre otros 6 . De todos ellos, pareciera que la presencia de atrofia óptica al momento del diagnóstico es uno de los factores más relevantes a la hora de establecer un pronóstico, independiente del tratamiento que se otorgue 33,35,36,38 . En nuestra serie, los peores resultados visuales se presentaron en aquellos pacientes con atrofia óptica, lo que corrobora los hallazgos de estudios previos.…”

Section: Discussionunclassified