Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade

Chinezu, Rareş; Fomekong, Franklin; Lasolle, H.; Trouillas, Jacqueline; Vasiljevic, Alexandre; Raverot, Gérald; Jouanneau, Emmanuel

doi:10.1016/j.wneu.2017.06.151

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…A clear limitation of the available literature includes the heterogeneity of the studied population. Patients present with VFDs and impaired VA prior to surgery, in 20-100% [7, 15, 16, 18, 19, 21, 23-31, 34-36, 38, 40, 41, 43, 45, 48-50, 53, 55], and 20-99% [18,19,23,24,28,34,38,40,43,50,53,55] of patients, respectively. Furthermore, consensus on grading or stratification of severity of visual dysfunction is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…2b) [15,16,18,19,21,24,26,27,29,31,40,41,43,49,50,55]. Postoperatively, VFDs were recorded as improved in 87.0% of patients (median, IQR 73.8-92.3%), stabilized in 12.8% (median, IQR 1.5-17.0%) and, worsened [18,19,23,24,28,34,38,40,43,50,53,55]. Severity of preoperative impairment of VA was reported in 5 studies with 5 different grading systems (Table 2) [18,24,34,50,55].…”

Section: Prior and Post Treatment Evaluation Of Vf And Vamentioning

confidence: 99%

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Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study

et al. 2020

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Purpose Surgery in patients with non-functioning pituitary macroadenomas (NFMA) is effective in ameliorating visual function. The urgency for decompression, and preferred timing of surgery related to the preoperative severity of dysfunction is unknown. Methods Systematic review for evidence to provide clinical guidance for timing of surgical decompression of the optic chiasm, and a cohort study of 30 NFMA patients, in whom mean deviation (MD), and severity of visual dysfunction was assessed. Results Systematic review 44 studies were included with a total of 4789 patients. Postoperatively, visual field defects improved in 87.0% of patients, stabilized in 12.8% and worsened in 1.0%. Specific protocols regarding timing of surgery were not reported. Only seven studies (16.7%) reported on either the duration of visual symptoms, or diagnostic, or treatment delay. Cohort study 30 NFMA patients (50% female, 60 eyes, mean age 58.5 ± 14.8 years), had a median MD of − 5.3 decibel (IQR − 3.1 to − 10.1). MD was strongly correlated with clinical severity (r = − 0.94, P < 0.0001), and were used for severity of defects cut-off values: (1) normal > − 2 dB, (2) mild − 2 dB to − 4 dB, (3) moderate − 4 to − 8 dB, (4) severe − 8 to − 17 dB, (5) very severe < − 17 dB. Conclusion Surgical decompression is highly effective in improving visual function. Uniform, quantitative grading of visual dysfunction was lacking. MD is a promising quantitative outcome measure. We provide recommendations for the evaluation of timing of surgery, considering severity of visual impairment, which will need further validation based on expert clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Prior and Post Treatment Evaluation Of Vf And Vamentioning

confidence: 99%

Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study

et al. 2020

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“…This finding may be partially explained by the baseline difference between the two groups with a higher degree of initial visual impairment present in the very elderly patients (93 vs 69%). In this series, visual deterioration was observed in only 1.5% of the total group and the authors suggested that visual deficits should not result in very elderly patients being denied surgery (40). Review of seven further studies on post-operative visual outcomes in patients aged from ≥65 to ≥80 years showed improvement in 34-92%, stability in 3-63% and deterioration in 0-8%, and comparison with various control groups (ranging in age from 18 to <80 years) demonstrated no difference in visual improvement rates (39,40,41,42,43,44,45).…”

Section: Visual Improvement and Factors Affecting Itmentioning

confidence: 63%

“…Given the delays in the diagnosis of visual deterioration in elderly patients (11), post-operative visual outcomes in this group are of particular interest. Chinezu et al (40), in a series of non-functioning adenoma patients undergoing endoscopic transsphenoidal surgery, found improvement of visual status in 80% of those aged >80 and 35% of those aged 65-75 years which was statistically significant. This finding may be partially explained by the baseline difference between the two groups with a higher degree of initial visual impairment present in the very elderly patients (93 vs 69%).…”

Section: Visual Improvement and Factors Affecting Itmentioning

confidence: 90%

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Lithgow

Batra

Matthews

et al. 2019

European Journal of Endocrinology

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Visual dysfunction is an important element in the morbidity encountered in patients with pituitary adenoma leading to functional impairment and compromised quality of life. It consists of many parameters (even in the absence of reported symptomatology) as a result of tumour growth in proximity to structures critical for vision (anterior visual pathway, cranial nerves within cavernous sinuses), and as an adverse consequence of therapeutic interventions. Adenoma resection leads to high rates of visual improvement and possibly continues beyond a year post surgery, but the exact timing of maximum effect requires elucidation. Retinal nerve fibre layer measurement may be a reliable, objective parameter predicting favourable visual outcomes, although its prognostic value when pathological, needs to be confirmed. For compromised vision after pituitary apoplexy, early surgical decompression remains usual practice until evidence-based guidance becomes available. The risk of radiation-induced visual toxicity is mainly influenced by total and per fraction dose of radiation and treatment modality. Careful selection of cases and of radiotherapy technique/planning are of major importance in minimising this risk. Dopamine agonists lead to visual recovery in a considerable number of prolactinoma patients. Visual morbidity should be considered a vital indicator in the metrics of quality of service/care in pituitary disease making regular, full ophthalmic examination an essential component of modern management of pituitary pathology at all time points of patient pathway. Well-designed studies minimising effects of bias and using tools and scoring systems reliably reflecting visual status will provide robust evidence on valid prognostication and patient stratification guiding clinical decision making.

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“…Were included for further analysis 8 studies [9,11,24,26,38,49,59,61], containing a total of 2387 patients (table 1). The flow-chart describing the study selection is displayed in figure 1.…”

Section: Data Extractionmentioning

confidence: 99%

Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis

Tuleasca

Ducos

Leroy³

et al. 2020

Acta Neurochir

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Introduction: Pituitary adenomas (PA) are common intracranial tumors. In the context of the ageing of the population, the question is whether postsurgical outcomes are comparable to the younger ones. The primary objective of the present study was to review published resection and recurrence rates after transsphenoidal resection. The secondary aim was to evaluate visual improvement and complication rates. Methods: The authors searched PubMed and Medline databases, of published English series, with no time frame limit, evaluating outcomes of transsphenoidal resection in populations aged more or less than 65, 70 and 80 years. We performed a systematic review and meta-analysis. Results: Median overall resection rates for younger population was 70.7% (range 54-76.8) and for elderly one was 65.7% (range 16.6-78.2) (two sample t test, p= 0.35). The only statistically significant difference for gross total resection rates (GTR) favored patients aged less than 80 (p=0.01). There was no statistically significant difference among recurrence rates. There was a statistically significant difference for visual improvement favoring patients aged more than 80 (p=0.03). For the age groups of less versus more than 70, there was a statistically significant difference for overall complication rate favoring younger groups (p<0.05). Conclusion: Present data shows GTR rates favoring younger patients. Recurrence rates remain similar over mean follow-up period. Moreover, visual improvement favors patients aged more than 80. Overall complications rates favors patients younger than 70, which might be also related to additional comorbidities, frequently present in seniors. Transsphenoidal surgery is safe and effective even for older patients.

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Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade

Cited by 16 publications

References 23 publications

Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study

Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study

MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Transsphenoidal resection for pituitary adenoma in elderly versus younger patients: a systematic review and meta-analysis

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