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Aluyi-Osa G, Suleman A, Salati C, Spadea L, Gagliano C, Musa M, Zeppieri M. Multidisciplinary management of pituitary macroadenoma. World J Methodol 2025; 15:97694. [DOI: 10.5662/wjm.v15.i3.97694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 11/18/2024] [Accepted: 12/03/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.
AIM To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.
METHODS A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.
RESULTS A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.
CONCLUSION Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future
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Affiliation(s)
- Gladness Aluyi-Osa
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
| | - Ayuba Suleman
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Italy
- Mediterranean Foundation "G.B. Morgagni", 95125 Catania, Italy
| | - Mutali Musa
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
- Department of Optometry, University of Benin, Benin 300283, Nigeria
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Guan Z, Li Q, Niu C, Fan S, Yu H, Wu W, Feng X, Dai C. Correction of Non-Uniform Rotational Distortion in the Proximally Controlled Endoscopic OCTA. JOURNAL OF BIOPHOTONICS 2025; 18:e202400467. [PMID: 39905654 DOI: 10.1002/jbio.202400467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 01/06/2025] [Accepted: 01/07/2025] [Indexed: 02/06/2025]
Abstract
Endoscopic Optical Coherence Tomography (OCT) can provide high-resolution cross-sectional images for internal organ tissues. Combining the endoscopic imaging with Optical Coherence Tomography Angiography (OCTA), information of blood vessels in superficial lumen tissues is expected to be acquired. However, in endoscopic OCT systems using proximal scanning probes, performance of OCTA encounters significant challenges due to non-uniform rotational distortion (NURD) caused by the non-constant rotation of the distal imaging unit. In this study, we proposed a registration method for endoscopic OCTA imaging in a proximally controlled OCT System. Global registration and A-line registration were employed to correct the distortion caused by mechanical friction between the catheter sheath and torque coil. Experimental performances in both microfluidic channel and rat rectum show significant correction of NURD. Our study achieved the first implementation of endoscopic OCTA under a spiral B-scan rotation scheme in a proximally controlled OCT system, facilitating clear visualization of blood flow.
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Affiliation(s)
- Zehua Guan
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Qiang Li
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Chen Niu
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Shuhao Fan
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Huanhuan Yu
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Wenjuan Wu
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
| | - Xiangfei Feng
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuixia Dai
- Shanghai Institute of Technology, College of Sciences, Shanghai, China
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Donica VC, Donica AL, Pavel IA, Danielescu C, Alexa AI, Bogdănici CM. Variabilities in Retinal Hemodynamics Across the Menstrual Cycle in Healthy Women Identified Using Optical Coherence Tomography Angiography. Life (Basel) 2024; 15:22. [PMID: 39859961 PMCID: PMC11766587 DOI: 10.3390/life15010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 12/25/2024] [Accepted: 12/26/2024] [Indexed: 01/27/2025] Open
Abstract
Background: Numerous conditions, both physiological and pathological, can influence changes in the retinal vascular architecture. In order to be able to highlight pathological aspects of systemic diseases with ocular activity, it is necessary to understand how physiological fluctuations can influence circulation at the retinal level. The present study attempts to evaluate retinal and choroidal vascular and structural changes in healthy female subjects over the course of a menstrual cycle using OCT-A. Methods: We analyzed 22 eyes from healthy reproductive women with a regular menstrual cycle. We performed five OCT-A scans of the subjects every 7-8 days over the course of a month starting from the first day of the menstrual cycle and ending with the first day of the next cycle, measuring perfusion density in the superficial and deep vascular plexuses, choroidal thickness, and FAZ perimeter. Results: There are physiological variations in retinal hemodynamics that can be identified using OCT-A, choroidal thickness having statistically significant increased values in the parafoveal nasal sector during the ovulatory phase (289.18 µm) compared to the early follicular phase (281.9 µm), and the subfoveal sector during the ovulatory phase (319.04 µm) compared to the early follicular phase (308.27 µm). Conclusions: These findings along with abnormally small FAZ perimeters indicate that the menstrual cycle phase should be considered whenever interpreting OCT-A results. Further studies that include larger cohorts, control groups, and hormone serum levels are necessary to confirm and correlate retinal vascular alterations and the phase of the menstrual cycle using OCT-A.
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Affiliation(s)
- Vlad Constantin Donica
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
| | - Alexandra Lori Donica
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
| | - Irina Andreea Pavel
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
| | - Ciprian Danielescu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
| | - Anisia Iuliana Alexa
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
| | - Camelia Margareta Bogdănici
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
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Tan Z, Lu KL, Zhang WC, Peng SY, Wen XJ, Dai TT, Pang YH. Comparative of OCT and OCTA parameters in patients with early chronic angle-closure glaucoma and early pituitary adenoma. Sci Rep 2024; 14:21448. [PMID: 39271729 PMCID: PMC11399151 DOI: 10.1038/s41598-024-71103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have the potential application in evaluating pathological structural change of the optic nerve. We aimed to evaluate the value of the OCT and OCTA parameters of the optic disk and macular in differentiating early chronic primary angle-closure glaucoma (CPACG) and early pituitary adenoma (PA) in case of mild visual field defects (the mean defect (MD) > 6 dB). The results showed that regarding OCTA parameters, CPACG patients had lower retinal blood flow density of most layers of the optic disk and macular than PA patients. Regarding OCT parameters, CPACG patients had thinner circumpapillary retinal nerve fiber layer (CP-RNFL) in all quadrants and average CP-RNFL, ganglion cell layer (GCL) and macular ganglion cell complex (GCC) in each quadrant of macular inner and outer rings, and inner plexus layer (IPL) of macular inner ring, superior-outer ring and temporal-outer ring than PA patients. The Z test indicated that OCTA parameters and OCT parameters had similar value in the diagnosis of disease. In conclusion, in the case of similar visual field damage, early CPACG patients have smaller blood flow density and thinner optic disk and macular than early PA. OCTA has similar performance to OCT in diagnosing CPACG and PA.
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Affiliation(s)
- Zhi Tan
- Radiology Department. Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Kai-Lun Lu
- Ophthalmology Department Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang, 524023, Guangdong Province, China
| | - Wan-Cheng Zhang
- Ophthalmology Department Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang, 524023, Guangdong Province, China
| | - Shu-Ying Peng
- Radiology Department. Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Xiu-Juan Wen
- Ophthalmology Department Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang, 524023, Guangdong Province, China
| | - Tong-Tong Dai
- Ophthalmology Department Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang, 524023, Guangdong Province, China
| | - Yan-Hua Pang
- Ophthalmology Department Affiliated Hospital of Guangdong Medical University, No. 57, South Renmin Avenue, Xiashan District, Zhanjiang, 524023, Guangdong Province, China.
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Kemchoknatee P, Singhakul C, Arjkongharn N, Vongsa N, Tangon D, Srisombut T. Insights into Visual Outcomes and Determinants in Pituitary Adenoma Surgery: A 5-Year Retrospective Cohort Study. Clin Ophthalmol 2024; 18:1779-1788. [PMID: 38919405 PMCID: PMC11198008 DOI: 10.2147/opth.s463303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose To investigate the long-term visual outcome and their determinants after an operation in Thai pituitary adenoma (PA). Patients and Methods A retrospective cohort study was conducted on PA patients who underwent surgery at Rajavithi Hospital. Baseline characteristics and visual parameters, including visual acuity (VA) and visual field (VF), were analyzed in relation to the visual prognosis outcome. The outcome was defined as VA improvement at 1-year postoperatively. Visual parameters were measured at each follow-up visit and compared. Factors for improved visual prognosis were evaluated using logistic regression analysis. Results A total cohort of 87 patients (64.37% female), 62.07% showed improvement in visual outcome. Most improvement occurred immediately after surgery, evident at the 1-month visit. The mean follow-up time was 47.45 months (±28.49 SD), mean difference in VA improvement at 1-year was -0.56 logMAR (95% CI -0.73, -0.47). In multivariable logistic regression model, prolonged onset duration was associated with a reduced odds of improved visual outcome, with an odds ratio (OR) of 0.946 (95% CI 0.899-0.996, p = 0.034). Baseline characteristics, tumor volume, Hardy and Knops classification, and surgical approaches were not identified as significant predictors. Conclusion Both TSS and transcranial approaches are effective for pituitary adenoma. A prompt operation is recommended for patients with prolonged onset duration, with thorough discussion on poor postoperative visual outcomes.
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Affiliation(s)
- Parinee Kemchoknatee
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Chotika Singhakul
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Niracha Arjkongharn
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Nattaporn Vongsa
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
| | - Duanghathai Tangon
- Faculty of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Thansit Srisombut
- Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan, Thailand
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Banc A. The Role of Optical Coherence Tomography Angiography in the Evaluation of Chiasmal and Retrochiasmal Compression. Neuroophthalmology 2024; 48:315-327. [PMID: 39145324 PMCID: PMC11321417 DOI: 10.1080/01658107.2024.2338411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 08/16/2024] Open
Abstract
The compression of the visual pathway is associated with structural retinal changes due to retrograde neurodegeneration. It was brought into question whether visual pathway compression is also associated with retinal vascular changes as assessed by optical coherence tomography angiography (OCT-A). The objective of this review is to discuss the role of OCT-A in the evaluation of patients with tumours of the sellar, parasellar, and retrochiasmal regions. The reported OCT-A parameters were the vessel densities of radial peripapillary capillary network, macular superficial vascular plexus and/or macular deep vascular complex. Optic nerve and macular OCT-A parameters were impaired in patients versus controls. These changes were associated with altered structural OCT parameters and visual field defects. OCT-A could be considered a marker of neurodegeneration in addition to structural OCT, and it has the potential to become a visual prognostic tool in patients with visual pathway compression.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yu WJ, Xiao J, Wang GX, Jiang C, Zha W, Liao RF. Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography. Int J Ophthalmol 2024; 17:365-373. [PMID: 38371253 PMCID: PMC10827611 DOI: 10.18240/ijo.2024.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To evaluate the predictive value of superficial retinal capillary plexus (SRCP) and radial peripapillary capillary (RPC) for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer (pRNFL) and ganglion cell complex (GCC). METHODS This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery. Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness pre- and post-operatively and with healthy controls. Logistic regression models were used to assess the relationship between preoperative GCC, pRNFL, SRCP, and RPC parameters and visual field recovery after surgery. RESULTS The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls. Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values. The best predictive GCC and pRNFL models were based on the superior GCC [area under the curve (AUC)=0.866] and the tempo-inferior pRNFL (AUC=0.824), and the best predictive SRCP and RPC models were based on the nasal SRCP (AUC=0.718) and tempo-inferior RPC (AUC=0.825). There was no statistical difference in the predictive value of the superior GCC, tempo-inferior pRNFL, and tempo-inferior RPC (all P>0.05). CONCLUSION Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion. This reduction persists despite the recovery of the visual field after decompression surgery. GCC, pRNFL, and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.
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Affiliation(s)
- Wen-Juan Yu
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jin Xiao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Guang-Xin Wang
- Department of Ophthalmology, the First People's Hospital of Hefei, Hefei 230061, Anhui Province, China
| | - Chang Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wei Zha
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Rong-Feng Liao
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Khan DZ, Hanrahan JG, Baldeweg SE, Dorward NL, Stoyanov D, Marcus HJ. Current and Future Advances in Surgical Therapy for Pituitary Adenoma. Endocr Rev 2023; 44:947-959. [PMID: 37207359 PMCID: PMC10502574 DOI: 10.1210/endrev/bnad014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
The vital physiological role of the pituitary gland, alongside its proximity to critical neurovascular structures, means that pituitary adenomas can cause significant morbidity or mortality. While enormous advancements have been made in the surgical care of pituitary adenomas, numerous challenges remain, such as treatment failure and recurrence. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (eg, endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient's journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, surgical abilities will be augmented by the future operative armamentarium, including advanced optical devices, smart instruments, and surgical robotics. Intraoperative support to surgical team members will benefit from a data science approach, utilizing machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, neural networks leveraging multimodal datasets will allow early detection of individuals at risk of complications and assist in the prediction of treatment failure, thus supporting patient-specific discharge and monitoring protocols. While these advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of the translation of such technologies, ensuring systematic assessment of risk and benefit prior to clinical implementation. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.
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Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
- Digital Surgery Ltd, Medtronic, London WD18 8WW, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
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Ergen A, Kaya Ergen S, Gunduz B, Subasi S, Caklili M, Cabuk B, Anik I, Ceylan S. Retinal vascular and structural recovery analysis by optical coherence tomography angiography after endoscopic decompression in sellar/parasellar tumors. Sci Rep 2023; 13:14371. [PMID: 37658097 PMCID: PMC10474160 DOI: 10.1038/s41598-023-40956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023] Open
Abstract
We assessed the potential retinal microcirculation alterations for postoperative visual recovery in sellar/paraseller tumor patients with Optical Coherence Tomography Angiography (OCT-A). Two hundred ten eyes with sellar/parasellar tumor for which preoperative and postoperative (3 months) MRI Scans, Visual Acuity Test, Optical Coherence Tomography (OCT), OCT-A and, Visual Field Test data were available, besides 92 healthy eyes were evaluated. In the preoperative phase, significant reductions were observed in retinal vascular densities in various regions, including the Superficial Retinal Capillary Plexus (SRCP) (whole: p < 0.001, fovea: p = 0.025, parafovea: p < 0.001), Deep Retinal Capillary Plexus (DRCP) (whole: p < 0.001, fovea: p = 0.003, parafovea: p < 0.001), Peripapillary Vascular Density (PVD) (whole: p = 0.045, peripapillary: p < 0.001, nasal: p < 0.001, inferior: p < 0.001, temporal: p < 0.001), and Retinal Nerve Fiber Layer (RNFL) (nasal: p = 0.024, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001) compared to the healthy control group. After surgery, the postoperative data of patients without chiasmal distortion were compared to their preoperative data. In the postoperative evaluation, significant increases were observed in vascular densities in patients without chiasmal distortion in the SRCP (whole: p < 0.001, parafovea: p = 0.045), DRCP (whole: p = 0.007, fovea: p = 0.006, parafovea: p = 0.040), PVD (peripapillary: p = 0.010, inferior: p < 0.001, temporal: p < 0.001, superior: p < 0.001), and RNFL (nasal: p = 0.011, inferior: p = 0.034, temporal: p = 0.046, superior: p = 0.011). Furthermore, significant associations were observed in the ROC analysis between the postoperative Visual Field Mean Deviation (VFMD) and SRCP (whole AUC = 0.793, p < 0.001, cut-off = 51.45, parafovea AUC = 0.820, p < 0.001, cut-off = 53.95), DRCP (whole AUC = 0.818, p < 0.001, cut-off = 55.95, parafovea AUC = 0.820, p < 0.001, cut-off = 59.05), PVD (temporal AUC = 0.692, p < 0.001, cut-off = 55.10), and RNFL (whole AUC = 0.690, p = 0.001, cut-off = 119.5, inferior AUC = 0.712, p < 0.001, cut-off = 144.75). These findings indicate a potential role of pre and post-operative OCT-A measurements in the assessment of surgical timing and postoperative visual recovery in patients with or without optic chiasm distortion.
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Affiliation(s)
- Anil Ergen
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Sebnem Kaya Ergen
- Department of Ophthalmology, Kocaeli Seka State Hospital, Kocaeli, Turkey
| | - Busra Gunduz
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Sevgi Subasi
- Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Melih Caklili
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Burak Cabuk
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Ihsan Anik
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey
| | - Savas Ceylan
- Department of Neurosurgery and Pituitary Research Center, School of Medicine, Kocaeli University, 41380, Kocaeli, Turkey.
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Banc A, Biousse V, Newman NJ, Kedar S. Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review. Neurosurgery 2023; 92:42-67. [PMID: 36519859 PMCID: PMC10158913 DOI: 10.1227/neu.0000000000002186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/15/2022] [Indexed: 12/23/2022] Open
Abstract
Compression of the anterior visual pathways by sellar and parasellar masses can produce irreversible and devastating visual loss. Optical coherence tomography (OCT) is a noninvasive high-resolution ocular imaging modality routinely used in ophthalmology clinics for qualitative and quantitative analysis of optic nerve and retinal structures, including the retinal ganglion cells. By demonstrating structural loss of the retinal ganglion cells whose axons form the optic nerve before decussating in the optic chiasm, OCT imaging of the optic nerve and retina provides an excellent tool for detection and monitoring of compressive optic neuropathies and chiasmopathies due to sellar and parasellar masses. Recent studies have highlighted the role of OCT imaging in the diagnosis, follow-up, and prognostication of the visual outcomes in patients with chiasmal compression. OCT parameters of optic nerve and macular scans such as peripapillary retinal nerve fiber layer thickness and macular ganglion cell thickness are correlated with the degree of visual loss; additionally, OCT can detect clinically significant optic nerve and chiasmal compression before visual field loss is revealed on automated perimetry. Preoperative values of OCT optic nerve and macular parameters represent a prognostic tool for postoperative visual outcome. This review provides a qualitative analysis of the current applications of OCT imaging of the retina and optic nerve in patients with anterior visual pathway compression from sellar and parasellar masses. We also review the role of new technologies such as OCT-angiography, which could improve the prognostic ability of OCT to predict postoperative visual function.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
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Early Retinal Microcirculation in Nonfunctioning Pituitary Adenomas Without Visual Field Defects Using Optical Coherence Tomography Angiography. J Neuroophthalmol 2022; 42:509-517. [PMID: 35482899 DOI: 10.1097/wno.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND For patients with nonfunctioning pituitary adenoma (NFPA) without manifesting visual acuity impairment or visual field defect (VFD), more sensitive and objective assessment methods will allow earlier detection before irreversible damage to the visual system. This study aimed to evaluate retinal vessel densities (VDs) alterations in these patients using optical coherence tomography angiography and to determine its diagnostic abilities. METHODS Between patients with NFPA without VFDs and age-matched, sex-matched healthy control individuals, comparisons of visual field metrics, retinal structural thickness, and microcirculation were conducted after adjusting for axial length (AL) and signal index of scans. Receiver operating characteristic (ROC) curves were further depicted to assess the diagnostic performance of significant parameters. To explore the impact of symptom duration, tumor size, and axial length on the significant parameters, multivariate regression analysis was conducted. RESULTS This cross-sectional study reviewed 107 patients with NFPA. Twenty-seven eyes of patients with NFPA without VFDs and 27 eyes of healthy controls were enrolled. Compared with healthy controls, patients with NFPA without VFDs had similar foveal avascular zone areas and perimeters, macular ganglion cell complex (mGCC) and peripapillary retinal nerve fiber layer thicknesses, and macular VDs. Only the VD in the radial peripapillary capillary (RPC) segment of the inferior temporal (IT) sector was much lower in the patient group. The 2 largest area under the ROC curves were the focal loss volume (FLV) of the mGCC and the VD in the RPC of the IT sector, both of which were significantly related to symptom duration and tumor size. CONCLUSIONS At the early stage of NFPA before VFD and retinal thickness thinning, fundus microcirculation impairments may occur initially in the microvascular density of the RPC segment of the IT sector. The FLV and the VD of RPC at the IT sector may provide a basis for the early diagnosis of NFPA without VFD in clinical practice.
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12
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Ng BCF, Mak CHK, Steffi CSY, Wing SK, Shing TT, Ching CF. A Factorial Analysis on Visual Outcomes of Transsphenoidal Surgery for Pituitary Macroadenoma. Asian J Neurosurg 2022; 17:280-285. [PMID: 36120608 PMCID: PMC9473845 DOI: 10.1055/s-0042-1751011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective
Sellar lesions are possible reversible causes of vision loss. This study is to provide quantitative objective measurement of efficacy of surgery for non-functioning pituitary adenoma and discuss different factors that could affect visual outcome of non-functioning pituitary adenoma.
Method
This is a single centre, retrospective study conducted at a tertiary neurosurgery referral centre. 108 cases of sellar tumors which underwent surgery during the 3-year period from early June 2015 to late May 2018 were reviewed. Pituitary adenoma that were non-functioning and without apoplexy at initial presentation were selected for the study. We have analyzed the correlation of different factors with the visual outcome, including the extent of vertical decompression in terms of change in tumor height post operation and the extent of lateral decompression in terms of change in Knosp grading. Visual outcome was represented by the visual impairment score (VIS), an integrated measurement of visual acuity and visual field deficit.
Results
Preoperative absolute tumor height and supracarotid height correlated with preoperative VIS scale (
p
≤ 0.01). Absolute Knosp grading correlates significantly with VA (
p
= 0.001) and VF (
p
≤ 0.001) of that particular eye. Although most patients had an objective improvement in visual acuity (VA) (88%) and visual field (VF) (99%) after operation, a larger reduction in tumor height and successful Knosp downgrading after surgery is associated with better VIS improvement. (
p
= 0.025) Change in supracarotid height shows trend in correlating with change in VIS (
p
= 0.084).
Conclusion
Height of tumor measured from genu of cavernous ICA correlates better with visual outcome than absolute tumor height. The extent of both vertical and lateral decompression of non-functioning pituitary adenoma are important determinants that lead to better visual outcome. As endoscopic approach is able to achieve a greater degree of lateral decompression, it is a preferred approach in pituitary surgery to achieve a better visual outcome.
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Affiliation(s)
- Ben Chat Fong Ng
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | | | | | - See Ka Wing
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | - Tse Tat Shing
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
| | - Cheung Fung Ching
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China
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13
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Prognostic value of radial peripapillary capillary density for visual field outcomes in pituitary adenoma: A case-control study. J Clin Neurosci 2022; 100:113-119. [DOI: 10.1016/j.jocn.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
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14
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Özcan Y, Kayıran A, Kelestimur F, Ekinci G, Türe U. Changes in the peripapillary and subfoveal choroidal vascularity index after transsphenoidal surgery for pituitary macroadenoma. Int Ophthalmol 2022; 42:3691-3702. [DOI: 10.1007/s10792-022-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
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15
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Jeong SS, Funari A, Agarwal V. Diagnostic and Prognostic Utility of Optical Coherence Tomography in Patients with Sellar/Suprasellar Lesions with Chiasm Impingement: A Systematic Review/ Meta-Analyses. World Neurosurg 2022; 162:163-176.e2. [PMID: 35276393 DOI: 10.1016/j.wneu.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this review, we appraised the current literature on the utility of optical coherence tomography (OCT) as a diagnostic and predictive factor for postoperative visual function outcomes in patients with sellar/suprasellar lesions with chiasmal impingement. METHODS A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following PRISMA guidelines. Included studies described diagnostic or prognostic utility of OCT in patients with sellar/suprasellar lesions with chiasmal impingement. Meta-analysis was represented with mean difference (MD) with 95% confidence intervals. Meta-regression was performed to determine predictive factors of visual outcomes. RESULTS Forty-eight articles were identified for final pooled analysis, representing a total of 2,435 patients with compressive sellar/suprasellar lesions and 952 healthy controls. Mean age was 43.3(11.4) years, with 1,494(48.8%) male and 1,566(51.2%) female patients. Mean retinal nerve fiber layer(RNFL) was significantly different in the study population compared to healthy controls(75.8μ[13.2] vs 91.4μ[10.8], p<0.00001). The nasal segment of RNFL had the largest mean difference (MD -9.76[-12.39, -7.13], p<0.0001). Visual acuity, visual field mean deviation (VF-MD), and visual field pattern standard deviation, all showed significant differences between the study population and healthy controls as well(p<0.0001). Meta-regressions showed significant predictive capability of preoperative RNFL in determining visual function outcome (p<0.05). CONCLUSION Our findings provide promising support for the growing evidence that OCT parameters can be utilized as both a diagnostic and prognostic tool for patients with compression of the optic apparatus. There is a need for further studies to gain a better understanding of OCTs and to improve patient outcomes.
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Affiliation(s)
- Seth S Jeong
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Abigail Funari
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Vijay Agarwal
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, USA; Department of Otolaryngology, Montefiore Medical Center, Bronx, New York, USA
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16
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Kalyvas A, Milesi M, Leite M, Yang K, Jacques LS, Vescan A, Mete O, Ezzat S, Zadeh G, Gentili F. Endoscopic treatment of sellar arachnoid cysts via a simple cyst-opening technique: Long-term outcomes from a single center. World Neurosurg 2022; 161:e625-e634. [PMID: 35217229 DOI: 10.1016/j.wneu.2022.02.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sellar arachnoid cysts (SACs) are rare lesions that require treatment only if symptomatic. The endoscopic endonasal approach has been widely utilized. Despite their simple cystic appearance and the straight-forward surgical intervention there are important associated risks, with CSF leak being the prevalent one. METHODS A retrospective analysis of patients with pathologically confirmed SAC between January 2006 and December 2019 was conducted. A homogeneous simple cyst-opening technique and skull base reconstruction utilizing nasoseptal flaps was used. RESULTS Ten patients were identified (7 female and 3 male, median age was 54.5 years, range 20-77); 8 had newly diagnosed SACs whereas 2 recurrences from a previously microsurgically fenestrated SAC. Eight patients presented with visual symptoms (VS), 1 with VS and fatigue, and 1 with headaches. Neuro-ophthalmological and endocrinological assessments revealed visual field (VF) deficits in 6, visual acuity (VA) decline in 5 and hypopituitarism in 2 patients. Median calculated volume was 1.71 ml (range 0.27 - 2.54 ml). Postoperatively, no CSF leak and no further surgical complications were noted. VF improved in 4/6 while VA improved in 4/5 patients. Anterior pituitary function improved in 1, worsened in 1 and remained stable in 8 patients. One patient suffered diabetes insipidus. One recurrence was recorded 54 months postoperatively. CONCLUSION SACs can be effectively treated with a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduces the risk of CSF leak without compromising nasal quality of life in the long-term or mandating additional incisions. A long-term follow-up is important to monitor for late recurrences.
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Affiliation(s)
- Aristotelis Kalyvas
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Matthias Milesi
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Matheus Leite
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Leslie St Jacques
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Allan Vescan
- Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shereen Ezzat
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Fred Gentili
- Division of Neurosurgery, Sprott Department of Surgery and University Health Network/Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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17
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Wang X, Chou Y, Zhu H, Xing B, Yao Y, Lu L, You H, Gan L, Wang M, Ma J, Zhong Y. Retinal Microvascular Alterations Detected by Optical Coherence Tomography Angiography in Nonfunctioning Pituitary Adenomas. Transl Vis Sci Technol 2022; 11:5. [PMID: 34985507 PMCID: PMC8742530 DOI: 10.1167/tvst.11.1.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Visual impairment assessment plays a significant role in diagnosis and clinical decisions in nonfunctioning pituitary adenoma (NFPA). Retinal microvascular alterations may potentially reflect the visual impairment. The purpose of this study was to evaluate fundus microvascular alterations in patients with NFPA. Methods Comparisons of visual field, retinal structure, and microcirculation were conducted between patients with NFPA and age- and sex-matched healthy controls. Multivariate regression modeling was used to assess the relationship between symptom duration, sellar mass size, and fundus vessel density (VD) of patients. Receiver operating characteristic (ROC) curves were depicted to determine the diagnostic performance of significant parameters to discriminate eyes with NFPA from healthy eyes. Results Forty eyes of patients and 40 eyes of healthy individuals were enrolled. Compared to healthy controls, patients with NFPA had a larger foveal avascular zone area and thinner ganglion cell complex thickness. The VDs of patients presented an obvious decrease in radial peripapillary capillary (RPC) and an increase in the deep capillary plexus segment of the perifoveal area. The peripapillary VDs of patients were significantly related to sellar mass size. The area under the ROC curve of VD in the RPC segment of the temporo-inferior sector was the largest (0.801; 95% confidence interval, 0.70–0.90; P < 0.001). Conclusions The fundus of patients with NFPA demonstrated significant and characteristic microvascular impairments. The VDs were also significantly associated with sellar mass size. Translational Relevance Retinal microvascular alterations detected by optical coherence tomography angiography are characteristic and related to sellar mass size, which may provide information that facilitates the diagnosis of NFPA.
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Affiliation(s)
- Xuqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China.,China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Yuyu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China.,China Pituitary Disease Registry Center, Beijing, P. R. China
| | - Huijuan Zhu
- China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China.,Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Bing Xing
- China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China.,Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.,Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Yong Yao
- China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China.,Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.,Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Lin Lu
- China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China.,Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Hui You
- China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China.,Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing P. R. China
| | - Linyang Gan
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Meng Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China.,China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China
| | - Yong Zhong
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, P. R. China.,China Pituitary Disease Registry Center, Beijing, P. R. China.,China Pituitary Adenoma Specialist Council, Beijing, P. R. China
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18
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Cennamo G, Solari D, Montorio D, Scala MR, D’Andrea L, Tranfa F, Cavallo LM. The role of OCT- angiography in predicting anatomical and functional recovery after endoscopic endonasal pituitary surgery: A 1-year longitudinal study. PLoS One 2021; 16:e0260029. [PMID: 34855775 PMCID: PMC8638874 DOI: 10.1371/journal.pone.0260029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/31/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this study was to investigate the changes in structural spectral-domain optical coherence tomography (SD-OCT), OCT Angiography (OCTA) parameters, and visual acuity, 1 year after endoscopic endonasal approach for the removal of an intra-suprasellar pituitary adenoma compressing optic chiasm and compare outcomes with 48 hours postoperative data. Methods Sixteen eyes of eight patients (4 males, 4 females, mean age 52 ± 11 years) were enrolled in this prospective study. The primary outcome was to evaluate the changes over time before and after surgery, analyzing the Best Corrected Visual Acuity (BCVA), Ganglion Cell Complex (GCC), Retinal Nerve Fiber Layer (RNFL) thicknesses, the retinal vessel density (VD) of Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), Radial Peripapillary Capillary (RPC) and the Foveal Avascular Zone (FAZ). The secondary outcome was to identify potential biomarkers that could predict visual acuity changes after 1-year follow-up. Results When comparing SD-OCT and OCTA measurements obtained after 1 year with those observed 48 hours after surgery, GCC and RNFL were significantly improved. After a significant reduction at 48 hours, GCC thickness showed a significant increase at 1 year after surgery (p = 0.007), while a significant restoration of RNFL thickness was found at 1 year (p = 0.005), as well as the VD of SCP, DCP, and RPC values. FAZ area did not change over time. BCVA significantly improved at each time after surgery (p = 0.037, p = 0.013). A statistically significant correlation was found between the preoperative BCVA, VD of SCP, DCP, RPC, and the postoperative BCVA at 1 year (p = 0.017, p = 0.029, p = 0.031, p = 0.023). Conclusion SD-OCT and OCTA provide helpful information to identify the retinal structural and vascular improvements 1 year after surgery. OCTA parameters could serve as potential predictive markers for visual acuity recovery at long-term follow-up.
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Affiliation(s)
- G. Cennamo
- Public Health Department, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - D. Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
- * E-mail:
| | - D. Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, Eye Clinic, University of Naples "Federico II", Naples, Italy
| | - M. R. Scala
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - L. D’Andrea
- Department of Neurosciences, Reproductive Sciences and Dentistry, Eye Clinic, University of Naples "Federico II", Naples, Italy
| | - F. Tranfa
- Department of Neurosciences, Reproductive Sciences and Dentistry, Eye Clinic, University of Naples "Federico II", Naples, Italy
| | - L. M. Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive Sciences and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy
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19
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Long term predictive ability of preoperative retinal nerve fiber layer thickness in visual prognosis after chiasmal decompression surgery. Clin Neurol Neurosurg 2021; 207:106734. [PMID: 34119898 DOI: 10.1016/j.clineuro.2021.106734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the relationship between preoperative retinal nerve fiber layer (RNFL) thickness and the recovery of visual field (VF) and visual acuity (VA) 1 year after surgery in chiasmal compression patients presenting with visual impairment. PATIENTS AND METHODS Twenty-nine eyes of 16 patients with chiasmal compression and 14 eyes of 14 control subjects were enrolled. All patients undergoing chiasmal decompression surgery via a transsphenoidal approach were prospectively evaluated before and 1 year after surgery with best corrected visual acuity (BCVA, logMAR), mean deviation (MD) value with standard automated perimetry (SAP) and RNFL thickness with optical coherence tomography. Eyes with chiasmal compression were divided into two groups according to the mean preoperative RNFL thickness: ≥ 100 µm (Group 1) and < 100 µm (Group 2). The relationship between the mean preoperative RNFL thickness and visual prognosis parameters (VF, VA) was analyzed. RESULTS The mean preoperative RNFL thickness was 115.92 ± 8.97 µm, 84.0 ± 8.85 µm, and 114.21 ± 7.75 µm in Group 1 (n = 15 eyes), Group 2 (n = 14 eyes) and the control group (n = 14 eyes), respectively. The mean preoperative BCVA was 0.15 ± 0.3 in Group 1, and 0.41 ± 0.39 in Group 2. The mean BCVA increased to 0.03 ± 0.1 in Group 1 in the postoperative period but did not change in Group 2. MD value was - 6.10 ± 5.54 in the preoperative period and - 2.59 ± 2.23 in the postoperative period for Group 1 (p = 0.014), while it was - 18.97 ± 4.14 in the preoperative period and - 18.57 ± 4.51 in the postoperative period in Group 2 (p = 0.24). CONCLUSIONS This study suggests that lower mean preoperative RNFL thickness was associated with poorer long-term visual prognosis. Preoperative RNFL thickness measurements may be helpful in predicting the recovery of VF and VA after decompression surgery in patients with chiasmal lesion presenting with visual impairment.
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20
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Wang MTM, King J, Symons RCA, Stylli SS, Daniell MD, Savino PJ, Kaye AH, Danesh-Meyer HV. Temporal patterns of visual recovery following pituitary tumor resection: A prospective cohort study. J Clin Neurosci 2021; 86:252-259. [PMID: 33775337 DOI: 10.1016/j.jocn.2021.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/10/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
Significant restoration of visual function can occur following pituitary tumor resection, although the time course of visual recovery remains poorly understood. This single-centre, two-year, prospective cohort study investigated the temporal patterns of visual recovery in consecutive patients undergoing pituitary tumor resection, between 2009 and 2018. Eyes were stratified based on pre-operative optical coherence tomography (OCT) retinal nerve fibre layer (RNFL) thickness measurements, with thin RNFL being defined as those within the fifth-percentile of age-matched normative values, and normal RNFL as those above the fifth-percentile. Visual function and OCT parameters were assessed pre-operatively, and at 6 weeks, 6 months, and 2 years post-operatively. 456 eyes of 228 patients (mean ± SD age, 53 ± 15 years) were included, of which 114 (25%) eyes had thin RNFL pre-operatively. Visual field recovery was observed in both groups during the first 6 weeks post-operatively (all Q ≤ 0.02), although improvements in visual field parameters between 6 weeks to 6 months were limited to eyes with thin RNFL (both Q < 0.05). No further improvements in visual function were detected beyond 6 months in both groups (both Q > 0.50). Similar trends were observed in linear regression analysis according to baseline visual function in both groups. In summary, eyes with normal RNFL thickness at baseline experienced most of their recovery within the first six weeks following surgery, while eyes with thin RNFL exhibited gradual improvements during the first six months. These findings have important implications when providing patient counselling and prognostication in the pre-operative setting.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - James King
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R C Andrew Symons
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stanley S Stylli
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark D Daniell
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Peter J Savino
- Shiley Eye Institute, University of California, San Diego, CA, United States
| | - Andrew H Kaye
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
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21
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Kopparapu S, Khalafallah AM, Botros D, Carey AR, Rodriguez FJ, Duan D, Rowan NR, Mukherjee D. Predictors of Postoperative Visual Outcome After Surgical Intervention for Craniopharyngiomas. World Neurosurg 2021; 148:e589-e599. [PMID: 33482413 DOI: 10.1016/j.wneu.2021.01.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Because of involvement of the optic apparatus, craniopharyngiomas frequently present with visual deterioration. Although visual improvement is a primary goal of surgical intervention, prediction models are lacking. METHODS We retrospectively reviewed all patients undergoing craniopharyngioma surgery at a single institution (2014-2019). Preoperative, intraoperative, and postoperative variables of interest were collected. Visual acuity and visual fields (VFs) were standardized into Visual Impairment Scores (VISs), defined by the German Ophthalmological Society. VIS ranged from 0 (normal vision) to 100 (complete bilateral blindness). Visual improvement/deterioration was defined as a postsurgical decrease/increase of ≥5 VIS points, respectively. RESULTS Complete ophthalmologic assessments were available for 61 operations, corresponding to 41 patients (age, 4-73 years). Vision improved after 28 operations (46%), remained stable after 27 (44%), and deteriorated after 6 (10%). In bivariate analysis, significant predictors of visual improvement included worse preoperative VIS (odds ratio [OR], 1.058; P < 0.001), worse preoperative VF mean deviation (OR, 1.107; P = 0.032), preoperative vision deficits presenting for longer than 1 month (OR, 6.050; P = 0.010), radiographic involvement of the anterior cerebral arteries (OR, 3.555; P = 0.019), and gross total resection (OR, 4.529; P = 0.022). The translaminar surgical approach was associated with visual deterioration (OR, 6.857; P = 0.035). In multivariate analysis, worse preoperative VIS remained significantly associated with postoperative visual improvement (OR, 1.060; P = 0.011). Simple linear correlation (R2=0.398; P < 0.001) suggests prediction of postoperative VIS improvement via preoperative VIS. CONCLUSIONS Patients with reduced preoperative vision, specific radiographic vascular involvement, and gross total resection showed increased odds of visual improvement, whereas the translaminar approach was associated with visual deterioration. Such characteristics may facilitate patient-surgeon counseling and surgical decision making.
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Affiliation(s)
- Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adham M Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew R Carey
- Department of Neuro-Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas R Rowan
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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