BACKGROUND Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. OBJECTIVE To analyze visual parameters and their association based on long-term follow-up. METHODS Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. RESULTS Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, −12.9 ± 7.3 dB to −6.3 ± 5.9 dB). CONCLUSION Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.

Diffuse idiopathic skeletal hyperostosis (DISH) of the cervical spine is a common spinal degenerative disease observed in 10% to 30% of the general population, 1 and it rarely manifests as dysphagia. Some have regarded it to contribute to stiffness and restricted segmental motion, 2-4 although in some cases, mechanical compression of the tracheoesophageal complex can result in dysphagia, hoarseness, and even dyspnea. It is presumed that dysphagia or airway obstruction due to cervical DISH is present in only 0.1% to 4% of cases: 5-7 Some authors refer to it as DISH-phagia, 8 which is a neologism of DISH and dysphagia. The prevalence of DISH-phagia is unknown, as many cases are not reported because of unfamiliarity among physicians with its signs.The disease course and treatment strategy of DISH-phagia are not established. While a few studies have reported longterm surgical outcomes, 9-12 no statistical analyses have been performed in this context. This study aimed to outline progno-

Esthesioneuroblastoma as a source of ectopic Cushing's syndrome is rare, and to the best of our knowledge, only 20 cases have been reported worldwide. A 46-year-old healthy man visited a local clinic for general weakness and hyposmia, and underwent examination with serial endocrinological workup and brain imaging. 68 Gallium-DOTA-TOC positron emission tomography scan was helpful where diagnosis of sellar MRI and inferior petrosal sinus sampling were discordant. Combined transcranial and endoscopic endonasal approach surgery was performed, and a diagnosis of esthesioneuroblastoma was given.

INTRODUCTION Diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia is a rare clinical condition. Some studies have reported surgical resection of anterior osteophytes, but there was no treatment guideline. METHODS We retrospectively investigated 21 cases of DISH-related dysphagia in Yonsei University Health System from 2003 to 2018. Patient's symptom were measured by O’neil's dysphagia scale. Prevertebral soft tissue (PVST) was defined as the distance of tracheal posterior border to most anterior portion of vertebra. All data were gathered both before surgery and after 1-mo of follow-up. We compared the symptom improved group (n = 13) with not improved group (n = 8) by various clinical and radiographic parameter. RESULTS In improved group (n = 13), postoperative PVST was 7.5 ± 3.4 mm whereas in not improved group (n = 8), it was 3.3 ± 0.8 mm. If considered the presence of cricoid cartilage, postoperative PVST + PVST cricoid was 8.4 ± 3.3 mm in improved group and 3.1 ± 1.0 mm in not-improved group. Significant statistical difference (P-value < .05) were noted in all. Area under curve (AUC) value of postoperative PVST was 0.889 (cutoff: 3.25 mm) and postoperative PVST + PVST cricoid was 0.942 (cutoff: 4.50 mm), respectively. CONCLUSION Surgical removal of anterior osteophytes in cervical DISH is an effective option. PVST is useful indicator in DISH-related dysphagia. Surgeons should take aim to make sufficient prevertebral space after surgery because it is highly related to symptom improvement