“…Depending on the anatomical position of the optic chiasm (normal position, prefixed or postfixed chiasm), pituitary adenomas with only a 10‐mm to 15‐mm suprasellar growth cause a chiasm defect . Either the tumor compromises the arterial supply of the optic nerve or chiasm or directly compresses the anterior visual pathway itself.…”
Section: Intradural Tumorsmentioning
confidence: 99%
“…Homonymous hemianopia is possible when the unilateral optic tract is compressed. The position of chiasm (normal position, prefixed or postfixed chiasm) has an influence on the pattern of visual field defect . Recently, optical coherence tomography (OCT) has emerged as a quantitative objective method of measuring indirectly the axonal loss of the anterior visual pathway by evaluating the retinal nerve fiber layer thickness .…”
Background
Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS).
Methods
Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus.
Results
The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated.
Conclusion
A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.
“…Depending on the anatomical position of the optic chiasm (normal position, prefixed or postfixed chiasm), pituitary adenomas with only a 10‐mm to 15‐mm suprasellar growth cause a chiasm defect . Either the tumor compromises the arterial supply of the optic nerve or chiasm or directly compresses the anterior visual pathway itself.…”
Section: Intradural Tumorsmentioning
confidence: 99%
“…Homonymous hemianopia is possible when the unilateral optic tract is compressed. The position of chiasm (normal position, prefixed or postfixed chiasm) has an influence on the pattern of visual field defect . Recently, optical coherence tomography (OCT) has emerged as a quantitative objective method of measuring indirectly the axonal loss of the anterior visual pathway by evaluating the retinal nerve fiber layer thickness .…”
Background
Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS).
Methods
Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus.
Results
The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated.
Conclusion
A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.
“…One study was excluded because it was conducted ex vivo on anatomical dissection ( Roebroeck et al, 2008 ). The remaining 39, published between 2007 and 2022, were included in the systematic review ( Akazawa et al, 2010 , Allen et al, 2018 , Altıntaş et al, 2017 , Ather et al, 2019 , Chakravarthi et al, 2021 , Davies-Thompson et al, 2013 , de Blank et al, 2013 , Ge et al, 2015 , Hajiabadi et al, 2015 , Hajiabadi et al, 2016 , He et al, 2021 , Ho et al, 2019 , Hodaie et al, 2010 , Hofer et al, 2010 , Jacquesson et al, 2019a , Jin et al, 2019 , Kamali et al, 2014 , Kammen et al, 2016 , Lacerda et al, 2021 , Lecler et al, 2018 , Liang et al, 2021 , Lin et al, 2018 , Lober et al, 2012 , Ma et al, 2016 , Maleki et al, 2012 , Manners et al, 2022 , Miller et al, 2019 , Puzniak et al, 2019 , Puzniak et al, 2021 , Salmela et al, 2009 , Staempfli et al, 2007 , Takemura et al, 2019 , Tao et al, 2009 , Techavipoo et al, 2009 , Wu et al, 2019 , Yang et al, 2011 , Yoshino et al, 2016 , Zhang et al, 2012b , Zolal et al, 2017 ) . Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Eight (20.5%) studies were conducted only on healthy volunteers ( Akazawa et al, 2010 , He et al, 2021 , Hofer et al, 2010 , Jin et al, 2019 , Kamali et al, 2014 , Kammen et al, 2016 , Maleki et al, 2012 , Staempfli et al, 2007 ), seven (17.9%) in patients affected by genetic conditions (e.g., albinism, congenital achiasma, Leber’s hereditary optic neuropathy) ( Ather et al, 2019 , Davies-Thompson et al, 2013 , Lecler et al, 2018 , Manners et al, 2022 , Puzniak et al, 2019 , Puzniak et al, 2021 , Takemura et al, 2019 ), three (7.7%) in patients affected by ophthalmological pathologies (e.g., amblyopia, aniridia, glaucoma) ( Allen et al, 2018 , Altıntaş et al, 2017 , Miller et al, 2019 ), nineteen (48.7%) in patients with tumors or other expansive processes ( de Blank et al, 2013 , Ge et al, 2015 , Hajiabadi et al, 2015 , Hajiabadi et al, 2016 , Ho et al, 2019 , Hodaie et al, 2010 , Jacquesson et al, 2019a , Liang et al, 2021 , Lin et al, 2018 , Lober et al, 2012 , Ma et al, 2016 , Salmela et al, 2009 , Tao et al, 2009 , Wu et al, 2019 , Yoshino et al, 2016 , Zhang et al, 2012b , Zolal et al, 2017 ), one (2.6%) in patients affected by demyelinating disorders (e.g., multiple sclerosis, neuromyelitis optica) ( Techavipoo et al, 2009 ), and two (5.1 %) in patients with other pathologies (traumas, epilepsy) ( Lacerda et al, 2021 , Yang et al, 2011 ) .…”
“…Patients with concomitant pituitary adenoma and ophthalmologic comorbidity pose as a clinical dilemma for neurosurgeons and neuro-ophthalmologists. Pre-operative assessment of the retina with OCT and the optic tract via visual pathway diffusion tensor imaging (DTI) tractography are helpful adjuncts for such a multi-disciplinary decision-making [10].…”
Background: Retinitis pigmentosa (RP) is one of the most severe hereditary retinal disorders with a worldwide prevalence reaching 1 in every 3000-5000 people and a total of almost one million affected individuals. RP is heterogeneous in its clinical presentations but typically presents as progressive visual dysfunction, including nyctalopia in adolescence, restricted peripheral vision (tunnel vision) in young adults, and loss of central vision at an advanced age. Case description: Herein, we want to report a case of RP who presented with gradual worsening of vision and headache, and further evaluation revealed a concomitant non-functional pituitary macroadenoma. Ophthalmologic evaluation revealed a little chance for him to regain his vision, so the patient refused to undergo endoscopic surgical resection. However, he is still under clinic-radiologic follow-up, to be evaluated for progression in tumor size and obstructive hydrocephalus. Conclusion: Presenting with similar symptoms of tunnel vision, the simultaneous occurrence of these two diseases in a patient may delay the diagnosis of the latter, leading to its progression.
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