Endoscopic Transsphenoidal Treatment of a Prolactinoma Patient With Brain and Optic Chiasmal Herniations

Zhang, Ning; Guo, Liemei; Ge, Jian; Qiu, Yongming

doi:10.1097/scs.0000000000000632

Cited by 6 publications

(7 citation statements)

References 10 publications

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“…Moreover, the expanding tumor may cause bone and meningeal erosion that can facilitate brain herniation when there is significant shrinkage of the tumor. In the reported cases ( 4 – 7 ), there was significant decrease in tumor size due to medical treatment of a prolactinoma. In our case, pituitary apoplexy may have contributed to increase the opening through the diaphragma sella, as it produces an increase in intrasellar pressure.…”

Section: Discussionmentioning

confidence: 91%

“…We found only four reported cases of brain associated with optic chiasm herniation in large prolactinomas following dopamine agonist treatment ( 4 – 7 ).…”

Section: Discussionmentioning

confidence: 95%

“…Zhang et al ( 7 ) reported a 24-year-old woman with a macroprolactinoma treated with bromocriptine, increased to 2.5 mg TID. Two years later she presented with severe visual field deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Simultaneous brain and optical chiasm herniation has been rarely reported following dopamine agonist treatment for large prolactinomas ( 4 – 7 ). Empty sella as well as herniation of the suprasellar visual system due to pituitary apoplexy has been seldom reported ( 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

et al. 2017

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Brain and optic chiasm herniation has been rarely reported following dopamine agonist treatment for large prolactinomas. We report a case of brain and optical chiasm herniation, secondary to an empty sella due to apoplexy of a prolactinoma, and we focus on the specific presentation of this case. A 32-year-old female presented to a neurologist complaining of headaches. Her past medical history was significant for acute vision loss in both eyes accompanied by right third nerve palsy when she was 16 years old. She does not recall any endocrine or imaging evaluation at that time and she had spontaneous partial recovery of left eye vision within 3 months, with permanent blindness of right eye. She did not return to any follow-up until her neurologist consultation. Brain magnetic resonance imaging (MRI) revealed herniation of frontal lobe and optic chiasm into the pituitary sella, as well as a pituitary hypointense lesion measuring 5 mm × 5 mm after gadolinium injection. Prolactin levels were 206 ng/ml (4.79–23.3 ng/ml). Repeated prolactin was 258 ng/ml (4.79–23.3 ng/ml). She was started on bromocriptine 2.5 mg/day. Prolactin levels and menstrual cycles normalized. A repeat brain MRI performed 5 months later showed disappearance of pituitary mass, with no changes in brain and chiasmal herniation. To our knowledge, this is the first reported case of brain associated with chiasm herniation secondary to pituitary apoplexy of a prolactinoma. In conclusion, this case highlights that frontal lobe herniation in combination with optic chiasm herniation can be a complication of pituitary tumor apoplexy. Long-term surveillance of patients with pituitary apoplexy is warranted to detect delayed complications.

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Section: Discussionmentioning

confidence: 91%

“…We found only four reported cases of brain associated with optic chiasm herniation in large prolactinomas following dopamine agonist treatment ( 4 – 7 ).…”

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

et al. 2017

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“…The incidence of visual deterioration and herniation of the optic chiasm varied from 0.8 to 10% (4 out of 501 and 3 out of 28) [9,13]. Patients were aged between 20 and 71 years, 55% had an endocrine active adenoma, 43% had a nonfunctioning pituitary adenoma (NFA) and 2% a Rathke's Cleft Cyst (RCC) [2,9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Furthermore, in 8 patients with secondary empty sella, chiasmal herniation and the severity of visual symptoms were not related [10].…”

Section: Introductionmentioning

confidence: 99%

Chiasmal herniation following treatment of pituitary macroadenoma

et al. 2020

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Purpose To evaluate whether the occurrence of chiasmal herniation coincides with visual field (VF) deterioration and to compare the course of VF defects in patients with and without radiological chiasmal herniation following treatment of pituitary adenoma. Methods This retrospective cohort study included 48 pituitary macroadenoma patients with chiasm compression, divided into three groups: Group 1 (N = 12), downward displaced optic chiasm and deteriorated VFs; Group 2 (N = 16), downward displaced optic chiasm; Group 3 (N = 20), control-group matched for tumour size and follow-up VFs, in mean deviation (dB). VFs were compared over time and a severity index, Chiasm Herniation Scale (CHS), for herniation based on radiological parameters was designed. Results After treatment, all groups showed improvement of VFs (Gr1: 2.97 dB p = 0.097, Gr2: 4.52 dB p = 0.001 and Gr3: 5.16 dB p = 0.000), followed by long-term gradual deterioration. The course of VFs between patients with and without herniation was not significantly different (p = 0.143), neither was there a difference in the course before and after herniation (p = 0.297). The median time till onset of herniation was 40 months (IQR 6 month-10 years) and did not significantly differ (p = 0.172) between the groups. There was no relation between VFs and the degree of herniation (p = 0.729). Conclusion Herniation does not appear to have clinical relevance with respect to VF outcome. The newly designed CHS is the first scoring system to quantify the severity of herniation and, in the absence of alternatives, may be useful to describe MRI findings to serve future added value in larger sized outcome studies.

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Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

et al. 2021

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Background The optimal management of clinoidal meningiomas (CMs) continues to be debated. Methods We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. Results and conclusion This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient’s counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.

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Endoscopic Transsphenoidal Treatment of a Prolactinoma Patient With Brain and Optic Chiasmal Herniations

Cited by 6 publications

References 10 publications

Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy

Chiasmal herniation following treatment of pituitary macroadenoma

Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

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