Progressive improvement of impaired visual acuity during the first year after transsphenoidal surgery for non-functioning pituitary macroadenoma

Dekkers, Olaf M.; Keizer, R J W de; Roelfsema, Ferdinand; Klaauw, A. A. vd; Honkoop, Persijn; Dulken, H. van; Smit, Johannes W. A.; Romijn, Johannes A.; Pereira, Alberto M.

doi:10.1007/s11102-007-0007-0

Cited by 56 publications

(41 citation statements)

References 25 publications

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“…This is due to our early visual field assessment of the patient than the other authors and needs of long term follow-up. Improvement of visual field defects is a continuing process for at least 1 year 12,5,7 . Kerrison et al 2000 7 , showed progressive improvement of visual fields even more than 2 years after surgical decompression of the optic chiasm.…”

Section: Discussionmentioning

confidence: 99%

Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Amin

Nath

Hossain

et al. 2013

Bangla. J. Neuroscience

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Background: Pituitary adenoma, which accounts for 17.4% of all brain tumors, is the third most frequently diagnosed brain tumor, following intracranial glioma and meningioma. The visual disturbance in pituitary adenoma ranged from blurring of vision with or without headache to total loss of vision. In patients with visual field defects, bitemporal hemianopia was the commonest visual field defect. Early improvement of visual function is one of the major indication surgery. Objective: The purpose of this study was to comparison between the pre and post-operative visual parameters and to find out the value in assessment of the prognosis of early postoperative visual function and also to find out the factor which influence the early post-operative visual outcome. Methods: A prospective study was done from September 2010 to April 2012 in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, 30 cases of pituitary adenoma had been included in this study of those who were presented with visual symptoms. Visual assessment was done before the operation and outcome was analyzed at discharged from hospital. Results: Within 60 eyes, 13 (43.3%) patients presented with blindness of one or both eyes. 10 (33.3%) presented with uniocular and 3 (10.0%) presented with binocular blindness. Duration of the symptoms ranged from 2 months to 48 months. Patients underwent either transcranial or transsphenoidal tumor decompression. At discharge out of 30 patients, 23 (76.7%) showed improvement, 2 (6.6%) patients were deteriorated post-operatively. P value was <0.001, in z test, Z=91.5, which was highly significant. Post-operative visual status was analyzed with age, sex, duration of symptoms, suprasellar extension, and methods of surgery and extent of tumor resection to find out that any other factor influenced the visual outcome. In bivariate analysis it was shown that only duration of the symptoms only other factor that influenced the visual outcome (statistically significant, p value 0.017). Conclusion: With this study it was statistically proved that pre-operative visual status is the main factor for improvement of early post-operative visual outcome in pituitary adenoma and duration of symptoms had also influence the early post-operative visual outcome. Duration less than 12 months had a favorable outcome. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17182 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 108-115

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Section: Discussionmentioning

confidence: 99%

Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Amin

Nath

Hossain

et al. 2013

Bangla. J. Neuroscience

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“…Surgical resection remains the initial treatment of choice for symptomatic non-prolactin-secreting pituitary macroadenomas 7,8 . Surgery offers the advantages of pathologic confirmation, immediate decompression of the optic apparatus, and rapid reduction of pathologic hormone secretion 7,9 .…”

Section: Discussionmentioning

confidence: 99%

“…Surgery offers the advantages of pathologic confirmation, immediate decompression of the optic apparatus, and rapid reduction of pathologic hormone secretion 7,9 . Long-term tumour control rates after surgery alone range between 50% and 80% 10 .…”

Section: Discussionmentioning

confidence: 99%

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

et al. 2008

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BackgroundThe use of fractionated stereotactic radiotherapy (FSRT) has evolved with technical advances in noninvasive immobilization, radiation delivery, and image guidance. The application of FSRT to pituitary tumours is aimed at reducing toxicity through improved dose conformality and reduced treatment margins. The aim of the present paper is to report our own experience and to review the published data on FSRT for pituitary macroadenomas. MethodsBetween September 2000 and October 2005, 13 patients with pituitary macroadenoma underwent FSRT at our institution. In 12 patients, radiotherapy treatment followed surgical resection (transsphenoidal resection in 8, frontal craniotomy in 3, and multiple transsphenoidal resections followed by craniotomy in 1). In 4 patients, the tumours were functional (2 adrenocorticotropic hormone-secreting, 1 prolactinoma, and 1 growth hormone-secreting); the tumours in the remaining patients were clinically non-secretory. Before radiation, 3 patients had panhypopituitarism, and 6 patients had visual field defects. All patients were treated with FSRT using non-coplanar micro-multileaf collimation portals. A median dose of 50.4 Gy (range: 45-60 Gy) was prescribed to the 76.9%-95.2% isodose surface and delivered in 1.8-Gy fractions. The median planning target volume (gross tumour plus 3 mm) was 33.5 cm 3 (range: 3.2-75 cm 3 ). ResultsAfter a median follow-up of 24 months (range: 6-60 months), local control was 100%. One patient achieved clinical complete response. Treatment was well tolerated acutely for all patients. Neither radiation-induced optic neuropathy nor any radiation-related endocrine dysfunction was observed in our patients. ConclusionsIn accordance with published series, we found FSRT to be safe and effective in the management of large pituitary macroadenomas.

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“…In case of visual field defects, transsphenoidal surgery is the treatment of choice, resulting in the improvement of visual function in the majority of patients (1). Selected patients require treatment by postoperative radiotherapy (2).…”

Section: Introductionmentioning

confidence: 99%

Alterations in diurnal rhythmicity in patients treated for nonfunctioning pituitary macroadenoma: a controlled study and literature review

Joustra

Thijs

Berg

et al. 2014

European Journal of Endocrinology

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Objective: Patients treated for nonfunctioning pituitary macroadenomas (NFMAs) have fatigue and alterations in sleep characteristics and sleep-wake rhythmicity frequently. As NFMAs often compress the optic chiasm, these complaints might be related to dysfunction of the adjacent suprachiasmatic nucleus (SCN). We aimed to explore whether indirect indices of SCN functioning are altered in the long term after surgery for NFMAs. Methods: We studied 17 NFMA patients in long-term remission after transsphenoidal surgery, receiving adequate and stable hormone replacement for hypopituitarism, and 17 control subjects matched for age, gender, and BMI. Indirect indices of SCN function were assessed from 24-h ambulatory recordings of skin and core body temperatures, blood pressure, and salivary melatonin levels. Altered melatonin secretion was defined as an absence of evening rise, considerable irregularity, or daytime values O3 pg/ml. We additionally studied eight patients treated for craniopharyngioma. Results: Distal-proximal skin temperature gradient did not differ between NFMAs and control subjects, but proximal skin temperature was decreased during daytime (PZ0.006). Core body temperature and non-dipping of blood pressure did not differ, whereas melatonin secretion was often altered in NFMAs (OR 5.3, 95% CI 0.9-30.6). One or more abnormal parameters (R2.0 SDS of control subjects) were observed during nighttime in 12 NFMA patients and during daytime in seven NFMA patients. Similar patterns were observed in craniopharyngioma patients. Conclusion: Heterogeneous patterns of altered diurnal rhythmicity in skin temperature and melatonin secretion parameters were observed in the majority of patients treated for NFMAs. On a group level, both NFMA and craniopharyngioma patients showed a lower daytime proximal skin temperature than control subjects, but other group averages were not significantly different. The observations suggest altered function of central (or peripheral) clock machinery, possibly by disturbed entrainment or damage of the hypothalamic SCN by the suprasellar macroadenoma or its treatment.

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Progressive improvement of impaired visual acuity during the first year after transsphenoidal surgery for non-functioning pituitary macroadenoma

Cited by 56 publications

References 25 publications

Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Fractionated Stereotactic Radiotherapy in the Treatment of Pituitary Macroadenomas

Alterations in diurnal rhythmicity in patients treated for nonfunctioning pituitary macroadenoma: a controlled study and literature review

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