Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent

Dutta, Pinaki; Gyurmey, Tenzin; Bansal, Reema; Pathak, Ashis; Dhandapani, Sivashanmugam; Rai, Ashutosh; Bhansali, Anil; Mukherjee, Kanchan Kumar

doi:10.4103/0028-3886.193829

Cited by 25 publications

(7 citation statements)

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“…In present study 16.7% presented with features of Acromegaly being the most commonest followed by cushing features in 10% which is consistent with Khaled Al Dahmani et al [13] 6%, Mukherji KK et al [12] 23.9%, Dong Kyu lee [20] 18.3%.…”

Section: Discussionsupporting

confidence: 88%

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Clinico-radiological factors affecting visual recovery in pituitary tumours

Kankane,

Agrawal,

Iyenger

2022

roneuro

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Objectives: It is a prospective, single institute, observational study: primary outcome measure; factors determining visual field improvement and secondary outcome measure; the relationship between severity of visual impairment and duration of symptoms. Material and Methods: It is a prospective, single institute, observational study that will be conducted between January 2020 and January 2022 in the department of Neurosurgery at the G. R. Medical College &J.A. Group of Hospitals, Gwalior(M.P.), a tertiary centre in India. All patients were admitted to the neuro-surgery department & operated on basis of a CT Scan of head/MRI findings. Patients with Laboratory findings having hypopituitarism, diabetes insipidus (DI), and hyperprolactinemia and willing to undergo Endocrinological & visual field tests in inclusion criteria. Data obtained from the study will be analyse by using appropriate statistical tests or methods Results: At present, series most common age presentation (36.7%) between 21-30 years. In our study, of the total patients, 60% were males and 40% were females. The male to female ratio is 2:1 most common complaint of vision loss and only 50% had hormonal symptoms. In our study 46.7% patients have duration of symptoms < 6 months and 6/6 - 6/24 visual acuity was present in 73.3% patients & 13.3% had optic atrophy(primary/secondary), 43.3%patients had bi-temporal hemianopia. In our study Suprasellar extension was present in 90% of patients & Vascular invasion was seen in 26.7% of patients. Conclusion: Good results are seen in patients who have a lesser duration of symptoms, and good pre-operative visual acuity has improved the final visual outcome. Post-operative visual recovery is most promising after 3 months to 1 year of surgery. immediate results of visual recovery should not be expected. Most patients presented with larger adenomas had poor visual recovery as compared to small adenomas. Patients who underwent endoscopic trans-nasal, trans-sphenoidal resection had better post-operative recovery.

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Section: Discussionsupporting

confidence: 88%

“…Hypersecretion of prolactin, growth hormone, ACTH and TSH produces corresponding clinical syndromes [19]. In present study 50%tumours were non functional which was not correlating with Mukherji K K et al [12] were 68.8% were non functioning &Dong Kyu lee [20] were 80% were non functioning tumours. .…”

Section: Discussionmentioning

confidence: 46%

Clinico-radiological factors affecting visual recovery in pituitary tumours

Kankane,

Agrawal,

Iyenger

2022

roneuro

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“…Surgery is very effective in relieving compressive visual symptoms, with 90% of patients having normal or improved symptoms after presenting with a visual deficit with an extremely low incidence of neuro-ophthalmic deterioration, as demonstrated in this series. This is keeping with the literature (42)(43)(44). Radiation-induced optic neuropathy is a rare complication of pituitary adenoma irradiation (8,45); none were reported in this cohort.…”

Section: Comparison With Other Studiessupporting

confidence: 92%

Non-functioning pituitary macroadenoma following surgery: long-term outcomes and development of an optimal follow-up strategy

et al. 2023

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ObjectivesRecurrence and regrowth of non-functioning pituitary macroadenomas (NFPMs) after surgery are common but remain unpredictable. Therefore, the optimal timing and frequency of follow-up imaging remain to be determined. We sought to determine the long-term surgical outcomes of NFPMs following surgery and develop an optimal follow-up strategy.MethodsPatients underwent surgery for NFPMs between 1987 and 2018, with a follow-up of 6 months or more, were identified. Demographics, presentation, management, histology, imaging, and surgical outcomes were retrospectively collected.ResultsIn total, 383 patients were included; 256 were men (256/383; 67%) with median follow-up of 8 years. Following primary surgery, 229 patients (229/383; 60%) achieved complete resection. Of those, 28 (28/229; 11%) developed recurrence, including six needed secondary surgery (6/229; 3%). The rate of complete resection improved over time; in the last quartile of cases, 77 achieved complete resection (77/95; 81%). Reoperation-free survival at 5, 10 and 15 years was 99%, 94% and 94%, respectively. NFPMs were incompletely resected in 154 patients (154/383; 40%); of those, 106 (106/154; 69%) had regrowth, and 84 (84/154; 55%) required reoperation. Surgical reintervention-free survival at 5, 10 and 15 years was 74%,49% and 35%, respectively. Young age and cavernous sinus invasion were risk factors for undergoing reoperation (P < 0.001 and P < 0.0001, respectively) and radiotherapy (P = 0.003 and P < 0.001, respectively). Patients with residual tumour required reoperation earlier than those underwent complete resection (P = 0.02). Radiotherapy to control tumour regrowth was delivered to 65 patients (65/383; 17%) after median time of 1 year following surgery. Radiotherapy was administered more in patients with regrowth of residual disease (61/106; 58%) than those who had NFPMs recurrence (4/28; 14%) (P ≤ 0.001) Following postoperative radiotherapy, one patient (1/65; 2%) had evidence of regrowth, seven (7/65; 11%) had tumour regression on imaging, and no patients underwent further surgery.ConclusionsNFPMs recurrence and regrowth are common, particularly in patients with residual disease post-operatively. We propose a follow-up strategy based on stratifying patients as “low risk” if there is no residual tumour, with increasing scan intervals, or “high risk” if there is a residual tumour, with annual scans for at least five years and extended lifelong surveillance after that.

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“…Several studies have reported that patients' age is related to visual prognosis in chiasmal compression after decompression surgery (Barzaghi et al, 2012; Danesh‐Meyer et al, 2019; Jacob et al, 2009; Rivoal et al, 2000; Sun et al, 2017; Yu et al, 2015), although other studies have failed to show any significant correlations between age and visual prognosis (Danesh‐Meyer et al, 2019; Dutta et al, 2016; Findlay et al, 1983; Gnanalingham et al, 2005; Grkovic & Davidovic, 2016; Marcus et al, 1991; Monteiro et al, 2010). Rivoal et al (2000) have reported that complete visual field recovery is observed more frequently in patients <40 years of age at the time of diagnosis using Goldmann perimeter in acromegaly patients.…”

Section: Discussionmentioning

confidence: 99%