Visual Acuity in Patients with Non-functioning Pituitary Adenoma: Prognostic Factors and Long-term Outcome After Surgery

Overview

Journal Brain Spine

Specialty Neurology

Date 2023 Nov 29

PMID 38020979

Authors

Erik Uvelius

Stig Valdemarsson

Johan Bengzon

Bjorn Hammar

Peter Siesjo

Affiliations

Soon will be listed here.

Abstract

Background: Visual acuity (VA) and visual field defects (VF) are evaluated in the preoperative management of non-functioning pituitary adenoma (NFPA). The former is less studied than the latter.

Research Question: To analyze preoperative factors, including adenoma volumetry, associated with reduced VA and postoperative improvement of VA over five years after surgery.

Methods: Eighty-seven patients who had primary surgery for NFPA were retrospectively reviewed. Eyes were categorized by best/worse preoperative VA. Ophthalmology review was performed before surgery, at three months, one to two years, and five years post-surgery.

Results: Reduced VA in any eye was present in 55%. VA of the worse eye improved in 77% and normalized in 54%. The majority improved within three months. Additional cases with VA improvement were seen at 1-2 years after surgery. No further improvement was seen five years after surgery. Fifty percent of patients with, per definition, normal preoperative VA showed improved VA postoperatively. Tumor height above the sella in the sagittal plane was the best radiological predictor of reduced VA. Volumetry did not add to accuracy. Age, sagittal tumor height and visual field defects were risk factors of preoperative reduced VA. No predictors of postoperative recovery were identified.

Conclusion: Half of patients with reduced VA recover fully. All patients, independent of age and degree of VA reduction, may improve. No predictors of recovery were found. Early improvement is common and improvement beyond two years is unlikely. The frequency of reduced VA is underestimated. The present results could be of value in pre- and postoperative counseling.

Citing Articles

Clinical efficacy of optical coherence tomography parameters to predict the visual field outcome following pituitary adenoma surgery.

Han K, Choi H, Kim S, Lee S, Lee J PLoS One. 2024; 19(11):e0313521.

PMID: 39531448 PMC: 11556729. DOI: 10.1371/journal.pone.0313521.

Insights into Visual Outcomes and Determinants in Pituitary Adenoma Surgery: A 5-Year Retrospective Cohort Study.

Kemchoknatee P, Singhakul C, Arjkongharn N, Vongsa N, Tangon D, Srisombut T Clin Ophthalmol. 2024; 18:1779-1788.

PMID: 38919405 PMC: 11198008. DOI: 10.2147/OPTH.S463303.

References

Sun W, Fu Y, Shi Y, Cheng J, Cao P, Shi R . Paranodal myelin damage after acute stretch in Guinea pig spinal cord. J Neurotrauma. 2011; 29(3):611-9. PMC: 3278818. DOI: 10.1089/neu.2011.2086. View

Anik I, Anik Y, Cabuk B, Caklili M, Pirhan D, Ozturk O . Visual Outcome of an Endoscopic Endonasal Transsphenoidal Approach in Pituitary Macroadenomas: Quantitative Assessment with Diffusion Tensor Imaging Early and Long-Term Results. World Neurosurg. 2018; 112:e691-e701. DOI: 10.1016/j.wneu.2018.01.134. View

Chabot J, Chakraborty S, Imbarrato G, Dehdashti A . Evaluation of Outcomes After Endoscopic Endonasal Surgery for Large and Giant Pituitary Macroadenoma: A Retrospective Review of 39 Consecutive Patients. World Neurosurg. 2015; 84(4):978-88. DOI: 10.1016/j.wneu.2015.06.007. View

Tjornstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Rosen T . The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011. Eur J Endocrinol. 2014; 171(4):519-26. DOI: 10.1530/EJE-14-0144. View

Rhoton Jr A . The sellar region. Neurosurgery. 2002; 51(4 Suppl):S335-74. View

Ferrante E, Ferraroni M, Castrignano T, Menicatti L, Anagni M, Reimondo G . Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol. 2006; 155(6):823-9. DOI: 10.1530/eje.1.02298. View

Monteiro M, Zambon B, Cunha L . Predictive factors for the development of visual loss in patients with pituitary macroadenomas and for visual recovery after optic pathway decompression. Can J Ophthalmol. 2010; 45(4):404-8. DOI: 10.3129/i09-276. View

Schmalisch K, Milian M, Schimitzek T, Lagreze W, Honegger J . Predictors for visual dysfunction in nonfunctioning pituitary adenomas - implications for neurosurgical management. Clin Endocrinol (Oxf). 2012; 77(5):728-34. DOI: 10.1111/j.1365-2265.2012.04457.x. View

Eda M, Saeki N, Fujimoto N, Sunami K . Demonstration of the optic pathway in large pituitary adenoma on heavily T2 weighted MR images. Br J Neurosurg. 2002; 16(1):21-9. DOI: 10.1080/02688690120114192. View

10.

Barzaghi L, Medone M, Losa M, Bianchi S, Giovanelli M, Mortini P . Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg Rev. 2011; 35(3):369-78. DOI: 10.1007/s10143-011-0365-y. View

11.

Muskens I, Zamanipoor Najafabadi A, Briceno V, Lamba N, Senders J, van Furth W . Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis. Pituitary. 2017; 20(5):539-552. PMC: 5606952. DOI: 10.1007/s11102-017-0815-9. View

12.

Ogra S, Nichols A, Stylli S, Kaye A, Savino P, Danesh-Meyer H . Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci. 2014; 21(5):735-40. DOI: 10.1016/j.jocn.2014.01.005. View

13.

Gan L, Ma J, Feng F, Wang Y, Cui J, Guo X . The Predictive Value of Suprasellar Extension for Visual Function Evaluation in Chinese Patients with Nonfunctioning Pituitary Adenoma with Optic Chiasm Compression. World Neurosurg. 2018; 116:e960-e967. DOI: 10.1016/j.wneu.2018.05.141. View

14.

Bergland R . The arterial supply of the human optic chiasm. J Neurosurg. 1969; 31(3):327-34. DOI: 10.3171/jns.1969.31.3.0327. View

15.

Mete O, Lopes M . Overview of the 2017 WHO Classification of Pituitary Tumors. Endocr Pathol. 2017; 28(3):228-243. DOI: 10.1007/s12022-017-9498-z. View

16.

Bonomo G, Bertani G, Carrabba G, Ferrante E, Pluderi M, Guastella C . The suprasellar volume of nonfunctioning pituitary adenomas: a useful tool for predicting visual field deficits. Pituitary. 2020; 23(5):552-557. DOI: 10.1007/s11102-020-01060-0. View

17.

Molitch M . Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017; 317(5):516-524. DOI: 10.1001/jama.2016.19699. View

18.

Kerrison J, Lynn M, Baer C, Newman S, Biousse V, Newman N . Stages of improvement in visual fields after pituitary tumor resection. Am J Ophthalmol. 2000; 130(6):813-20. DOI: 10.1016/s0002-9394(00)00539-0. View

19.

Butenschoen V, Schwendinger N, von Werder A, Bette S, Wienke M, Meyer B . Visual acuity and its postoperative outcome after transsphenoidal adenoma resection. Neurosurg Rev. 2020; 44(4):2245-2251. PMC: 8338826. DOI: 10.1007/s10143-020-01408-x. View

20.

Rosset A, Spadola L, Ratib O . OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging. 2004; 17(3):205-16. PMC: 3046608. DOI: 10.1007/s10278-004-1014-6. View