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 IJOHNS  Vol.5 No.3 , May 2016
Visual Disorders Outcome after Endoscopic Endonasal Trans-Sphenoidal Surgery of Pituitary Macroadenomas
Abstract: Objective: Describe the outcome of visual disorders after endonasal transsphenoidal (EET) surgery of pituitary macroadenomas with preoperative chiasmal compression. Patients and Methods: From 2009 to 2013, 225 patients underwent EET surgery for sellar tumor. Among them, 168 suffered from visual disorders induced by chiasmatic compression, of which 88 met the inclusion criteria for this study. Average duration of follow up was 1.8 yrs ± 0.4 yrs. All patients had sellar MRI before surgery and yearly postoperatively, visual acuity (VA) and/or visual field (VF) measurements before, 3 months after surgery and yearly postoperatively. Results: All tumors were macroadenomas with a mean preoperative MRI-estimated volume of 10.0 {plus minus} 9.07 cm3. Preoperative VA was impaired with an average of 0.43 ± 0.13 LogMAR (left eye) and 0.36 ± 0.14 LogMAR (right eye) and VF was disturbed in 99% ± 2% of the cases with the most frequent disorder being bitemporal hemianopsia (38 patients). Post-operatively, the mean residual MRI-estimated tumor volume was 3.15 ± 3.71 cm3. Mean tumor volume reduction was 62% ± 9% (p < 0.001). Optic chiasmal compression resolved in 72% ± 10% of the cases. Visual function improved in 86% ± 7% of cases (p < 0.001). Conclusion: Endoscopic endonasal management of pituitary gland neoplasms is effective to reduce tumor volume. This technique achieved significant visual improvement in the majority of cases presenting with chiasmal compression syndrome.
Cite this paper: Bakkouri, W. , Hervé, P. , Dzidzinyo, B. , Anis, A. , Louise, B. , Alain, C. , Catherine, V. , Malika, B. and Denis, A. (2016) Visual Disorders Outcome after Endoscopic Endonasal Trans-Sphenoidal Surgery of Pituitary Macroadenomas. International Journal of Otolaryngology and Head & Neck Surgery, 5, 134-140. doi: 10.4236/ijohns.2016.53023.
References

[1]   Torales, J., Halperin, I., Hanzu, F., Mora, M., Alobid, I., De Notaris, M., et al. (2014) Endoscopic Endonasal Surgery for Pituitary Tumors. Results in a Series of 121 Patients Operated at the Same Center and by the Same Neurosurgeon. Endocrinología y Nutrición (English Edition), 61, 410-416.
http://dx.doi.org/10.1016/j.endoen.2014.07.002

[2]   Juraschka, K., Khan, O.H., Godoy, B.L., Monsalves, E., Kilian, A., Krischek, B., et al. (2014) Endoscopic Endonasal Transsphenoidal Approach to Large and Giant Pituitary Adenomas: Institutional Experience and Predictors of Extent of Resection. Journal of Neurosurgery, 121, 75-83.
http://dx.doi.org/10.3171/2014.3.JNS131679

[3]   Gómez, R.C. (2014) Non-Functioning Pituitary Tumors: 2012 Update. Endocrinología y Nutrición (English Edition), 61, 160-170.
http://dx.doi.org/10.1016/j.endoen.2014.02.011

[4]   Peter, M. and De Tribolet, N. (1995) Visual Outcome after Transsphenoidal Surgery for Pituitary Adenomas. British Journal of Neurosurgery, 9, 151-157.
http://dx.doi.org/10.1080/02688699550041485

[5]   Ammirati, M., Wei, L. and Ciric, I. (2013) Short-Term Outcome of Endoscopic versus Microscopic Pituitary Adenoma Surgery: A Systematic Review and Meta-Analysis. Journal of Neurology, Neurosurgery & Psychiatry, 84, 843-849.
http://dx.doi.org/10.1136/jnnp-2012-303194

[6]   Chone, C.T., Sampaio, M.H., Sa-kano, E., Paschoal, J.R., Garnes, H.M., Queiroz, L., et al. (2014) Endoscopic Endonasal Transsphenoidal resection of pituitary Adenomas: Preliminary Evaluation of Consecutive Cases. Brazilian Journal of Otorhinolaryngology, 80, 146-151.
http://dx.doi.org/10.5935/1808-8694.20140030

[7]   Davies, B.M., Carr, E., Soh, C. and Gnanalingham, K.K. (2016) Assessing Size of Pituitary Adenomas: A Comparison of Qualitative and Quantitative Methods on MR. Acta Neurochirurgica (Wien), 158, 677-683.

[8]   Cusimano, M.D., Kan, P., Nassiri, F., Anderson, J., Goguen, J., Vanek, I., et al. (2012) Outcomes of Surgically Treated Giant Pituitary Tumours. Canadian Journal of Neurological Sciences, 39, 446-457.
http://dx.doi.org/10.1017/S0317167100013950

[9]   Koutourousiou, M., Gardner, P.A., Fernandez-Miranda, J.C., Paluzzi, A., Wang, E.W. and Snyderman, C.H. (2013) Endoscopic Endonasal Surgery for Giant Pituitary Adenomas: Advantages and Limitations. Journal of Neurosurgery, 118, 621-631.
http://dx.doi.org/10.3171/2012.11.JNS121190

[10]   Yang, I., Wang, M.B. and Bergsneider, M. (2010) Making the Transition from Microsurgery to Endoscopic Trans- Sphenoidal Pituitary Neurosurgery. Neurosurgery Clinics of North America, 21, 643-651.

[11]   Komotar, R.J., Starke, R.M., Raper, D.M.S., Anand, V.K. and Schwartz, T.H. (2012) Endoscopic Endonasal Compared with Microscopic Transsphenoidal and Open Transcranial Resection of Giant Pituitary Adenomas. Pituitary, 15, 150-159.
http://dx.doi.org/10.1007/s11102-011-0359-3

[12]   Roelfsema, F., Biermasz, N.R. and Pereira, A.M. (2012) Clinical Factors Involved in the Recurrence of Pituitary Adenomas after Surgical Remission: A Structured Review and Meta-Analysis. Pituitary, 15, 71-83.
http://dx.doi.org/10.1007/s11102-011-0347-7

[13]   Gopalan, R., Schlesinger, D., Vance, M.L., Laws, E. and Sheehan, J. (2011) Long-Term Outcomes after Gamma Knife Radiosurgery for Patients with a Nonfunctioning Pituitary Adenoma. Neurosurgery, 69, 284-293.
http://dx.doi.org/10.1227/NEU.0b013e31821bc44e

[14]   Berkmann, S., Schlaffer, S., Nimsky, C., Fahlbusch, R. and Buchfelder, M. (2014) Follow-Up and Long-Term Outcome of Nonfunctioning Pituitary Adenoma Operated by Transsphenoidal Surgery with Intraoperative High-Field Magnetic Resonance Imaging. Acta Neurochirurgica (Wien), 156, 2233-2243.
http://dx.doi.org/10.1007/s00701-014-2210-x

[15]   Paluzzi, A., Fernandez-Miranda, J.C., Tonya Stefko, S., Challinor, S., Snyderman, C.H. and Gardner, P.A. (2014) Endoscopic Endonasal Approach for Pituitary Adenomas: A Series of 555 Patients. Pituitary, 17, 307-319.
http://dx.doi.org/10.1007/s11102-013-0502-4

[16]   Robenshtok, E., Benbassat, C.A., Hirsch, D., Tzvetov, G., Cohen, Z.R., Iraqi, H.M., et al. (2014) Clinical Course and Outcome of Nonfunctioning Pituitary Adenomas in the Elderly Compared with Younger Age Groups. Endocrine Practice, 20, 159-164.

[17]   Murad-Kejbou, S. and Eggenberger, E. (2009) Pituitary Apoplexy: Evaluation, Management, and Prognosis. Current Opinion in Ophthalmology, 20, 456-461.
http://dx.doi.org/10.1097/ICU.0b013e3283319061

[18]   Cohen, A.R., Cooper, P.R., Kupersmith, M.J., Flamm, E.S. and Ran-sohoff, J. (1985) Visual Recovery after Transsphenoidal Removal of Pituitary Adenomas. Neurosurgery, 17, 446-452.
http://dx.doi.org/10.1227/00006123-198509000-00008

[19]   Hofstetter, C.P., Nanaszko, M.J., Mubita, L.L., Tsiouris, J., Anand, V.K. and Schwartz, T.H. (2012) Volumetric Classification of Pituitary Macroadenomas Predicts Outcome and Morbidity Following Endoscopic Endonasal Transsphenoidal Surgery. Pituitary, 15, 450-463.
http://dx.doi.org/10.1007/s11102-011-0350-z

[20]   Egger, J., Kapur, T., Nimsky, C. and Kikinis, R. (2012) Pituitary Adenoma Volumetry with 3D Slicer. PloS One, 7, e51788.
http://dx.doi.org/10.1371/journal.pone.0051788

 
 
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