Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Max J. van Essen; Ivo S. Muskens; Nayan Lamba; Stephan F.J. Belunek; Arthur T.J. van der Boog; G. Johan Amelink; Peter H. Gosselaar; Tristan P.C. van Doormaal; Aline M.E. Stades; Joost J.C. Verhoeff; Maria M. van Genderen; Christine A.E. Eenhorst; Marike L.D. Broekman

doi:10.1055/s-0039-3402020

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2021; 82(S 03): e79-e87
DOI: 10.1055/s-0039-3402020

Original Article

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Max J. van Essen

¹Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands

,

Ivo S. Muskens

¹Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands

²Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, California, United States

,

Nayan Lamba

³Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States

,

Stephan F.J. Belunek

⁴Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Arthur T.J. van der Boog

⁵Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands

,

G. Johan Amelink

¹Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands

,

Peter H. Gosselaar

¹Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands

,

Tristan P.C. van Doormaal

¹Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands

,

Aline M.E. Stades

⁶Department of Internal medicine, University Medical Center Utrecht, Utrecht, The Netherlands

,

Joost J.C. Verhoeff

⁷Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands

,

Maria M. van Genderen

⁴Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Christine A.E. Eenhorst

⁴Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Marike L.D. Broekman

³Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States

⁸Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands

⁹Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

› Author Affiliations

Abstract

Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes.

Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al.

Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively (p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort (p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD (p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04).

Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.

Keywords

pituitary adenoma - transsphenoidal - endoscopy - visual field - visual acuity - visual outcome

Full Text

References

References
1 McDowell BD, Wallace RB, Carnahan RM, Chrischilles EA, Lynch CF, Schlechte JA. Demographic differences in incidence for pituitary adenoma. Pituitary 2011; 14 (01) 23-30
2 Ironside JW. Best Practice No 172: pituitary gland pathology. J Clin Pathol 2003; 56 (08) 561-568
3 Miller NR, Walsh FB, Hoyt WF. Walsh & Hoyt’s Clinical Neuro-Ophthalmology: The Essentials. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005
4 Greenman Y, Stern N. Non-functioning pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009; 23 (05) 625-638
5 Abouaf L, Vighetto A, Lebas M. Neuro-ophthalmologic exploration in non-functioning pituitary adenoma. Ann Endocrinol (Paris) 2015; 76 (03) 210-219
6 Ogra S, Nichols AD, Stylli S, Kaye AH, Savino PJ, Danesh-Meyer HV. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci 2014; 21 (05) 735-740
7 Luomaranta T, Raappana A, Saarela V, Liinamaa MJ. Factors affecting the visual outcome of pituitary adenoma patients treated with endoscopic transsphenoidal surgery. World Neurosurg 2017; 105: 422-431
8 Schmalisch K, Milian M, Schimitzek T, Lagrèze WA, Honegger J. Predictors for visual dysfunction in nonfunctioning pituitary adenomas—implications for neurosurgical management. Clin Endocrinol (Oxf) 2012; 77 (05) 728-734
9 Muskens IS, Zamanipoor Najafabadi AH, Briceno V. et al. Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis. Pituitary 2017; 20 (05) 539-552
10 Loyo-Varela M, Herrada-Pineda T, Revilla-Pacheco F, Manrique-Guzman S. Pituitary tumor surgery: review of 3004 cases. World Neurosurg 2013; 79 (02) 331-336
11 Gondim JA, Almeida JP, de Albuquerque LAF, Gomes E, Schops M, Ferraz T. Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg Focus 2010; 29 (04) E7
12 Sheehan JM, Douds GL, Hill K, Farace E. Transsphenoidal surgery for pituitary adenoma in elderly patients. Acta Neurochir (Wien) 2008; 150 (06) 571-574
13 Pereira EAC, Plaha P, Chari A. et al. Transsphenoidal pituitary surgery in the elderly is safe and effective. Br J Neurosurg 2014; 28 (05) 616-621
14 Fujimoto K, Yano S, Shinojima N, Hide T, Kuratsu JI. Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: surgical and follow-up results. Surg Neurol Int 2017; 8 (01) 213
15 Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 2013; 16 (03) 393-401
16 Zaidi HA, Awad A-W, Bohl MA. et al. Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 2016; 124 (03) 596-604
17 Starke RM, Williams BJ, Vance ML, Sheehan JP. Radiation therapy and stereotactic radiosurgery for the treatment of Cushing's disease: an evidence-based review. Curr Opin Endocrinol Diabetes Obes 2010; 17 (04) 356-364
18 Cavallo LM, Solari D, Tasiou A. et al. Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas: experience on a 59-patient series. World Neurosurg 2013; 80 (3-4): 342-350
19 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. J Neurosurg 2013; 118 (03) 621-631
20 Pinar E, Yuceer N, Imre A, Guvenc G, Gundogan O. Endoscopic endonasal transsphenoidal surgery for pituitary adenomas. J Craniofac Surg 2015; 26 (01) 201-205
21 Nasseri SS, Kasperbauer JL, Strome SE, McCaffrey TV, Atkinson JL, Meyer FB. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001; 15 (04) 281-287
22 Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R. Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 2003; 98 (02) 350-358
23 Rudnik A, Kos-Kudła B, Larysz D, Zawadzki T, Bazowski P. Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuroendocrinol Lett 2007; 28 (04) 438-444
24 Kim JH, Lee JH, Lee JH, Hong AR, Kim YJ, Kim YH. Endoscopic transsphenoidal surgery outcomes in 331 nonfunctioning pituitary adenoma cases after a single surgeon learning curve. World Neurosurg 2018; 109: e409-e416
25 Karppinen A, Ritvonen E, Roine R. et al. Health-related quality of life in patients treated for nonfunctioning pituitary adenomas during the years 2000-2010. Clin Endocrinol (Oxf) 2016; 84 (04) 532-539
26 Fujimoto N, Saeki N, Miyauchi O, Adachi-Usami E. Criteria for early detection of temporal hemianopia in asymptomatic pituitary tumor. Eye (Lond) 2002; 16 (06) 731-738
27 Danesh-Meyer HV, Wong A, Papchenko T. et al. Optical coherence tomography predicts visual outcome for pituitary tumors. J Clin Neurosci 2015; 22 (07) 1098-1104
28 Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33 (04) 610-617
29 Holladay JT. Proper method for calculating average visual acuity. J Refract Surg 1997; 13 (04) 388-391
30 Lee IH, Miller NR, Zan E. et al. Visual defects in patients with pituitary adenomas: the myth of bitemporal hemianopsia. AJR Am J Roentgenol 2015; 205 (05) W512-8
31 Thotakura AK, Patibandla MR, Panigrahi MK, Addagada GC. Predictors of visual outcome with transsphenoidal excision of pituitary adenomas having suprasellar extension: a prospective series of 100 cases and brief review of the literature. Asian J Neurosurg 2017; 12 (01) 1-5
32 Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 2005; 56 (06) 1222-1233
33 Laws Jr ER, Trautmann JC, Hollenhorst Jr RW. Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg 1977; 46 (06) 717-722
34 Powell M. Recovery of vision following transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 1995; 9 (03) 367-373
35 Findlay G, McFadzean RM, Teasdale G. Recovery of vision following treatment of pituitary tumours: application of a new system of assessment to patients treated by transsphenoidal operation. Acta Neurochir (Wien) 1983; 68 (3-4): 175-186
36 Yu F-F, Chen L-L, Su Y-H, Huo L-H, Lin X-X, Liao R-D. Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study. Int J Ophthalmol 2015; 8 (06) 1224-1228
37 Lee J, Kim SW, Kim DW. et al. Predictive model for recovery of visual field after surgery of pituitary adenoma. J Neurooncol 2016; 130 (01) 155-164
38 Ho RW, Huang HM, Ho JT. The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. J Korean Neurosurg Soc 2015; 57 (01) 23-31
39 Pelletier AL, Rojas-Roldan L, Coffin J. Vision loss in older adults. Am Fam Physician 2016; 94 (03) 219-226
40 Costello F. Optical coherence tomography in neuro-ophthalmology. Neurol Clin 2017; 35 (01) 153-163

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