Visual Improvement after Endoscopic Endonasal Transsphenoidal Excision of Pituitary Gland Tumor

Authors

  • ZUBAIR AHMED KHAN Department of Neurosurgery, Postgraduate Medical Institute, Lahore General Hospital, Lahore
  • HABIB SULTAN Department of Neurosurgery, Postgraduate Medical Institute, Lahore General Hospital, Lahore
  • MUHAMMAD WAQAS Department of Neurosurgery, Postgraduate Medical Institute, Lahore General Hospital, Lahore
  • SARFRAZ KHAN
  • TOQEER AHMED
  • ANWAR CHAUDHRY Department of Neurosurgery, Postgraduate Medical Institute, Lahore General Hospital, Lahore

DOI:

https://doi.org/10.36552/pjns.v23i4.385

Keywords:

Transsphenoidal excision, Pituitary adenoma, Visual acuity.

Abstract

Objective: To evaluate the frequency of improved visual acuity after Endoscopic Endonasal Transsphenoidal excision of pituitary gland tumor.
Study Design: Descriptive case series.
Materials and Methods: In our study, Pre-operative visual acuity was noted by using the Snellen’s chart. Then patients underwent pituitary gland excision though Endoscopic Endonasal Transsphenoidal approach under general anesthesia. After surgery, patients were shifted in postsurgical wards and then will be discharged from there and were examinedfor 3 months in OPD. Snellen’s chart was used to evaluate patents for visual acuity after 3 months by an experienced ophthalmologist having at least 4 years residency experience If visual acuity increased ? 1 line, then improved visual acuity was labeled.
Results: Improved visual acuity after pituitary gland tumor excision was seen in 59(89.39%) patients. Age and gender of patients did not show any statistically significant association for improved visual acuity.
Conclusions: Results of this study showed that pituitary gland tumor excision through Endoscopic Endonasal Transsphenoidal approach is effective in terms of visual acuity improvement. Our main objectives in pituitary surgery are protection and reinstatement of vision and this surgical approach give maximum cover to vision restoration.

References

1. D’Ambrosio AL, Syed ON, Grobelny BT, Freda PU, Wardlaw S, Bruce JN. Simultaneous above and below approach to giant pituitary adenomas: surgical strategies and long-term follow-up. Pituitary, 2009; 12 (3): 217-25. Doi:10.1007/s11102-009-0171-5
2. Müslüman AM, Cansever T, Y?lmaz A, Kanat A, Oba E, Çavu?o?lu H, et al. Surgical results of large and
giant pituitary adenomas with special consideration of ophthalmologic outcomes. World neurosurgery, 2011; 76 (1): 141-8. Doi:10.1016/j.wneu.2011.02.009
3. Ho R-W, Huang H-M, Ho J-T. The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidaladenectomy: a report of 78 cases. Journal of Korean Neurosurgical Society, 2015; 57 (1): 23-31. Doi:10.3340/jkns.2015.57.1.23
4. Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery, and Psychiatry, 2013; 84 (8): 843-9. Doi:10.1136/jnnp-2012-303194
5. Kuruvilla R, Ewend M, Senior B, Givre S. Visual Function after Minimally Invasive Pituitary Surgery (MIPS). Fax J. 2006-07: Online.
6. Elgamal EA, Osman E, El-Watidy S, Jamjoom Z, Hazem A, Al-Khawajah N, et al. Pituitary adenomas: patterns of visual presentation and outcome after transsphenoidal surgery-an institutional experience. Internet J Ophthalmol Vis Sci. 2007; 4 (2).
7. Gnanalingham K, Bhattacharjee S, Pennington R, Ng J, Mendoza N. The time course of visual field recovery following Transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. Journal of Neurology, Neurosurgery & Psychiatry, 2005; 76 (3): 415-9. Doi:10.1136/jnnp.2004.035576
8. Svien HJ, Love JG, Kennedy WC, Colby Jr MY, Kearns TP. Status of vision following surgical treatment for pituitary chromophobe adenoma. Journal of neurosurgery, 1965; 22 (1): 47-52.
Doi:10.3171/jns.1965.22.1.0047
9. Prasad S, Volpe NJ, Balcer LJ. Approach to opticneuropathies: clinical update. The neurologist, 2010; 16 (1): 23-34. Doi:10.1097/NRL.0b013e3181be6fad
10. Murad-Kejbou S, Eggenberger E. Pituitary apoplexy: evaluation, management, and prognosis. Current opinion in ophthalmology, 2009; 20 (6): 456-61.
Doi:10.1097/ICU.0b013e3283319061
11. Seuk J-W, Kim C-H, Yang M-S, Cheong J-H, Kim J-M. Visual outcome after transsphenoidal surgery in patients with pituitary apoplexy. Journal of Korean Neurosurgical Society, 2011; 49 (6): 339-44.
12. 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, 2017.
Doi:10.4103/1793-5482.149995
13. Constantino ER, Leal R, Ferreira CC, Acioly MA, Landeiro JA. Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications. Arquivos de neuro-psiquiatria. 2016; 74 (5): 388-95.
14. Cusimano MD, Kan P, Nassiri F, Anderson J, Goguen J, Vanek I, et al. Outcomes of surgically treated giant pituitary tumours. The Canadian Journal of Neurological Sciences, 2012; 39 (04): 446-57.
Doi: https://doi.org/10.1017/S0317167100013950
15. Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P. Extended endoscopic endonasal approach for selected pituitary adenomas: early experience: Clinical article. Journal of neurosurgery, 2011; 114 (2): 345-53. Doi:10.3171/2010.9.JNS10262
16. Gondim JA, Almeida JPC, Albuquerque LAF, Gomes EF, Schops M. Giant pituitary adenomas: surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World neurosurgery, 2014; 82 (1): e281-e90. Doi:10.1016/j.wneu.2013.08.028
17. Hofstetter CP, Nanaszko MJ, Mubita LL, Tsiouris J, Anand VK, Schwartz TH. Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery. Pituitary, 2012; 15 (3): 450-63. Doi:10.1007/s11102-011-0350-z
18. Juraschka K, Krischek B, Monsalves E, Kilian A, Ghare A, Godoy BL, et al. Endoscopic Endonasal Transsphenoidal Approach to Large and Giant Pituitary Adenomas: Institutional Experience and Predictors of Extent of Resection. Journal of Neurological Surgery Part B: Skull Base, 2013; 74 (S 01): A014.
19. Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic
endonasal surgery for giant pituitary adenomas: advantages and limitations: Clinical article. Journal of neurosurgery, 2013; 118 (3): 621-31.
Doi:10.3171/2012.11.JNS121190
20. Nakao N, Itakura T. Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma. Journal of Clinical Neuroscience, 2011; 18 (1): 71-5.
Doi:10.1016/j.jocn.2010.04.049
21. Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J. Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery, 1985; 17 (3): 446-52. Doi:10.1227/00006123-198509000-00008
22. Sullivan L, O'day J, McNeill P. Visual Outcomes of Pituitary Adenoma Surgery: St. Vincent's Hospital 1968-1987. Journal of Neuro-Ophthalmology, 1991; 11 (4): 262-7. PMID:1838546
23. Powell M. Recovery of vision following transsphenoidal surgery for pituitary adenomas. British journal of neurosurgery, 1995; 9 (3): 367-74. PMID:7546358
24. Agrawal D, Mahapatra AK. Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surgical neurology, 2005; 63 (1): 42-6. Doi:10.1016/j.surneu.2004.03.014
25. Symon L, Jakubowski J. Transcranial management of pituitary tumours with suprasellar extension. Journal of Neurology, Neurosurgery & Psychiatry, 1979; 42 (2): 123-33. PMID:217970

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Published

2019-12-28

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Original Articles