J.ophthalmol.(Ukraine).2019;5:22-26.

http://doi.org/10.31288/oftalmolzh201952226

Received: 03 July 2019; Published: 30 October 2019


Neuroophthalmological symptoms of pituitary adenomas with supraparasellar extension

K.S. Iegorova, Cand Sc (Med); M.O. Guk, Dr Sc (Med); O.M. Guk, Cand Sc (Med); L.O. Danevych, Cand Sc (Med); D.M. Tsiurupa, Cand Sc (Med); A.O. Mumliev, Cand Sc (Med)

Romodanov Neurosurgery Institute; Kyiv (Ukraine)

E-mail:  iegorova_katya@ukr.net

TO CITE THIS ARTICLE: Iegorova KS, Guk MO, Guk OM, Danevych LO, Tsiurupa DM, Mumliev AO. Neuroophthalmological symptoms of pituitary adenomas with supraparasellar extension. J.ophthalmol.(Ukraine).2019;5:22-26.  http://doi.org/10.31288/oftalmolzh201952226

Background: Pituitary adenomas (PA) are benign neoplasms that arise from adenohypophysis; they are most common skull base tumors, and account for 12% to15% of all intracranial tumors. In PA with supraparasellar extension, a tumor grows upward, causing chiasmal and lateral cavernous sinus compression. Because prolonged compression of the optic nerve/chiasm complex results in the development of primary descending ONA in 31% to 72% of patients, leading to blindness in 3.5% to 16% of patients, the issue is worthy of attention.

Purpose: To investigate neuro-ophthalmological symptoms in pituitary adenomas with a supraparasellar extension before and after treatment.

Materials and Methods: This retrospective study included the records of 107 patients who received treatment for pituitary adenomas with a supraparasellar extension at the Romodanov Institute during 2017 to 2018. The main group included 49 patients (98 eyes) who had visual impairments and/or visual field deficits. Patients underwent clinical and neurological, eye and otoneurological examination (including neuroimaging studies) before and after treatment.

Results: Visual impairments with the development of markedly asymmetric chiasmal syndrome were most common in the clinical picture, with a severe visual acuity loss (25.5% of eyes) and significant sensitivity loss (39.8% of eyes) in the more affected eye, mild or moderate visual acuity loss and visual field loss in the less affected eye, and development of primary descending optic nerve atrophy in 36 (73.5%) patients. After treatment, visual acuity restored or improved in 57 (58.2%) eyes, and arithmetic mean of the sensitivity loss, the mean defect (MD), improved in 46 (46.9%) eyes (these improvements were significant, p < 0.05).

Conclusion: Pituitary adenomas with supraparasellar extension were characterized by the development of visual and oculomotor impairments, which evidenced the presence of various directions of tumor expansion. Visual impairments with the development of markedly asymmetric chiasmal syndrome were most common in the clinical picture. Mean BCVA improved from 0.51±0.04 at baseline to 0.66±0.03 after treatment, and mean overall visual field sensitivity loss improved from 12.11 ± 0.69 dB at baseline to 8.6 ± 0.7 dB after treatment (both improvements were significant, p < 0.05).

Keywords: optic nerve atrophy, pituitary adenoma, chiasmal syndrome

References

1.Abouaf L, Vighetto A, Lebas M. Neuro-ophthalmologic exploration in non-functioning pituitary adenoma. Ann Endocrinol (Paris). 2015 Jul;76(3):210-9. doi: 10.1016/j.ando.2015.04.006..

Crossref   PubMed

2.Guk MO. [Diagnosis and comprehensive treatment of hormonally-inactive pituitary adenomas]. Dissertation for Doctor of Medical Sciences. Kyiv. 2017.

3.Kitthaweesin K, Ployprasith C. Ocular manifestations of suprasellar tumors. J Med Assoc Thai. 2008; 91(5):711-5.

4.Ntali G., Wass J.A. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018 Apr;21(2):111-118. doi: 10.1007/s11102-018-0869-3.

Crossref    PubMed 

5.Yasargil M. G. Microsurgery Applied to Neurosurgery. Stuttgart: Thieme, 1969. 

6.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 Oct;33(4):610-7; discussion 617-8. 

Crossref    PubMed  

7.Kim SH, Lee KC, Kim SH. Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci. 2007 Dec;14(12):1158-62.

Crossref    PubMed   

8.Chuang CC, Chen E, Huang YC, Tu PH, Chen YL, Pai PC. Surgical outcome of oculomotor nerve palsy in pituitary adenoma. J Clin Neurosci.  2011 Nov;18(11):1463-8. doi: 10.1016/j.jocn.2011.02.041.

Crossref   PubMed   

9.Hage R., Eshraghi S.R., Oyesiku N.M., Ioachimescu A.G., Newman N.J., Biousse V., Bruce B.B. Third, fourth, and sixth cranial nerve palsies in pituitary apoplexy. World Neurosurg. 2016 Oct;94:447-452. doi: 10.1016/j.wneu.2016.07.026.

Crossref    PubMed  

10.Kan E, Kan EK, Atmaca A, Atmaca H, Colak R. Visual field defects in 23 acromegalic patients. Int Ophthalmol. 2013 Oct;33(5):521-5. doi: 10.1007/s10792-013-9733-7. 

Crossref   PubMed 

11.Poon A., McNeill P., Harper A., O’Day J. Patterns of visual loss associated with pituitary macroadenomas. Aust N Z J Ophthalmol. 1995 May;23(2):107-15. 

Crossref    PubMed

12.Kerrisson JB, Lynn MJ, Baer CA, Newman SA, Biousse V, Newman NJ. Stages of improvement in visual fields after pituitary tumor resection. Am J Ophthalmol. 2000; 130(6): 813-20.

Crossref 

13.Serova NK. [Clinical neuroophthalmology: neurosurgical aspects]. Tver’: Triada; 2011. Russian.

14.Tron EZh. [Visual pathway disorders]. Moscow: Medgiz; 1955. Russian.

 

The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.