Marjolein Tabak1,2, Iris C M Pelsma3,4, Mark C Kruit5,4, Wouter R van Furth6,4, Nienke R Biermasz3,4, Irene C Notting7,4. 1. Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands. marjoleintabak@live.nl. 2. Center for Pituitary Tumours Leiden, Leiden University Medical Center, Leiden, The Netherlands. marjoleintabak@live.nl. 3. Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. 4. Center for Pituitary Tumours Leiden, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 6. Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
PURPOSE: To evaluate whether the occurrence of chiasmal herniation coincides with visual field (VF) deterioration and to compare the course of VF defects in patients with and without radiological chiasmal herniation following treatment of pituitary adenoma. METHODS: This retrospective cohort study included 48 pituitary macroadenoma patients with chiasm compression, divided into three groups: Group 1 (N = 12), downward displaced optic chiasm and deteriorated VFs; Group 2 (N = 16), downward displaced optic chiasm; Group 3 (N = 20), control-group matched for tumour size and follow-up VFs, in mean deviation (dB). VFs were compared over time and a severity index, Chiasm Herniation Scale (CHS), for herniation based on radiological parameters was designed. RESULTS: After treatment, all groups showed improvement of VFs (Gr1: 2.97 dB p = 0.097, Gr2: 4.52 dB p = 0.001 and Gr3: 5.16 dB p = 0.000), followed by long-term gradual deterioration. The course of VFs between patients with and without herniation was not significantly different (p = 0.143), neither was there a difference in the course before and after herniation (p = 0.297). The median time till onset of herniation was 40 months (IQR 6 month-10 years) and did not significantly differ (p = 0.172) between the groups. There was no relation between VFs and the degree of herniation (p = 0.729). CONCLUSION: Herniation does not appear to have clinical relevance with respect to VF outcome. The newly designed CHS is the first scoring system to quantify the severity of herniation and, in the absence of alternatives, may be useful to describe MRI findings to serve future added value in larger sized outcome studies.
PURPOSE: To evaluate whether the occurrence of chiasmal herniation coincides with visual field (VF) deterioration and to compare the course of VF defects in patients with and without radiological chiasmal herniation following treatment of pituitary adenoma. METHODS: This retrospective cohort study included 48 pituitary macroadenomapatients with chiasm compression, divided into three groups: Group 1 (N = 12), downward displaced optic chiasm and deteriorated VFs; Group 2 (N = 16), downward displaced optic chiasm; Group 3 (N = 20), control-group matched for tumour size and follow-up VFs, in mean deviation (dB). VFs were compared over time and a severity index, Chiasm Herniation Scale (CHS), for herniation based on radiological parameters was designed. RESULTS: After treatment, all groups showed improvement of VFs (Gr1: 2.97 dB p = 0.097, Gr2: 4.52 dB p = 0.001 and Gr3: 5.16 dB p = 0.000), followed by long-term gradual deterioration. The course of VFs between patients with and without herniation was not significantly different (p = 0.143), neither was there a difference in the course before and after herniation (p = 0.297). The median time till onset of herniation was 40 months (IQR 6 month-10 years) and did not significantly differ (p = 0.172) between the groups. There was no relation between VFs and the degree of herniation (p = 0.729). CONCLUSION: Herniation does not appear to have clinical relevance with respect to VF outcome. The newly designed CHS is the first scoring system to quantify the severity of herniation and, in the absence of alternatives, may be useful to describe MRI findings to serve future added value in larger sized outcome studies.
Authors: E Ulysses Dorotheo; Rosa A Tang; Hasan M Bahrani; Jade S Schiffman; M Tariq Bhatti; Stephen B Lewis Journal: Surv Ophthalmol Date: 2005 Nov-Dec Impact factor: 6.048
Authors: Ivo S Muskens; Amir H Zamanipoor Najafabadi; Vanessa Briceno; Nayan Lamba; Joeky T Senders; Wouter R van Furth; Marco J T Verstegen; Timothy R S Smith; Rania A Mekary; Christine A E Eenhorst; Marike L D Broekman Journal: Pituitary Date: 2017-10 Impact factor: 4.107
Authors: Marjolein Tabak; Iris C M Pelsma; Mark C Kruit; Wouter R van Furth; Nienke R Biermasz; Irene C Notting Journal: Pituitary Date: 2020-10-15 Impact factor: 4.107