Preoperative radiological compression features and their relationship with pre- and postoperative visual field defects in pituitary macroadenomas: a retrospective cohort from the neuro-ophthalmological clinic
Frontiers in Ophthalmology, vol. 6, pp. 1724655
Abstract
Purpose: The study aimed to correlate preoperative magnetic resonance imaging (MRI) characteristics with pre- and postoperative visual field deficits (VFDs) in patients with non-functioning pituitary macroadenoma (NFMA). Methods: This retrospective cohort study included 74 patients with preoperative high-quality MRI sequences and detailed visual field assessments (including masked ophthalmologist interpretation of perimetry) before and <9 months postoperatively. Patients (median age 59 years; 43% female) underwent surgery between 2005 and 2016. Two neuro-ophthalmologists independently scored visual fields (i.e., affected, pattern, improvement) while masked to mean deviations (MD). Radiological contact, deformity, hyperintensity, and atrophy of the optic system (nerves, chiasm [Fujimoto grading], and tracts) were scored. Generalized estimating equations (GEE) were used for correlation analyses. Receiver operating characteristic (ROC) analysis was used to determine MD cutoff values. Results: Higher preoperative Fujimoto grades correlated with lower preoperative MD (P <0.001). Hyperintensity of the optic system was observed in five of 74 patients. Temporal hemianopia and quadrantanopia (47%) were the most frequently observed preoperative VFD patterns, even in the eyes with optic nerve or tract compression. A preoperative MD cutoff of -1.41 dB (ROC sensitivity 92%, specificity 95%) was suggested for determining affected visual fields. Moreover, an MD cutoff Δ2.52 dB (ROC sensitivity 87%, specificity 78%) was suggested for improvement of visual fields. Conclusions: Preoperative optic chiasm compression results in lower MD values. Compression of the optic nerve or tract was not associated with postoperative MD in this patient population. Following the ROC analysis, we suggest using MD ≤-1.41 dB to determine preoperatively affected visual fields for research purposes.
Authors 13
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Nienke Ruurdje Biermasz Aachen Department of Internal Medicine Division of Endocrinology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center
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Jan-Willem M. Beenakker Aachen Department of Ophthalmology, Leiden University Medical Center Department of Radiation Oncology Department of Radiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
Department of Radiation Oncology, Leiden University Medical Center
Department of Radiology, Leiden University Medical Center
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Leiden University Medical Center
Affiliation as printed
Department of Ophthalmology, Leiden University Medical Center
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Iris C. M. Pelsma Aachen Department of Internal Medicine Division of Endocrinology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center
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