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Abstract #60637 Published in IGR 16-4
Decision making for patients with concomitant pituitary macroadenoma and ophthalmologic comorbidity: a clinical controversy
Hajiabadi M; Alimohamadi M; Fahlbusch RWorld neurosurgery 2015; 84: 147-153
BACKGROUND: Coexisting complex visual field defects and serious ophthalmological comorbidities make management of the pituitary macroadenomas more challenging. Diffusion tensor imaging (DTI) MRI that tracks neural fibers in the white matter has been used recently to visualize the impact of different pathologies on cranial nerves. This study explains application of anterior optic pathway tractography for patients with ophthalmological comorbidities and pituitary adenoma. METHODS: Two patients with atypical visual field defects due to nonfunctional pituitary macroadenoma and simultaneous ophthalmological morbidities (one glaucoma and the other giant cell arteritis) were selected for surgical decompression of the anterior optic apparatus. Standard perimetry and optic pathway DTI were done preoperatively, intraoperatively and 3 months after surgery. RESULTS: The non-typical pattern of visual field defect could not differentiate between the ophthalmological disease and the chiasmatic compression due to pituitary macroadenoma as the main cause. Preoperative visual pathway DTI tractography showed lack of decussating chiasmatic fibers in both of the patients. DTI tractography revealed re-appearance of these fibers intraoperatively in one and postoperatively in the other one. Three months after surgery, the visual field and acuity improved and DTI tractography confirmed presence of crossing chiasmatic fibers. CONCLUSION: Visual pathway DTI tractography is a promising adjunct to the standard perimetry in preoperative assessment of pituitary macroadenoma with serious ophthalmologic comorbidities. It may also be useful in the intraoperative determination of the optic pathway decompression and for following the visual outcome of these patients after surgery.
International Neuroscience Institute, Hannover, Germany; Iranian International Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address: dr.m.haji55@gmail.com.
Full articleClassification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
