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Conservative Management of Pituitary Macroadenoma Contacting the Optic Apparatus

Published online by Cambridge University Press:  23 September 2016

Won Hyung A. Ryu
Affiliation:
Shulich School of Medicine & Dentistry, University of Western Ontario, London
Samantha Tam
Affiliation:
Queen's University, School of Medicine, Kingston, Ontario, Canada
Brian Rotenberg
Affiliation:
Department of Otolaryngology — Head and Neck Surgery, University of Western Ontario, London
Mohamed Ahmed Labib
Affiliation:
Department of Clinical Neurosciences — Division of Neurosurgery, University of Western Ontario, London
Donald Lee
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London
David A. Nicolle
Affiliation:
Department of Ophthalmology, University of Western Ontario, London
Stan Van Uum
Affiliation:
Department of Medicine — Division of Endocrinology and Metabolismy, University of Western Ontario, London
Neil Duggal*
Affiliation:
Department of Clinical Neurosciences — Division of Neurosurgery, University of Western Ontario, London
*
Department of Clinical Neurological Sciences, (Division of Neurosurgery), University of Western Ontario, 339 Windermere Road, London, Ontario, N6A 5A5, Canada
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Abstract

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Objectives:

To describe the tumor characteristics and visual function in conservatively managed patients with non-functioning pituitary macroadenoma (NFMA) that contacted/compressed the visual pathway.

Design:

Retrospective case-series.

Setting:

Tertiary-care academic institution.

Participants:

Six patients with diagnosis of NFMA.

Main Outcome:

Visual function and radiological characteristics of the optic apparatus and pituitary tumor.

Results:

All patients had radiological evidence of optic apparatus compression but only one had visual field defect at the initial presentation. While two of the six patients developed visual field changes during follow-up (41±34.8 months), the patient with visual field defect at the time of diagnosis improved to normal vision.

Conclusions:

Select NFMAs that contact the optic apparatus, without visual dysfunction, may be managed with close ophthalmological and radiographic monitoring, depending on tumor and imaging characteristics. This may be of particular relevance in patients considered to have a high peri-operative risk, such as advanced age or significant co-morbidities.

Résumé

RésuméObjectifs:

Le but de l'étude était de décrire les caractéristiques des tumeurs et la fonction visuelle chez les patients atteints de macro adénomes pituitaires non fonctionnels (MANF) adjacents ou comprimant les voies optiques, traités de façon conservatrice.

Méthodologie:

Il s'agit d'une étude rétrospective portant sur six patients ayant consulté dans une institution académique de soins tertiaires, chez qui un diagnostic de MANF a été posé. L'issue primaire était la fonction visuelle et les caractéristiques radiologiques de l'appareil optique et de la tumeur pituitaire.

Résultats:

Tous les patients avaient une compression de l'appareil optique à l'imagerie, mais seulement un avait un déficit du champ visuel au moment de la première évaluation. Deux des six patients ont présenté des changements du champ visuel au cours du suivi (41 ± 34,8 mois) ; le patient qui avait un déficit du champ visuel au moment du diagnostic a recouvré une vision normale.

Conclusions:

Certains MANF qui touchent à l'appareil optique sans provoquer de dysfonction visuelle peuvent être suivis étroitement en ophtalmologie et en radiologie, selon les caractéristiques de la tumeur et de l'imagerie. Ceci peut être particulièrement pertinent chez les patients considérés à haut risque périopératoire, tels les patients âgés ou qui ont des comorbidités importantes.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2010

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