Decision Making for Patients With Concomitant Pituitary Macroadenoma and Ophthalmologic Comorbidity: A Clinical Controversy

World Neurosurgery
Mohamadreza HajiabadiRudolf Fahlbusch

Abstract

Coexisting complex visual field defects and serious ophthalmologic comorbidities make the management of the pituitary macroadenomas more challenging. Diffusion tensor imaging (DTI) magnetic resonance imaging 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 ophthalmologic comorbidities and pituitary adenoma. Two patients with atypical visual field defects caused by nonfunctional pituitary macroadenoma and simultaneous ophthalmologic 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. The nontypical pattern of visual field defect could not differentiate between the ophthalmologic disease and the chiasmatic compression attributable 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 the reappearance of these fibers intraoperatively ...Continue Reading

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Citations

Jul 23, 2019·International Forum of Allergy & Rhinology·Eric W WangCarl H Snyderman
Sep 15, 2020·Chinese Neurosurgical Journal·Mousa TaghipourMeisam Ghanbari

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