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Visual recovery following optic nerve decompression for chronic compressive neuropathy

  • Clinical Article
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Abstract

Purpose

Visual failure due to optic nerve compression is a common indication for decompressive surgery. Most data only refer to the odds of improvement, deterioration or remaining the same. However, patients frequently wish to know more detail about the outcomes of surgery. Our aim was to assess the visual outcome from optic nerve decompression for visual failure in detail in order to help counsel patients pre-operatively.

Methods

Sixty-eight patients undergoing 71 operations to decompress 87 optic nerves between 1991 and 2007 were identified. Thirty-four decompressions were performed via a transzygomatic and 37 via a transbasal approach. Fifty-two patients had meningiomas, 3 pituitary adenomas, 3 craniopharyngiomas, 3 chordomas, 2 adenocarcinomas, 2 fibrous dysplasia, 1 schwannoma, 1 granular pituitary tumour and 1 olfactory neuroblastoma. Visual acuity and fields were recorded pre-operatively, immediately post-operatively, at first follow-up and at most recent follow-up.

Results

Forty-three eyes (49.4%) experienced an improvement in either acuity or fields. Twenty-four (27.5%) were unchanged and 20 (22.9%) deteriorated. Average improvement was 0.88 Snellen lines (logMAR 0.13). Improvement was seen between immediate post-operative acuity and first follow-up in 52%, but 22% suffered a late deterioration after 1 year. There was no relationship between age, duration of symptoms, pathology, approach or redo surgery and visual outcome. There was a complex relationship between pre-operative visual acuity and post-operative improvement and outcome. Better pre-operative acuity predicted better outcome and greater odds of improvement, although patients with poor pre-operative vision had a greater average magnitude of improvement.

Conclusions

Patients experience significant benefit from optic nerve decompression irrespective of pre-operative visual status. Although early decompression is desirable, good results can still be obtained in patients with severe visual failure. Detailed data on visual outcome can help counsel patients pre-operatively to aid decision-making and set expectations.

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References

  1. Adler JR, Gibbs IC, Puataweepong P, Chang SD (2006) Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions. Neurosurgery 59(2):244–254

    Article  PubMed  Google Scholar 

  2. Al-Mefty O (1990) Clinoidal meningiomas. J Neurosurg 73:840–849

    PubMed  CAS  Google Scholar 

  3. Andrews BT, Wilson CB (1988) Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome. J Neurosurg 69:523–528

    PubMed  CAS  Google Scholar 

  4. Bailey IL, Lovie JE (1980) The design and use of a new near-vision chart. Am J Optom Physiol Opt 57(6):378–387

    PubMed  CAS  Google Scholar 

  5. Bassiouni H, Asgari S, Stolke D (2006) Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 66:37–45

    Article  PubMed  Google Scholar 

  6. Chi JH, McDermott MW (2002) Tuberculum sellae meningiomas. Neurosurg Focus 14(6):1–6

    Article  Google Scholar 

  7. Chicani CF, Miller NR (2003) Visual outcome in surgically treated suprasellar meningiomas. J Neuroophthalmol 23(1):3–10

    PubMed  Google Scholar 

  8. Cook SW, Smith Z, Kelly DF (2004) Endonasal transsphenoidal removal of tuberculum sellae meningiomas: technical note. Neurosurgery 55(1):239–244

    Article  PubMed  Google Scholar 

  9. Currie Z, Bhan A, Pepper I (2000) Reliability of Snellen charts for testing visual acuity for driving: prospective study and postal questionnaire. BMJ 321(7267):990–992

    Article  PubMed  CAS  Google Scholar 

  10. De Divitiis E, Cavallo LM, Cappabianca P, Esposito F (2007) Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumours. II. Neurosurgery 60(1):46–58

    PubMed  Google Scholar 

  11. Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrine outcomes. J Neurosurg 96:235–243

    PubMed  Google Scholar 

  12. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250

    Article  PubMed  CAS  Google Scholar 

  13. Faye EE (1976) Clinical low vision. Little, Brown, Boston

    Google Scholar 

  14. Feiz-Erfan I, Han PP, Spetzler RF et al (2005) The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 103:485–490

    PubMed  Google Scholar 

  15. Giosis M, Bigioli F, Guareschi M, Frigerio A, Mortini P (2005) Fibrous dysplasia of the orbital region: current clinical perspectives in ophthalmology and cranio-maxillofacial surgery. Ophthal Plast Reconstr Surg 22(5):383–387

    Google Scholar 

  16. Goel A, Muzamdar D, Desai KI (2002) Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51(6):1358–1364

    Article  PubMed  Google Scholar 

  17. Hentschel SJ, DeMonte F (2003) Olfactory groove meningiomas. Neurosurg Focus 14(6):1–5

    Article  Google Scholar 

  18. Holloday JT (2004) Visual acuity measurements. J Cataract Refract Surg 30:287–290

    Article  Google Scholar 

  19. Honeybull S, Neil-Dwyer G, Evans BT, Lang DA (1997) Transzygomatic approach: an anatomical study. Br J Oral Maxillofac Surg 35:334–340

    Article  Google Scholar 

  20. ICD-10 (1990) International statistical classification of diseases and related health problems: tenth revision, 2nd edn. WHO, Geneva

    Google Scholar 

  21. Jallo GI, Benjamin V (2002) Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51(6):1432–1440

    Article  PubMed  Google Scholar 

  22. Lang DA, Honeybull S, Neil-Dwyer G, Evans BT, Weller RO, Gill J (1999) The extended transbasal approach: clinical applications and complications. Acta Neurochir (Wien) 141:579–585

    Article  CAS  Google Scholar 

  23. Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended approach for resection of suprasellar lesions. J Neurosurg 106:400–406

    Article  PubMed  Google Scholar 

  24. Lim LT, Frazer DG, Jackson AJ (2007) Clinical studies: visual acuities beyond Snellen. Br J Ophthalmol 92:153

    Article  Google Scholar 

  25. Lovie-Kitchen JE (1988) Validity and reliability of visual acuity measurements. Ophthalmic Physiol Opt 8:363–370

    Article  Google Scholar 

  26. Margalit NS, Lesser JB, Moche J, Sen C (2003) Meningiomas involving the optic nerve: technical aspects and outcomes for a series of 50 patients. Neurosurgery 33(3):523–533

    Article  Google Scholar 

  27. Nakamura M, Roser F, Jacobs C, Vorkapic P, Samii M (2006) Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery 58(4):626–639

    Article  PubMed  Google Scholar 

  28. Pamir MN, Özduman K, Belirgen M, Kilic T, Özec MM (2005) Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Acta Neurochir (Wien) 147:1121–1130

    Article  CAS  Google Scholar 

  29. Papay FA, Morales L, Flaharty P et al (1995) Optic nerve decompression in cranial base fibrous dysplasia. J Craniofac Surg 6(1):5–10

    Article  PubMed  CAS  Google Scholar 

  30. Park CK, Jung HW, Yang SY, Seol HJ, Paek SH, Kim DG (2006) Surgically treated tuberculum sellae and diaphragma sellae meningiomas: the importance of short-term visual outcome. Neurosurgery 59(2):238–243

    Article  PubMed  Google Scholar 

  31. Puchner MJA, Fisher-Lampsatis RCM, Hermann HD, Freckman N (1998) Suprasellar meningiomas—neurological and visual outcome at long term follow-up in a homogeneous series of patients treated microsurgically. Acta Neurochir (Wien) 140:1231–1238

    Article  CAS  Google Scholar 

  32. Schick U, Hassler W (2005) Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 76:977–983

    Article  PubMed  CAS  Google Scholar 

  33. Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M (2006) Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci 47:1236–1240

    Article  PubMed  Google Scholar 

  34. Shrivastava RK, Sen C, Costantino PD, Rocca RD (2005) Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:491–497

    PubMed  Google Scholar 

  35. Sleep TJ, Hodgkins PR, Honeybul S, Neil-Dwyer G, Lang D, Evans B (2003) Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy. Eye 17:571–578

    Article  PubMed  CAS  Google Scholar 

  36. Suri A, Narang KS, Sharma BS, Mahapatra AK (2008) Visual outcome after surgery in patients with suprasellar tumours and preoperative blindness. J Neurosurg 108:19–25

    Article  PubMed  Google Scholar 

  37. Van Effentere R, Boch AL (2002) Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3–11

    Google Scholar 

  38. Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas. J Neurosurg 73:3–11

    PubMed  Google Scholar 

  39. Zevgaridis D, Medele RJ, Müller A, Hischa AC, Steiger HJ (2001) Meningiomas of the sellar region presenting with visual impairment: impact of various prognostic factors on surgical outcome in 62 patients. Acta Neurochir (Wien) 143:471–476

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Diederik O. Bulters, Emad Shenouda, Nijaguna Mathad & Dorothy A. Lang

  2. Department of Maxillofacial Surgery, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Barrie T. Evans

Authors
  1. Diederik O. Bulters
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  2. Emad Shenouda
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  3. Barrie T. Evans
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  4. Nijaguna Mathad
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  5. Dorothy A. Lang
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Correspondence to Diederik O. Bulters.

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Bulters, D.O., Shenouda, E., Evans, B.T. et al. Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir 151, 325–334 (2009). https://doi.org/10.1007/s00701-009-0192-x

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  • DOI: https://doi.org/10.1007/s00701-009-0192-x

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