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CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 287-288

Visual outcome following microscopic transsphenoidal surgery for pituitary adenomas: A few concerns


Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Mehmet Turgut
Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222886

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How to cite this article:
Turgut M. Visual outcome following microscopic transsphenoidal surgery for pituitary adenomas: A few concerns. Neurol India 2018;66:287-8

How to cite this URL:
Turgut M. Visual outcome following microscopic transsphenoidal surgery for pituitary adenomas: A few concerns. Neurol India [serial online] 2018 [cited 2019 Apr 18];66:287-8. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/287/222886




Sir

I read with interest the article entitled “Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent” by Dutta et al.,[1] with great interest. The authors presented results of analysis of a total of 1007 consecutive patients with pituitary adenomas in this study and they concluded that there is an inverse correlation between the preoperative duration of symptoms and rapidity of postoperative visual recovery, that is, recovery of nerve conduction, suggesting the importance of “early” surgical intervention of less than 6 months.[1] Afterwards, they used the term “late surgery” for description of the interval between symptom onset-to-surgical intervention longer than a year.[1] Even today, the optimal management of this problem still remains controversial, but I would like to point out that there are a few concerns that have to be addressed:

First, the authors reported that vision loss is irreversible if the visual pathway is compressed to the point of total loss of function in patients with pituitary apoplexy, but 90% of blind eyes showed a remarkable improvement in vision, when surgical decompression of the optic apparatus was undertaken “early”.[1] However, I want to underline the fact that the term “early” is very different from that protrayed by the authors, as was seen in our reported case and in literature. It refers to surgical intervention within the first week of admission of the patient to the hospital [2],[3],[4],[5]

Second, based on our overview of 186 published cases of apoplectic pituitary adenoma presenting with monocular or binocular blindness, there was no significant difference in the recovery of visual loss in cases who underwent surgery within 3 days of the apoplectic onset of their symptoms compared with those who underwent surgery within 4-7 days of the apoplexy (78% versus 71%, respectively).[2] Furthermore, there was also no significant difference in the visual recovery in patients who underwent surgery within the first day of the apoplexy compared with those who underwent surgery within 2-7 days of the apoplectic event.[2] At present, most authors recommend “early” but not necessarily emergency transsphenoidal surgery within the first week, for cases with pituitary apoplexy whose visual loss is not improving or has deteriorated during the first few days [2],[3],[4],[6]

Third, the authors state that there was not much improvement after 1 year, due to “remyelination” of decompressed optic pathways. I think that the term “remyelination” should be “demyelinization”. Undoubtedly, a multidisciplinary management team that includes a neurosurgeon, an ophthalmologist, an endocrinologist, and a neuroradiologist is vital for achieving an optimal outcome in patients with pituitary apoplexy.

As you can guess, we convey these comments not as a criticism of the article published in Neurology India but, instead, as a constructive process for editorial review.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dutta P, Gyurmey T, Bansal R, Pathak A, Dhandapani S, Rai A, Bhansali A, Mukherjee KK. Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent. Neurol India 2016;64:1247-53.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Turgut M, Ozsunar Y, Başak S, Güney E, Kir E, Meteoǧlu I. Pituitary apoplexy: An overview of 186 cases published during the last century. Acta Neurochir (Wien) 2010;152:749-61.  Back to cited text no. 2
    
3.
Agrawal D, Mahapatra AK. Visual outcome of blind eyes in pituitary apoplexy transsphenoidal surgery: A series 14 eyes. Surg Neurol 2005;63:42-6.  Back to cited text no. 3
    
4.
Parent AD. Visual recovery after blindness from pituitary apoplexy. Can J Neurol Sci 1990;17:88-91.  Back to cited text no. 4
    
5.
Muthukumar N, Rossette D, Soundaram M, Senthilbabu S, Badrinarayanan T. Blindness following pituitary apoplexy: Timing of neurosurgery and neuro-ophthalmic outcome. J Clin Neurosci 2008;15:873-9.  Back to cited text no. 5
    
6.
Turgut M, Seyithanoǧlu MH, Tüzgen S. Definition, history, frequency, histopathology and pathophysiology of pituitary apoplexy. In: Pituitary Apoplexy, Turgut M, Mahapatra AK, Powell M, Muthukumar N (eds.). New York, Heidelberg, Dordrecht, London: Springer, 2013, pp. 3-10.  Back to cited text no. 6
    




 

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