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Table of Contents    
CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 288-289

Authors' Reply: How long can the optic nerve defy compression?


1 Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Pinaki Dutta
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222838

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How to cite this article:
Rai A, Dutta P, Dhandapani S. Authors' Reply: How long can the optic nerve defy compression?. Neurol India 2018;66:288-9

How to cite this URL:
Rai A, Dutta P, Dhandapani S. Authors' Reply: How long can the optic nerve defy compression?. Neurol India [serial online] 2018 [cited 2019 Feb 16];66:288-9. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/288/222838




Sir,

We are indeed obliged for the keen interest taken by Dr. Turgut in our article and his minute observations.[1],[2] The constructive comments made by him are useful for the readers; in fact, we could have cited their paper in the discussion section where visual outcome of pituitary apoplexy patients has been described.

Vision is one of the most significant components of outcome after surgery for sellar suprasellar tumors, affecting not only the patients but also their families.[1],[2],[3] The duration of optic nerve compression is definitely an important determinant of visual outcome. In our study, the median duration of optic nerve decompression following the onset of apoplexy was two days; however, if we see the mean duration, it is concordant with that of Turgut et al.[1],[2] There is not much difference if the surgical intervention is done within a few hours to seven days. On the contrary, the paper by Maccagnan et al., had shown a good visual outcome even if the surgical intervention had been done as late as at 65 days.[4] This illustrates the high degree of plasticity of the optic nerve.[4],[5],[6] However, significant improvement has been observed in patients rendered blind by pituitary apoplexy if early surgical decompression has been undertaken.[1]

Recent studies have reported a better visual outcome even in conservatively managed patients only with replacement therapies and dexamethasone or hydrocortisone as an anti-edema measure.[7],[8] In our series, one-third of patients were also having radiological evidence of apoplexy. There is a significant difference between radiological and clinical apoplexy. Radiological apoplexy may be silent more often and it is difficult to elucidate the exact duration. So, the same guidelines may not be applicable to all patients with an apoplexy. The guidelines are made for day-to-day management; however, they may not be 'Gospel truth' in every situation.

As rightly pointed out, the word should have been demyelination rather than remyelination. As highlighted by the author, a multidisciplinary management with periodic assessment of the visual acuity and field along with sensorium charting in the first 48 hours is of utmost importance in the management of patients suffering from pituitary apoplexy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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. 1
    
2.
Dutta P, Gyurmey T, Bansal R, Pathak A, Dhandapani S, Rai A, et al. Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent. Neurol India 2016;64:1247.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Dhandapani M, Gupta S, Sivashanmugam Dhandapani PK, Samra K, Sharma K, Dolma K, et al. Study of factors determining caregiver burden among primary caregivers of patients with intracranial tumors. Surg Neurol Int 2015;6:160.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Maccagnan P, Macedo CLD, Kayath MJ, Nogueira RG, Abucham J. Conservative management of pituitary apoplexy: A prospective study. J Clin Endocrinol Metab 1995; 80:2190-7.  Back to cited text no. 4
    
5.
Rosa AM, Silva MF, Ferreira S, Murta J, Castelo-Branco M. Plasticity in the human visual cortex: An ophthalmology-based perspective. Biomed Res Int 2013; 2013:568354.  Back to cited text no. 5
    
6.
Dhandapani S, Negm HM, Cohen S, Anand VK, Schwartz TH. Endonasal endoscopic transsphenoidal resection of tuberculum sella meningioma with anterior cerebral artery encasement. Cureus Cureus. 2015;7:e311.  Back to cited text no. 6
    
7.
Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ. Acute management of pituitary apoplexy-surgery or conservative management? Clin Endocrinol (Oxf) 2004;61:747-52.  Back to cited text no. 7
    
8.
Dutta P, Dhandapani S, Kumar N, Gupta P, Ahuja C, Mukherjee KK. Bevacizumab for radiation induced optic neuritis among aggressive residual/recurrent suprasellar tumors: More than a mere antineoplastic effect. World Neurosurg 2017;107:1044.e5-1044.e10  Back to cited text no. 8
    




 

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