Article
Automated pupillometry indicates decompression of the optic chiasm following transsphenoidal resection of pituitary tumours
Die Anwendung der Pupillometry ermöglicht eine Evaluation der Chiasma opticum-Dekompression nach transsphenoidaler Resektion von Hypophysentumoren
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Authors
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Christopher Beynon
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Mohammed Nofal
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Jessica Jesser
- Universitätsklinikum Heidelberg, Neuroradiologische Klinik, Heidelberg, Deutschland
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Philip Dao Trong
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Klaus Zweckberger
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Edgar Santos
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Pituitary tumours may lead to compression of the optic chiasm and visual impairment in patients. Therefore, decompression of the optic chiasm is a major goal of surgical treatment. Automated pupillometry has been used in various clinical settings for assessing the optic system. The aim of the present study was to evaluate its potential to improve diagnostic modalities in patients undergoing transsphenoidal resection of pituitary tumours.
Methods: The automated pupillometer NPi-200® (Neuroptics, CA, USA) was used in patients treated at our institution for transsphenoidal resection of a pituitary tumour. The neurological pupil index (NPi) was assessed before and within 24 hours after surgery. Patients were divided into two groups depending on pupillometry findings prior to surgery (Group A: NPi < 4.0; Group B: NPi > 4.0). Clinical findings of visual impairment and optic chiasm compression on imaging studies were analysed. The impact of transsphenoidal tumour resection on NPi values was analysed and compared between both groups.
Results: A total of 32 patients were included in this study. NPi values below 4.0 were observed in 7 patients (Group A) and of these, 7 (100%) suffered from visual impairment and compression of the optic chiasm. Only 47% patients of group B (n=25) had impaired vision and/or compression of the optic chiasm. During transsphenoidal tumour resection, intraoperative magnetic resonance imaging revealed decompression of the optic chiasm in all patients. NPi values of patients from group A improved significantly from a mean of 3.6±0.4 (before surgery) to 4.2±0.4 (after surgery; p=0.0002). In contrast, NPi values did not change significantly after surgery in patients from group B (before surgery: 4.5±0.2; after surgery: 4.5±0.3; p=0.07). The sensitivity of NPi
Conclusion: The use of automated pupillometry may detect optic chiasm compression in patients with pituitary tumours and moreover, postoperative improvement of initial NPI values < 4.0 indicates sufficient decompression of the optic chiasm following transsphenoidal tumour resection. Further studies are needed to evaluate the potential of this technique to gain valuable information in the surgical treatment of pituitary tumours.
Figure 1 [Fig. 1]
