Ophthalmological outcome after resection of tumors based on the pineal gland

Clinical article

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Object

Descriptions of visual dysfunction in pineal gland tumors tend to focus on upward gaze palsy alone. The authors aimed to characterize the nature, incidence, and functional significance of ophthalmological dysfunction after resection of tumors based on the pineal gland.

Methods

Review of a retrospective case series was performed and included consecutive patients who underwent surgery performed by a consultant neurosurgeon between 2002 and 2011. Only tumors specifically based on the pineal gland were included; tumors encroaching on the pineal gland from other regions were excluded. All patients with visual signs and/or symptoms were reviewed by a specialist consultant neuroophthalmologist to accurately characterize the nature of their deficits. Visual disturbance was defined as visual symptoms caused by a disturbance of ocular motility.

Results

A total of 20 patients underwent resection of pineal gland tumors. Complete resection was obtained in 85%, and there were no perioperative deaths. Visual disturbance was present in 35% at presentation; of those who had normal ocular motility preoperatively 82% had normal motility postoperatively. In total, 55% of patients had residual visual disturbance postoperatively. Although upward gaze tended to improve, significant functional deficits remained, particularly with regard to complex convergence and accommodation dysfunction. Prisms were used in 25% but were only ever partially effective. Visual outcome was only related to preoperative visual status and tumor volume (multivariate analysis).

Conclusions

Long-term visual morbidity after pineal gland tumor resection is common and leads to significant functional impairment. Improvement in deficits rarely occurs spontaneously, and prisms only have limited effectiveness, probably due to the dynamic nature of supranuclear ocular movement coordination.

Abbreviations used in this paper:EORTC QLQ C-30 and BN-20 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Brain Module; QOL = quality of life.

Article Information

Address correspondence to: Michael G. Hart, M.B.Ch.B., Department of Neurosurgery, Addenbrooke's Hospital, Box 166, Cambridge CB2 0QQ, United Kingdom. email: mikehart82@me.com.

Please include this information when citing this paper: published online May 10, 2013; DOI: 10.3171/2013.3.JNS122137.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Presentation and management of hydrocephalus. ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; VPS = ventriculoperitoneal shunt.

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    Tumor locations as seen on MRI. Left: An epidermoid tumor demonstrating clearly its intimacy to the pineal gland. Right: An astrocytoma unequivocally based primarily on the pineal gland itself.

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    Kaplan-Meier plot demonstrating overall survival for the cohort. Three patients died at a mean of 14 months postoperatively. There are 17 long-term survivors. Mean survival has not been reached since the majority of patients are still alive. All patients had at least 12 months of follow-up (mean 36 ± 26 months).

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    Postoperative ophthalmological outcome. Each symbol represents a patient and his or her concordant ophthalmological status. The arrows demonstrate changes between groups. All other patients remained within their group. On univariate analysis, preoperative ophthalmological status significantly predicted postoperative ophthalmological status (p < 0.005, chi-square test).

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    Quality of life. The numbers in parentheses reflect the relative section of the EORTC QLQ C-30 or BN-20 questionnaire from which the answers were derived. For all parameters except 29 and 30 the scale was: 1, not at all; 2, a little; 3, quite a bit; 4, very much. For 29 and 30 the scales ranged from 1 (very poor) to 7 (excellent). The only significant difference related to double vision (36). *p < 0.05 (ANOVA). ADLs = activities of daily living.

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    Tumor volume and risk of visual deterioration.

References

1

Aaronson NKAhmedzai SBergman BBullinger MCull ADuez NJ: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:3653761993

2

Bruce JNPineal tumors. Winn HR: Youmans Neurological Surgery ed 5New YorkElsevier2004. 10111029

3

Bruce JNStein BM: Surgical management of pineal region tumors. Acta Neurochir (Wien) 134:1301351995

4

Henson JWUlmer SHarris GJ: Brain tumor imaging in clinical trials. AJNR Am J Neuroradiol 29:4194242008

5

Hernesniemi JRomani RAlbayrak BSLehto HDashti RRamsey C III: Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 70:5765832008

6

Macdonald DRCascino TLSchold SC JrCairncross JG: Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:127712801990

7

Nazzaro JMShults WTNeuwelt EA: Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76:7467511992

8

Osoba DAaronson NKMuller MSneeuw KHsu MAYung WK: The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires. Qual Life Res 5:1391501996

9

Parinaud H: Paralysie des movements associés des yeux. Arch Neurol 5:1451721883

10

Pearce JM: Parinaud's syndrome. J Neurol Neurosurg Psychiatry 76:992005

11

Pierrot-Deseilligny CHChain FGray FSerdaru MEscourolle RLhermitte F: Parinaud's syndrome: electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain 105:6676961982

12

Sano KAlternate surgical approaches to pineal regions neoplasms. Schmidek HHSweet WH: Operative Neurosurgical Techniques: Indications Methods and Results ed 4New YorkSaunders2000. 895907

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