Prognostic significance of intraoperative change in the fractional anisotropy and the volume of the optic chiasma during resection of suprasellar tumors

Restricted access


The aim of this study was to test the prognostic significance of intraoperative changes in the fractional anisotropy (FA) and the volume of the optic chiasma and their correlation with visual outcome.


Twenty-eight sequential patients with suprasellar tumors presenting with chiasma compression syndrome were surgically treated under intraoperative MRI control between March 2014 and July 2016. The FA and the volume of the optic chiasma were measured immediately before and immediately after tumor resection. The visual impairment score (VIS) was used to quantify the severity of the ophthalmological disturbances before surgery, 10–14 days after surgery, and again 3 months thereafter. The change in the FA and the volume of the optic chiasma was correlated to the improvement of vision. The correlation between other predictors such as the age of the patients and the duration of symptoms and the visual outcome was tested.


The VIS improved significantly after surgery. The FA values of the optic chiasma decreased significantly after decompression, whereas the volume of the optic chiasma increased significantly after decompression. The early and delayed improvement of vision was strongly correlated to the decrease in the average FA and the increase of the volume of the optic chiasma. The duration of symptoms showed a significant negative correlation to the visual outcome. However, the decrease in the FA showed the strongest correlation to the improvement of the VIS, followed by the expansion of the optic chiasma, and then the duration of symptoms.


The decrease in the FA and the expansion of the optic chiasma after its decompression are strong early predictors of the visual outcome. These parameters are also able to predict delayed improvement of vision.

ABBREVIATIONS DTI = diffusion tensor imaging; FA = fractional anisotropy; VIS = visual impairment score.

Article Information

Correspondence Hussam Metwali, International Neuroscience Institute, Rudolf-Pichlmayr-Straße 4, Hannover D-30625, Germany.

INCLUDE WHEN CITING Published online June 23, 2017; DOI: 10.3171/2016.12.JNS162741.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    A–D: Fused T1-weighted and DT images showing the segmented optic chiasma before tumor resection. E–H: Fused T1-weighted and DT images showing the segmented optic chiasma after tumor resection. Segmentation was performed on volumetric T1-weighted images. Figure is available in color online only.

  • View in gallery

    A scatter plot showing the correlation between the decrease in the FA (x axis) and the improvement of the VIS (y axis).

  • View in gallery

    Illustrative case. Charts of visual acuity (left) and visual field defect (right) used for calculation of the VIS. The marked numbers provide an example of the calculation made in this case. The visual acuity was normal on both sides; the score of visual acuity of both eyes was 0. The patient had complete temporal hemianopia in the left eye and partial temporal hemianopia in the right eye. The score of the field of vision was 20. When the visual acuity score was added to the field defect score, the total was 20. This number represents the VIS.

  • View in gallery

    A and B: Preoperative MR images of a pituitary adenoma that compressed the optic chiasma. C and D: Postoperative MR images showing the chiasma after tumor resection, which was performed via the transsphenoidal approach. Figure is available in color online only.


  • 1

    Anik IAnik YKoc KCeylan SGenc HAltintas O: Evaluation of early visual recovery in pituitary macroadenomas after endoscopic endonasal transphenoidal surgery: Quantitative assessment with diffusion tensor imaging (DTI). Acta Neurochir (Wien) 153:8318422011

  • 2

    Barzaghi LRMedone MLosa MBianchi SGiovanelli MMortini P: Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg Rev 35:3693792012

  • 3

    Bauer CMHeidary GKoo BBKilliany RJBex PMerabet LB: Abnormal white matter tractography of visual pathways detected by high-angular-resolution diffusion imaging (HARDI) corresponds to visual dysfunction in cortical/cerebral visual impairment. J AAPOS 18:3984012014

  • 4

    Beppu TFujiwara SNishimoto HKoeda ANarumi SMori K: Fractional anisotropy in the centrum semiovale as a quantitative indicator of cerebral white matter damage in the subacute phase in patients with carbon monoxide poisoning: correlation with the concentration of myelin basic protein in cerebrospinal fluid. J Neurol 259:169817052012

  • 5

    Berkmann SSchlaffer SNimsky CFahlbusch RBuchfelder M: Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma. J Neurosurg 121:116611752014

  • 6

    Berman JIGlass HCMiller SPMukherjee PFerriero DMBarkovich AJ: Quantitative fiber tracking analysis of the optic radiation correlated with visual performance in premature newborns. AJNR Am J Neuroradiol 30:1201242009

  • 7

    Cauley KAFilippi CG: Diffusion-tensor imaging of small nerve bundles: cranial nerves, peripheral nerves, distal spinal cord, and lumbar nerve roots—clinical applications. AJR Am J Roentgenol 201:W326W3352013

  • 8

    Clemm von Hohenberg CSchocke MFWigand MCNachbauer WGuttmann CRKubicki M: Radial diffusivity in the cerebellar peduncles correlates with clinical severity in Friedreich ataxia. Neurol Sci 34:145914622013

  • 9

    Dai HYin DHu CMorelli JNHu SYan X: Whole-brain voxel-based analysis of diffusion tensor MRI parameters in patients with primary open angle glaucoma and correlation with clinical glaucoma stage. Neuroradiology 55:2332432013

  • 10

    Dong QWelsh RCChenevert TLCarlos RCMaly-Sundgren PGomez-Hassan DM: Clinical applications of diffusion tensor imaging. J Magn Reson Imaging 19:6182004

  • 11

    Dudink JLequin Mvan Pul CBuijs JConneman Nvan Goudoever J: Fractional anisotropy in white matter tracts of very-low-birth-weight infants. Pediatr Radiol 37:121612232007

  • 12

    Fahlbusch RSchott W: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:2352432002

  • 13

    Gerganov VMGiordano MSamii MSamii A: Diffusion tensor imaging-based fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas. J Neurosurg 115:108710932011

  • 14

    Giordano MNabavi AGerganov VMJavadi ASSamii MFahlbusch R: Assessment of quantitative corticospinal tract diffusion changes in patients affected by subcortical gliomas using common available navigation software. Clin Neurol Neurosurg 136:142015

  • 15

    Gnanalingham KKBhattacharjee SPennington RNg JMendoza N: The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. J Neurol Neurosurg Psychiatry 76:4154192005

  • 16

    Hajiabadi MSamii MFahlbusch R: A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment. J Neurosurg 125:7597652016

  • 17

    Ibrahim ITintera JSkoch AJirů FHlustik PMartinkova P: Fractional anisotropy and mean diffusivity in the corpus callosum of patients with multiple sclerosis: the effect of physiotherapy. Neuroradiology 53:9179262011

  • 18

    Jacob MRaverot GJouanneau EBorson-Chazot FPerrin GRabilloud M: Predicting visual outcome after treatment of pituitary adenomas with optical coherence tomography. Am J Ophthalmol 147:647070.e1–70.e2 2009

  • 19

    Kochunov PThompson PMLancaster JLBartzokis GSmith SCoyle T: Relationship between white matter fractional anisotropy and other indices of cerebral health in normal aging: tract-based spatial statistics study of aging. Neuroimage 35:4784872007

  • 20

    Lee SKim SJYu YSKim YHPaek SHKim DG: Prognostic factors for visual recovery after transsphenoidal pituitary adenectomy. Br J Neurosurg 27:4254292013

  • 21

    Lerner AMogensen MAKim PEShiroishi MSHwang DHLaw M: Clinical applications of diffusion tensor imaging. World Neurosurg 82:961092014

  • 22

    Likitjaroen YMeindl TFriese UWagner MBuerger KHampel H: Longitudinal changes of fractional anisotropy in Alzheimer’s disease patients treated with galantamine: a 12-month randomized, placebo-controlled, double-blinded study. Eur Arch Psychiatry Clin Neurosci 262:3413502012

  • 23

    Lober RMGuzman RCheshier SHFredrick DREdwards MSYeom KW: Application of diffusion tensor tractography in pediatric optic pathway glioma. J Neurosurg Pediatr 10:2732802012

  • 24

    Lutz JThon NStahl RLummel NTonn JCLinn J: Microstructural alterations in trigeminal neuralgia determined by diffusion tensor imaging are independent of symptom duration, severity, and type of neurovascular conflict. J Neurosurg 124:8238302016

  • 25

    Michelson GEngelhorn TWärntges SEl Rafei AHornegger JDoerfler A: DTI parameters of axonal integrity and demyelination of the optic radiation correlate with glaucoma indices. Graefes Arch Clin Exp Ophthalmol 251:2432532013

  • 26

    Müslüman AMCansever TYılmaz AKanat AOba EÇavuşoğlu H: Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes. World Neurosurg 76:14114863–66 2011

  • 27

    Neetu SSunil KAshish AJayantee KUsha Kant M: Microstructural abnormalities of the trigeminal nerve by diffusion-tensor imaging in trigeminal neuralgia without neurovascular compression. Neuroradiol J 29:13182016

  • 28

    Oppenheim CRodrigo SPoupon CDumas de la Roque ANaggara OMeder JF: [Diffusion tensor MR imaging of the brain. Clinical applications.] J Radiol 85:2872962004 (Fr)

  • 29

    Paterno’ VFahlbusch R: High-field iMRI in transsphenoidal pituitary adenoma surgery with special respect to typical localization of residual tumor. Acta Neurochir (Wien) 156:4634742014

  • 30

    Rollins NK: Clinical applications of diffusion tensor imaging and tractography in children. Pediatr Radiol 37:7697802007

  • 31

    Salmela MBCauley KAAndrews TGonyea JVTarasiewicz IFilippi CG: Magnetic resonance diffusion tensor imaging of the optic nerves to guide treatment of pediatric suprasellar tumors. Pediatr Neurosurg 45:4674712009

  • 32

    Sato YIto KOgasawara KSasaki MKudo KMurakami T: Postoperative increase in cerebral white matter fractional anisotropy on diffusion tensor magnetic resonance imaging is associated with cognitive improvement after uncomplicated carotid endarterectomy: tract-based spatial statistics analysis. Neurosurgery 73:5925992013

  • 33

    Smith KJBlakemore WFMcDonald WI: The restoration of conduction by central remyelination. Brain 104:3834041981

  • 34

    Sundgren PCDong QGómez-Hassan DMukherji SKMaly PWelsh R: Diffusion tensor imaging of the brain: review of clinical applications. Neuroradiology 46:3393502004

  • 35

    Turken AWhitfield-Gabrieli SBammer RBaldo JVDronkers NFGabrieli JD: Cognitive processing speed and the structure of white matter pathways: convergent evidence from normal variation and lesion studies. Neuroimage 42:103210442008

  • 36

    Ung NMathur MChung LKCremer NPelargos PFrew A: A systematic analysis of the reliability of diffusion tensor imaging tractography for facial nerve imaging in patients with vestibular schwannoma. J Neurol Surg B Skull Base 77:3143182016

  • 37

    Vedantam AEckardt GWang MCSchmit BDKurpad SN: Clinical correlates of high cervical fractional anisotropy in acute cervical spinal cord injury. World Neurosurg 83:8248282015

  • 38

    Vitaz TWInkabi KECarrubba CJ: Intraoperative MRI for transphenoidal procedures: short-term outcome for 100 consecutive cases. Clin Neurol Neurosurg 113:7317352011

  • 39

    Wheeler-Kingshott CATrip SASymms MRParker GJBarker GJMiller DH: In vivo diffusion tensor imaging of the human optic nerve: pilot study in normal controls. Magn Reson Med 56:4464512006




All Time Past Year Past 30 Days
Abstract Views 98 98 4
Full Text Views 141 141 2
PDF Downloads 172 172 1
EPUB Downloads 0 0 0


Google Scholar