Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
World Neurosurg. 2019 Dec;132:e722-e731. doi: 10.1016/j.wneu.2019.08.031. Epub 2019 Aug 14.
Prediction of visual outcome after endoscopic endonasal tumor resection still remains a challenge. We investigated the prognostic value of the preoperative peripapillary retinal nerve fiber layer (pRNFL) using optical coherence tomography for visual outcome after endoscopic endonasal surgery (EES) for suprasellar tumors.
We retrospectively analyzed 122 patients who underwent EES for sellar and suprasellar tumors between January 2016 and January 2018. We retrospectively analyzed the pre- and postoperative relationship between pRNFL thickness and visual outcome based on visual acuity (visual acuity score) and visual field (mean deviation [MD]).
Preoperatively, 216 eyes (mean global pRNFL thickness, 94.3 ± 12.4 μm; 88.5%) were included in the normal pRNFL group (≥70 μm) and 28 eyes (mean global pRNFL thickness, 54.3 ± 11.0 μm; 11.5%) were included in the thin pRNFL group (<70 μm). There was a very strong correlation between pre- and postoperative pRNFL thickness (r = 0.930). The thin pRNFL group showed a stronger correlation between pre- and postoperative MDs than the normal pRNFL group (r = 0.619 and r = 0.420, respectively; P < 0.01). Multivariate analyses identified pRNFL thickness as the only significant predictor of postoperative visual acuity (odds ratio [OR], 25.02; 95% confidence interval [CI], 7.68-81.50; P < 0.01) and visual field (OR, 39.46; 95% CI, 10.39-149.83; P < 0.01).
Preoperative pRNFL thickness plays a prognostic value in postoperative visual outcome after EES for sellar and suprasellar tumors. Patients with pRNFL thickness ≥70 μm before surgery are more likely to improve visual outcome than those with thickness <70 μm.
内镜经鼻肿瘤切除术的视觉预后预测仍然是一个挑战。我们研究了术前视乳头周围视网膜神经纤维层（pRNFL）的预测价值，使用光学相干断层扫描（OCT）评估内镜经鼻手术（EES）治疗鞍上和鞍旁肿瘤的视觉预后。
我们回顾性分析了 2016 年 1 月至 2018 年 1 月期间接受 EES 治疗的 122 例鞍区和鞍旁肿瘤患者。我们根据视力（视力评分）和视野（平均偏差 [MD]）分析了术前和术后 pRNFL 厚度与视觉预后之间的关系。
术前，216 只眼（平均 pRNFL 厚度 94.3 ± 12.4 μm；88.5%）纳入正常 pRNFL 组（≥70 μm），28 只眼（平均 pRNFL 厚度 54.3 ± 11.0 μm；11.5%）纳入薄 pRNFL 组（<70 μm）。术前和术后 pRNFL 厚度之间存在很强的相关性（r=0.930）。薄 pRNFL 组术前和术后 MD 之间的相关性强于正常 pRNFL 组（r=0.619 和 r=0.420；P<0.01）。多因素分析确定 pRNFL 厚度是术后视力（优势比 [OR]，25.02；95%置信区间 [CI]，7.68-81.50；P<0.01）和视野（OR，39.46；95% CI，10.39-149.83；P<0.01）的唯一显著预测因素。
术前 pRNFL 厚度在 EES 治疗鞍上和鞍旁肿瘤的术后视觉预后中具有预测价值。术前 pRNFL 厚度≥70 μm 的患者比厚度<70 μm 的患者更有可能改善视力预后。
