Title

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Pretreatment Ophthalmology Evaluation in Patients With Suspected Nonfunctioning Pituitary Adenomas.

Department

Neurosurgery

Document Type

Article

Abstract

BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. Visual symptoms from NFPAs are common and include visual field defects, loss of central vision, and motility problems resulting in diplopia.

OBJECTIVE: To create evidence-based guidelines in an attempt to formulate guidance for preoperative ophthalmologic evaluation of NFPA patients.

METHODS: An extensive literature search was performed. Only clinical articles describing preoperative ophthalmologic evaluation of adult patients with NFPA were included. To ascertain the class of evidence for the posttreatment follow-up, the authors used the Clinical Assessment evidence-based classification.

RESULTS: Six studies met the inclusion criteria with respect to the questions regarding the preoperative ophthalmologic evaluation of NFPA patients. Based on the studies located through the search, the authors formulated evidence-based recommendations as they pertain to the necessity of ophthalmologic evaluation before surgical treatment.

CONCLUSION: Preoperative ophthalmologic evaluation is recommended. Such evaluation can provide prognostic factors for recovery and, when paired with postoperative evaluation, documents postoperative change. In addition to formal ophthalmologic examination, tests of value include automated static perimetry and optical coherence tomography. Older patients and patients with longer duration (>4 months) of vision loss should be counseled regarding the reduced chance of postoperative vision improvement. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_4.

ABBREVIATIONS: NFPA, nonfunctioning pituitary adenomaOCT, optical coherence tomography.

Medical Subject Headings

Adenoma; Adult; Aged; Evidence-Based Medicine; Humans; Male; Middle Aged; Ophthalmology; Pituitary Neoplasms; Vision Disorders; Vision Tests

Publication Date

10-1-2016

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

79

Issue

4

First Page

530

Last Page

532

PubMed ID

27635960

Digital Object Identifier (DOI)

10.1227/NEU.0000000000001388

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