Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of i
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Quality of care evaluation in non‑functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study Iris C. M. Pelsma1,4 · Marco J. T. Verstegen2,4 · Friso de Vries1,4 · Irene C. Notting3,4 · Marike L. D. Broekman2,5 · Wouter R. van Furth2,4 · Nienke R. Biermasz1,4 · Alberto M. Pereira1,4
© The Author(s) 2020
Abstract Purpose Surgery in patients with non-functioning pituitary macroadenomas (NFMA) is effective in ameliorating visual function. The urgency for decompression, and preferred timing of surgery related to the preoperative severity of dysfunction is unknown. Methods Systematic review for evidence to provide clinical guidance for timing of surgical decompression of the optic chiasm, and a cohort study of 30 NFMA patients, in whom mean deviation (MD), and severity of visual dysfunction was assessed. Results Systematic review 44 studies were included with a total of 4789 patients. Postoperatively, visual field defects improved in 87.0% of patients, stabilized in 12.8% and worsened in 1.0%. Specific protocols regarding timing of surgery were not reported. Only seven studies (16.7%) reported on either the duration of visual symptoms, or diagnostic, or treatment delay. Cohort study 30 NFMA patients (50% female, 60 eyes, mean age 58.5 ± 14.8 years), had a median MD of − 5.3 decibel (IQR − 3.1 to − 10.1). MD was strongly correlated with clinical severity (r = − 0.94, P − 2 dB, (2) mild − 2 dB to − 4 dB, (3) moderate − 4 to − 8 dB, (4) severe − 8 to − 17 dB, (5) very severe 39.7%). Of the QAT, three items were most important for the quality of this review: reported timing of surgery, pre-operative visual function tests, and postoperative visual function tests. Timing of surgery scores were low, as solely three studies reported this factor (subscores ranging from 1 to 3). Prior and post treatment evaluation of VF and VA As depicted in Supplementary Fig. 2a, preoperative VFDs were reported in 69.0% (median, IQR 62.5–93.0%) of 2305 patients (48.1% of included population) in 27 studies (61.4%) [7, 15, 16, 18, 19, 21, 23–31, 34–36, 38, 40, 41, 43, 45, 48–50, 53, 55]. Severity of preoperative VFDs was reported in 9 studies (20.5%) only, which are shown in Table 2 [18, 19, 24–26, 34, 35, 48, 55]. Pre- and postoperative VFDs were reported for 1,300 NFMA patients (27.1% of included population), of which 72.0% (median, IQR 65.8–92.5%) of patients were reported to have preoperative VFD, in 16 articles (36.4% of included studies) (Supplementary Fig. 2b) [15, 16, 18, 19, 21, 24, 26, 27, 29, 31, 40, 41, 43, 49, 50, 55]. Postoperatively, VFDs were recorded as improved in 87.0% of patients (median, IQR 73.8–92.3%), stabilized in 12.8% (median, IQR 1.5–17.0%) and, worsened
General study and patient characteristics Studies
Number included studies Study design
Patients
Publication dates Study period Number included patients Patients per study Age (years)a Male patientsb Surgical approach
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