The authors present a retrospective cohort study with the aim of comparing recovery rate and time of ocular motor cranial nerve palsies (CNP) caused by pituitary adenoma or meningioma. Cases were identified from a single tertiary referral centre over a 43-year period. Adults with tumour or surgery induced ocular motor CNP (3rd, 4th or 6th) were included. Cases were excluded for incomplete ophthalmology/orthoptic reports, previous history of diplopia, strabismus surgery or mechanical restriction and other systemic diseases causing CNP. All cases were followed up until recovery or beyond 18 months. Demographics, tumour details, ophthalmologic and orthoptic assessments were extracted from the medical records. A recovery scale was developed which factored in the following elements: deviation and movement assessment, duction restrictions, restrictions on Hess chart and diplopia. The scale has 5 categories: complete recovery, clinically relevant recovery (objective restrictions without symptoms impacting daily life), partial recovery, no change and deterioration. A total of 58 individuals (64 eyes) met the inclusion criteria, of which 25 were diagnosed with meningioma and 33 were diagnosed with pituitary adenoma. Demographic information is presented separately for the 2 tumour types. The significant differences found between the groups were a higher proportion of females in the meningioma group and a higher proportion of the pituitary adenoma group had received surgical intervention for their tumour and the CNP aetiology was tumour related. A total of 102 CNPs were diagnosed, with recovery observed in 76.5%. Complete recovery was more common in pituitary adenoma (54.8% vs 7.5%), and recovery time for CNP caused by meningioma was found to take significantly longer (37.9 vs 3.3 months). Recovery rates across the different types of CNP regardless of aetiology was highest in 6th CNP (84.1%) and lowest in third CNP (65.1%). No significant difference in time to recovery was found. There was no significant difference in recovery rates for CNP as a direct result of the tumour versus as a result of surgery. No prognostic factors for recovery were found to be significant. This study provides important information regarding prognosis to better information patients and plan follow-up strategies.
Prognosis of ocular motor cranial nerve palsies caused by pituitary adenoma and meningioma
Reviewed by Lauren Hepworth
Recovery of third, 4th and 6th cranial nerve palsies in pituitary adenoma and meningioma patients.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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