Predictors of visual function recovery in patients with non-traumatic optic neuropathy after surgical treatment

Background. Non-traumatic optic neuropathy is damage of the optic nerve caused by its progressive compression by a tumor or other hyperplastic process which leads to atrophy and constant visual impairment. Therefore, the optic nerve needs to be decompressed but there are no methods of predicting the results of decompression.

Aim. To identify factors affecting dynamics of visual impairment after decompression and their prognostic value.

Materials and methods. The results of surgical treatment of 64 patients with non-traumatic optic neuropathy were analyzed. All patients were examined using visometry, visual filed test, and ophthalmoscopy. Visual field changes were classified per 7 grades of severity. Determination of predictive significance of quantitative variables for favorable surgical results was performed using ROC analysis. The obtained threshold values were used to identify key predictors of favorable outcome and to develop a prognostic model employing multivariable logistic regression.

Results. The most significant predictors of improvement in vision after surgery are severity of visual field change and visual acuity prior to surgery. These characteristics gave prognostic accuracy of more than 80 % independently of other factors. The least significant characteristic for predicting visual improvement was duration of anamnesis. The final regression model included 3 predictors: duration of visual impairment less than 12 months (3 points), visual acuity >0.1 (4 points), and degree of visual filed change <5 (5 points). For maximal points, calculated probability of improvement in vision is 93.5 %. The model is statistically significant (Wald χ2 test; p <0.001) and complies with factual data (Hosmer–Lemeshow test; p = 0.504). The developed model explains 60.8 % of outcome variability, and accuracy of prognosis is 90.5 %.

Conclusion. Factors affecting dynamics of visual function in patients with compression non-traumatic optic neuropathy after microsurgical decompression of the optic nerve were identified. Identification of these predictors allowed to develop a score for evaluation of probability of vision improvement after surgery.

1. Serova N.K. Differential diagnosis of optic neuropathy in patients with cns diseases and normal tension glaucoma. Oftalmologicheskie vedomosti = Ophthalmology Reports 2019;1(12):73–6. (In Russ.). DOI: 10.17816/OV12173-76

2. Sheremet N.L., Andreeva N.A., Meshkov A.D. et al. Etiological structure of nonglaucomatous optic neuropathies. Sibirskiy nauchnyy meditsinskiy zhurnal = Siberian Scientific Medical Journal 2018;(38):25–31. (In Russ.). DOI: 10.15372/SSMJ20180504

3. Li E., Howard M.A., Vining E.M. et al. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: a systematic review. Orbit 2018;37(4):280–6. DOI: 10.1080/01676830.2017.1423087

4. Unsold R., Seeger W. The Clinical signs and symptoms of optic nerve compression and clinical disease entities masking compressive lesions. In: Compressive optic nerve lesions at the optic canal. Springer-Verlag, 1989. Pp. 15–34.

5. Dandy W.E. Prechiasmal intracranial tumors of the optic nerves. Am J Ophthalmol 1922;5(3):169–88. DOI: 10.1016/S0002-9394(22)90261-2

6. Avetisov E.S. Disbinocular amblyopia and its treatment. Moscow: Meditsina, 1968. 208 p. (In Russ.).

7. Kutin M.A., Serova N.K., Kalinin P.L. et al. New scale of assessment of severity of visual function in patients with craniopharyngioma and other chiasmal-sellar tumors. Vestnik nevrologii, psikhiatrii i neirokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery 2016;12:33–7. (In Russ.).

8. Jaeger W., Thomann H. [German Ophthalmological Association. Recommendations for evaluation of reduced earning capacity caused by damage to vision. September 1981]. Klin Monbl Augenheilkd 1982;3(180):242–4. (In German). DOI: 10.1055/s-2008-1055061

9. Kutin M.A., Kadashev B.A., Kalinin P.L. et al. Transcranial microsurgical decompression of the optic canal in surgical treatment of meningiomas of the sellar region. Voprosy neyrokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2020;84(3):61–73. (In Russ.). DOI: 10.17116/neiro20208403161

10. Lasunin N.V., Cherekaev V.A., Serova N.K. et al. Optic nerve decompression in treatment of neoplasms involving optic canal. Voprosy neyrokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2014;4(78):31–41. (In Russ.).

11. Chen L., Gao M., Zhang H. et al. Effect of optic canal opening on postoperative visual acuity in patients with tuberculum sellae meningiomas. J Neurol Surg A Cent Eur Neurosurg 2024;85(1): 1–6. DOI: 10.1055/a-1768-3553

12. Mahmoud M., Nader R., Al-Mefty O. Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery. Neurosurgery 2010;67(3):108–19. DOI: 10.1227/01.NEU.0000383153.75695.24

13. Sakata K., Komaki S., Takeshige N. et al. Visual outcomes and surgical approach selection focusing on active optic canal decompression and maximum safe resection for suprasellar meningiomas. Neurol Med Chir 2023;63(9):381–92. DOI: 10.2176/jns-nmc.2021-0142

14. Taha A.N., Erkmen K., Dunn I.F. et al. Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique. Neurosurg Focus 2011;30(5):E12. DOI: 10.3171/2011.2.FOCUS 1118

15. Ali A.K., Elayoty A.E.D., Elserry T.H. et al. Visual outcome predictors after surgical excision of meningiomas compressing the optochiasmatic complex. Egyptian Journal of Neurosurgery 2020;35(1):1–6. DOI: 10.1186/s41984-020-00088-5

16. Duan C., Song D., Wang F. et al. Factors influencing postoperative visual improvement in 208 patients with tuberculum sellae meningiomas. Acta Neurochir 2024;166(1):140. DOI: 10.1007/s00701-024-06033-x

17. Fahlbusch R. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 2002;96(2):235–43. DOI: 10.3171/jns.2002.96.2.0235

18. Pamir M.N., Özduman K., Belirgen M. et al. Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Acta Neurochir 2005;147(11):1121–30. DOI: 10.1007/s00701-005-0625-0

19. Rosenstein J., Lindsay S. Surgical management of suprasellar meningioma. Part 2: prognosis for visual function following craniotomy. J Neurosurg 1984;61(4):642–8. DOI: 10.3171/jns.1984.61.4.0642

20. Schick U. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 2005;76(7):977–83. DOI: 10.1136/jnnp.2004.039974

21. Wang C.W., Li Y.Y., Zhu S.G. et al. Surgical management and evaluation of prognostic factors influencing postoperative visual outcome of suprasellar meningiomas. World Neurosurg 2011;75(2):294–302. DOI: 10.1016/j.wneu.2010.08.021

22. Zevgaridis D., Medele R.J., Muller A. et al. Meningiomas of the sellar region presenting with visual impairment: impact of various prognostic factors on surgical outcome in 62 patients. Acta Neurochir 2001;143(5):471–6. DOI: 10.1007/s007010170076

23. Andrews B.T., Wilson C.B. Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome. J Neurosurg 1988;69(4):523–8. DOI: 10.3171/jns.1988.69.4.0523

24. Galal A., Faisal A., Al-Werdany M. et al. Determinants of postoperative visual recovery in suprasellar meningiomas. Acta Neurochir 2010;152(1):69–77. DOI: 10.1007/s00701-009-0492-1

25. Nakamura M., Roser F., Jacobs C. et al. Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery 2006;58(4):626–39. DOI: 10.1227/01.NEU.0000197104.78684.5D

26. Baucher G., Troude L., Roux A. et al. Predictors of visual function after resection of skull base meningiomas with extradural anterior clinoidectomy. Neurosurg Rev 2022;45(3):2133–49. DOI: 10.1007/s10143-021-01716-w

27. Chaichana K., Jackson C., Patel A. et al. Predictors of visual outcome following surgical resection of medial sphenoid wing meningiomas. J Neurol Surg B Skull Base 2012;73(5):321–6. DOI: 10.1055/s-0032-1321510

28. Cristante L. Surgical treatment of meningiomas of the orbit and optic canal: a retrospective study with particular attention to the visual outcome. Acta Neurochir 1994;126(1):27–32. DOI: 10.1007/BF01476490

29. Goel A., Muzumdar D., Desai K.I. Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 2002;51(6):1358–63.

30. Lehmberg J., Krieg S.M., Mueller B., Meyer B. Impact of anterior clinoidectomy on visual function after resection of meningiomas in and around the optic canal. Acta Neurochir 2013;155(7):1293–9. DOI: 10.1007/s00701-013-1741-x

31. Margalit N., Kesler A., Ezer H. et al. Tuberculum and diaphragma sella meningioma – surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period. Acta Neurochir 2007;149(12):1199–204. DOI: 10.1007/s00701-007-1280-4

32. Margalit N.S., Lesser J.B., Moche J. et al. Meningiomas involving the optic nerve: technical aspects and outcomes for a series of 50 patients. Neurosurgery 2003;53(3):523–33. DOI: 10.1227/01.neu.0000079506.75164.f4

33. Mortini P., Barzaghi L.R., Serra C. et al. Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin Neurol Neurosurg 2012;114(6):597–606. DOI: 10.1016/j.clineuro.2011.12.021

34. Zamanipoor Najafabadi A.H., Genders S.W., Van Furth W.R. Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis. Acta Neurochir 2021;163(1):73–82. DOI: 10.1007/s00701-020-04554-9

35. Bove I., Solari D., Colangelo M. et al. Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach. J Neurosurg 2023;140(3):696–704. DOI: 10.3171/2023.7.JNS23437

36. Snell A., Sterling S. The percentage evaluation of macular vision. Trans Am Ophthalmol Soc 1925;23:204–27.

37. Hughes M.A., Ho J.W., Keenlyside A. et al. The digital Cullen chart: a red colour perimetry aid for visual field examination. Br J Neurosurg 2024;38(6):1470–4. DOI: 10.1080/02688697.2021.2014782