Recovery of Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Adenoma and Meningioma Patients

Li-Pei J Lu; Iris C M Pelsma; Friso de Vries; Saskia P A van Hulst-Ginjaar; Wouter R van Furth; Marco J T Verstegen; Fleur L Fisher; Amir H Zamanipoor Najafadabadi; Nienke R Biermasz; Stijn W van der Meeren; Irene C Notting

doi:10.1097/WNO.0000000000001990

Recovery of Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Adenoma and Meningioma Patients

J Neuroophthalmol. 2023 Sep 4. doi: 10.1097/WNO.0000000000001990. Online ahead of print.

Authors

Li-Pei J Lu¹, Iris C M Pelsma, Friso de Vries, Saskia P A van Hulst-Ginjaar, Wouter R van Furth, Marco J T Verstegen, Fleur L Fisher, Amir H Zamanipoor Najafadabadi, Nienke R Biermasz, Stijn W van der Meeren, Irene C Notting

Affiliation

¹ Departments of Ophthalmology (L-PJL, SPAvH-G, AHZN, SWvdM, ICN), and Neurosurgery (WRvF, MJTV, FLF, AHZN), and Division of Endocrinology and Metabolism (ICMP, FdV, WRvF, MJTV, AHZN, NRB, SWvdM, ICN), and Department of Medicine, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, the Netherlands; and Department of Ophthalmology (SWvdM), Amsterdam University Medical Center, Amsterdam, the Netherlands.

PMID: 37669254
DOI: 10.1097/WNO.0000000000001990

Abstract

Background: This retrospective, observational cohort study aimed to determine recovery rate and recovery time of ocular motor nerve palsies (OMP) of third (CN III), fourth (CN IV), or sixth cranial nerves (CN VI)-and associated prognostic factors-in meningioma and pituitary adenoma (PA) patients.

Methods: A total of 25 meningioma (28 eyes) and 33 PA patients (36 eyes), treated at the Leiden University Medical Center in the Netherlands from January 1, 1978 to January 31, 2021, were included. OMPs were evaluated according to a newly created recovery scale using on-clinical and orthoptic examinations, which were performed every 3-4 months until palsy recovery, or at 18 months follow-up.

Results: Recovery rates of CN III (meningioma 23.5% vs PA 92.3%), CN IV (meningioma 20% vs PA 100%), and CN VI (meningioma 60% vs PA 100%) palsies were observed at 18 months follow-up, with differences between the 2 tumor types being observed in the treated patients only. Median recovery time of all OMPs combined was significantly longer in meningioma patients (37.9 ± 14.3 months vs 3.3 ± 0.1 months; P < 0.001). No significant protective or risk factors for recovery rate or time were identified.

Conclusions: OMP recovery rates in treated patients were more favorable in patients with PA compared with patients with meningiomas, independent of OMP cause. With these new insights in OMP recovery, more accurate prognoses and appropriate follow-up strategies can be determined for meningioma and PA patients with OMPs.