Factors Affecting the Visual Outcome of Pituitary Adenoma Patients Treated with Endoscopic Transsphenoidal Surgery.

Factors Affecting the Visual Outcome of Pituitary Adenoma Patients Treated with Endoscopic Transsphenoidal Surgery.

World Neurosurg. 2017 Jun 02;:

Authors: Luomaranta T, Raappana A, Saarela V, Liinamaa MJ

Abstract
OBJECTIVE: To evaluate visual acuity (VA) and visual fields (VF) quantitatively before and after endoscopic transsphenoidal surgery (ETS), with special attention to prognostic factors such as the pituitary adenomas' (PAs') suprasellar extension (SSE), volume and the patients' age.
METHODS: Medical records of 47 PA patients operated with ETS were evaluated. VA, VF and visual impairment score (VIS) were determined pre- (VISpre) and postoperatively (VISpost). The PA's SSE, volume and chiasmal contact and their correlation with visual function was pre- and postoperatively assessed.
RESULTS: The final cohort included 47 patients. VA improved in 54/76 eyes (71.0 %) after ETS and 69/76 eyes (90.7 %) gained normal VA. Postoperative VF recovery occurred in 32/37 (86.5 %) of the eyes. The mean VISchange was 12.0 (95% CI 7.7-16.3) and improved in all patients with tumor-related visual impairment (n=25). However, visual outcome was poorer when VISpre>40. When VISpre was 21-40, age linearly correlated with VIS improvement (p=0.03); younger patients had satisfactory and older poorer visual outcome. The mean SSE in patients with VF defects (n=20) was 16.6 mm (95% CI 13.3-19.9) and in patients with no VF defects (n=23) 6.6 mm (95% CI 4.9-8.3, p<0.001) and cut-off value for visual perturbations was 9.5 mm for SSE and 8.6 ml for PA volume (p<0.001 for both).
CONCLUSIONS: The visual outcome after ETS for PAs was excellent and significant complications rare. Severe preoperative visual impairment resulted poorer postoperative visual outcome. The SSE of PA was the most important predictor of visual outcome after ETS.

PMID: 28583452 [PubMed - as supplied by publisher]

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