Changes in the Visual Field associated with Cranio-caudal Diameter of Pituitary Macro adenoma

Abstract

Background: Pituitary macro adenomas are benign in origin, mass effects of which, may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The visual disturbance in pituitary macro adenomas range from dimness of vision to bilateral total loss of vision. Visual field defect is one of the common presentations of pituitary macro adenomas. They usually results in bitemporal hemianopia by causing compression on optic chiasm. Our main objective of this study was to evaluate the changes of visual field in relation with cranio-caudal diameter of pituitary macro adenoma. Methods and Materials: This cross-sectional, observational study was carried out at Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from April, 2019 to September, 2020. Thirty six patients with pituitary macro adenomas underwent visual field analysis using Humphrey Field Analyzer30-2 program at Bangabandhu Sheikh Mujib Medical University. Correlation betweenmean deviation of visual field with craniocaudal diameter of pituitary macroadenomas, volume of tumor, duration of sypmtoms were observed. Results: This study was conducted on 67 eyes of 36 patients including 22 male and 14 female subjects with mean age of 39.00 years and histologically proven pituitary adenoma. Mean cranio-caudal diameter was 31.72 mm. Highest number of patients had cranio-caudal diameter of 32-41 mm with mean deviation of -12.95 dB and -12.24dB in right and left eye respectively. Regarding correlation of mean deviation of visual field with cranio-caudal diameter of pituitary macro adenoma, Pearson correlation showed that r value was -0.358(p-value0.044) in right eye and -0.527(p-value 0.012) in left eye. Conclusion: When pituitary macro adenomas grow in vertical direction it results in deterioration of visual field by compressing optic chiasma. The present study ascertains that there is significant correlation between the cranio-caudal diameter of pituitary macro adenoma and deviation visual field.