Predictors of visual outcome with transsphenoidal excision of pituitary adenomas having suprasellar extension: A prospective series of 100 cases and brief review of the literature

Abstract

Objective:The aim was to assess the factors influencing the visual outcome following trans-sphenoidal excision of pituitary adenomas.Materials and Methods:One hundred consecutive patients of pituitary adenomas with suprasellar extension (SSE) were operated by trans-sphenoidal approach from July 2003 to December 2006. There were 52 male and 48 female patients with a mean age of 42.47 years. The visual impairment score, which was used to evaluate the visual outcome was produced by adding the scores for visual acuity and visual field defects of each patient (from the tables of the German Ophthalmological Society). The mean diameter, the SSE and the parasellar extension of the lesion were noted in the magnetic resonance imaging study. The average follow-up was 43.5 months.Results:The mean diameter of the tumor was 32.97 mm, and the mean SSE was 14.95 mm. The parasellar extension was present in 27 patients. The vision improved in 61 of the 71 patients (85.91%). The shorter the duration of visual symptoms and smaller the size of the lesion resulted in better visual outcome. The age and the preoperative visual impairment did not show any correlation with the visual outcome.Conclusions:Patients with visual symptoms of <1-year duration (P < 0.01) and adenomas of <36.5 mm diameter (P < 0.009) have better visual outcome.

ICAR: endoscopic skull‐base surgery

“…Longer duration of VF deficits correlate with worse visual outcomes . Thotakura et al . found that patients with long‐lasting (≥1 year) preoperative visual symptoms showed significantly worse visual outcomes after resection.…”

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

“…Although existing literature suggests SSE to be predictive of VFD at presentation, most studies also indicate greater tumor size, frequently accompanied by SSE, to be associated with less postoperative improvement. 7,8,31,32,[36][37][38] The contrary can be seen in this study, where a higher Fujimoto grade was associated with a greater odds of postoperative VFD improvement. This inconsistency might come from differences in study population with some of these studies having a larger tumors, 31 a lower percentage of NFPA, 32 a higher percentage of preoperative VFD, 8 or a lower percentage of postoperative improvement.…”

“…6,30 It has also been demonstrated that larger tumors are more likely to cause visual deficits, which is in line with our findings. 8,31,32 One study found SSE greater than 9.5 mm to be associated with visual dysfunction which indicates that this association between tumor size and VFD is especially strong among tumors growing in a craniocaudal direction. 7 In our cohort, a similar trend was seen with higher Fujimoto grade independently being associated with an increased likelihood of VFD at presentation.…”

Pituitary adenomas

“…Timely intervention can result in improvement in vision within hours of waking from trans-sphenoidal surgery such that patients are able to read and drive where previously limited. A meta-analysis of visual outcomes after pituitary surgery found that complete recovery was probably less likely if the pre-operative visual defect was severe and of longer duration,14 with one study finding worse outcomes if the visual field deficit had been present for more than a year 15. Visual field defects caused by a macroprolactinoma can also improve rapidly with dopamine agonist therapy 1617…”