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

Abstract

Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes. Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al. Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively (p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort (p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD (p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04). Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.

Multidisciplinary Team Care in Pituitary Tumours

“…A complete neuro-ophthalmological examination may help predict the likelihood of visual acuity and visual field deficit improvement, which may occur in 68% and 81% of patients undergoing pituitary tumour resection [ 86 ]. Such examination is often useful in establishing the need and urgency of the operation in patients with large tumours, as well as to assess visual outcomes after surgery [ 42 , 87 , 88 ]. Moreover, a careful examination may identify other causes of visual impairment, such as cataracts, preventing unnecessary pituitary operations or superfluous cataract surgeries [ 89 ].…”

Visual field improvement after endoscopic transsphenoidal surgery in patients with pituitary adenoma

“…In addition, previous studies have focused on the factors influencing postoperative visual field recovery, including the duration of symptoms, the preoperative mean defect (MD), age, retinal nerve fiber layer (RNFL) thickness, tumor volume, suprasellar tumor extension, and expression levels of vascular endothelial growth factor (VEGF)/Ki-67 ( 12 – 15 ).…”