The Visual Outcome of Pituitary Macroadenoma After Surgery: 5-year-experience
Keywords:
Pituitary macroadenoma, visual outcome, predictive factors of visual recoveryAbstract
Background: Pituitary adenoma reported an overall prevalence 10-17% of brain tumors. The most common presentation of pituitary macroadenoma is visual impairment by tumor compressed to optic chiasm. The standard treatment of pituitary macroadenoma is surgery for optic chiasm decompression in order to improve visual function.
Objective: We aimed to study the visual outcome of patients with pituitary macroadenoma after surgery and the predictive factors of visual recovery.
Methods: This retrospective study included patients with pituitary tumors larger than 1 centimeter who underwent surgery from 2017 to 2020. Data were collected from medical records.
Results: Of the 100 patients included in the study, 82% present with visual disturbances. Transsphenoidal surgery was performed in 88% of patients. After surgery, 78% of patients showed overall visual improvement. Factors affecting visual outcomes after surgery included preoperative visual impairment (VIS level 3) and invasive pituitary features, which were associated with poor postoperative visual function (P = 0.01 and P = 0.03, respectively). Patients who underwent surgery using the transsphenoidal approach had a significantly higher overall visual function improvement rate of 89.7% (P = 0.02).
Conclusions: Patients with pituitary macroadenoma commonly presentation with visual but most patients show improvement in visual function after surgical treatment. Factors affecting visual function after surgery include the patient’s preoperative vision acuity, the presence of invasive pituitary features, and the surgical approach used (specifically, the transsphenoidal approach)
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Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery. 2005;56(6):1222–33.
Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas A systematic review. Cancer. 2004;101(3):613–9.
Garibi J, Pomposo I, Villar G, Gaztambide S. Giant pituitary adenomas: clinical characteristics and surgical results. Br J Neurosurg. 2002;16(2):133–9.
Lampropoulos KI, Samonis G, Nomikos P. Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: A study on 184 patients. Hormones. 2013;12(2):254–64.
Hudson H, Rissell C, Gauderman WJ, Feldon SE. Pituitary tumor volume as a predictor of postoperative visual field recovery. Quantitative analysis using automated static perimetry and computed tomography morphometry. J Clin Neuroopthalmol 1991;11:280-3.
Shults WT. Compressive optic neuropathies. In: Miller NR, Newman NJ, editors. Walsh and Hoyt’s Clinical Neuro-Ophthalmology. 5th ed. Baltimore: Williams and Wilkins; 1998. p. 657-8.
Dutta P, Gyurmey T, Bansal R, Pathak A, Dhandapani S, Rai A, et al. Visual outcome in 2000 eyes following microscopic transsphenoidal surgery for pituitary adenomas: Protracted blindness should not be a deterrent. Neurol India. 2016;64(6):1247-53.
Outcome of Patients with Pituitary Adenomas Following Surgery and Its Contributory Factors at a Tertiary Hospital in Ghana. Ethiop J Health Sci. 2019;29(1):895-902.
Lee J, Kim SW, Kim DW, Shin JY, Choi M, Oh MC, et al. Predictive model for recovery of visual field after surgery of pituitary adenoma. Journal of neurooncology. 2016;130(1):155-64.
Thotakura AK, Patibandla MR, Panigrahi MK, Addagada GC. 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. Asian J Neurosurg. 2017;12(1):1-5.
Moussa G, Bassilious K, Mathews N. A novel excel sheet conversion tool from Snellen fraction to LogMAR including “counting fingers”, “hand movement”, “light perception” and “no light perception” and focused review of literature of low visual acuity reference values. Acta Ophthalmologica. 2020;(12):963-65
International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)- WHO Version for 2016. Retrieved from http://apps.who.int/classifications/icd10/browse/2016/en#/H54
Muskens IS, Zamanipoor Najafabadi AH, Briceno V, Lamba N, Senders JT, van Furth WR, et al. Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis. Pituitary. 2017;20(5):539–52.
Wang MTM, King J, Symons RCA, Stylli SS, Daniell MD, Savino PJ, et al. Temporal patterns of visual recovery following pituitary tumor resection: A prospective cohort study. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia [Internet]. 2021;86:252–9.
Luomaranta T, Raappana A, Saarela V, Liinamaa MJ. Factors Affecting the Visual Outcome of Pituitary Adenoma Patients Treated with Endoscopic Transsphenoidal Surgery. World Neurosurgery. 2017;105:422–31.
Fredes F, Undurraga G, Rojas P, Constanzo F, Lazcano C, Pinto J, et al. Visual Outcomes after Endoscopic Pituitary Surgery in Patients Presenting with Preoperative Visual Deficits. Journal of Neurological Surgery Part B, Skull Base [Internet]. 2017;78(6):461–5.
Lee DK, Sung MS, Park SW. Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma. Korean Journal of Ophthalmology : KJO [Internet]. 2018;32(6):488–96.
Butenschoen VM, Schwendinger N, von Werder A, Bette S, Wienke M, Meyer B, et al. Visual acuity and its postoperative outcome after transsphenoidal adenoma resection. Neurosurgical Review [Internet]. 2021;44(4):2245–51.
Chung YS, Na M, Yoo J, Kim W, Jung IH, Moon JH, et al. Optical Coherent Tomography Predicts Long Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study. Neurosurgery [Internet]. 2020;88(1):106–12.
Gnanalingham KK. The time course of visual field recovery following transsphenoidal surgery for pituitary adenomas: predictive factors for a good outcome. Journal of Neurology, Neurosurgery & Psychiatry. 2005;76(3):415–9.
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