Evaluation of the Transcranial Approach to Pituitary Adenomas Based on Quantitative Analysis of Pre and Postoperative Visual Function

Abstract

Over a 16-year period, 105 patients with pituitary adenoma accompanied by visual disturbance under went transcranial intracapsular removal of the tumor followed by radiotherapy. Postoperative recov ery of visual function in these patients was compared with the results obtained in other institutions after trans-sphenoidal surgery. The severity of preoperative visual impairment was correlated with the duration of visual impairment, the degree of optic atrophy, the extent of suprasellar tumor infil tration, and age. Trans-sphenoidal surgery appears more effective in patients with mild preoperative visual disturbance, whereas the transcranial approach yields better results in patients with moderate to severe preoperative visual deficits.

Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method

“…Many preoperative factors have been advocated to influence the postoperative visual outcome. Young age, short preoperative duration of symptoms, small field loss and good acuity were the prognostic factors reported in the literature as associated to a better postoperative visual outcome [5,19,23,24]. Suzukawa [24] reported the optic atrophy and a high degree of suprasellar extension as negative prognostic factors, but this study included pituitary adenomas operated trough transcranial approach.…”

“…Young age, short preoperative duration of symptoms, small field loss and good acuity were the prognostic factors reported in the literature as associated to a better postoperative visual outcome [5,19,23,24]. Suzukawa [24] reported the optic atrophy and a high degree of suprasellar extension as negative prognostic factors, but this study included pituitary adenomas operated trough transcranial approach. A recent study, based on quantitative analysis of the visual field defect, reports that the recovery of the visual field is associated with a shorter duration of symptoms and a smaller preoperative defect in the visual acuity and field.…”

Optical coherence tomography predicts visual outcome for pituitary tumors

“…Since then, investigators have attempted to identify pre-operative characteristics that may predict recovery. Variables such as age, duration of symptoms, tumour size and volume, pre-operative visual acuity (VA) or visual field (VF) loss, optic atrophy and pattern electroretinogram have been explored but none has been able to consistently predict visual recovery following surgery [3][4][5][6][7][8][9][10][11][12][13][14][15]. Such predictors of visual outcome would be helpful to allow counseling of patients in relation to their ultimate likely visual function as well as tailoring of management strategies regarding the timing of surgery.…”

Optic nerve potentials and cortical potentials after stimulation of the anterior visual pathway during neurosurgery

“…The most likely mechanism is direct manipulative and thermal damage during microsurgery while vasospasm may also play a role [1]. Recent series of patients after neurosurgery for central skull base meningiomas show up to 24% incidence of unfavorable visual outcome [1][2][3][4][5][6][7][8][9][10][11][12][13], while the risk is insignificantly lower for nonmeningiomatous pathology [1,13,14].…”