Factors affecting the prognosis of visual acuity and visual fields in pituitary adenoma patients treated with endonasal endoscopic transsphenoidal surgery

Abstract

PurposeThe objective of this study was to evaluate visual acuity (VA) and visual fields (VF) quantitatively before and after endonasal endoscopic transsphenoidal surgery (EETS), with special attention to the prognostic factors such as the tumors’ suprasellar dimension (SSD) and volume.MethodsA total of forty‐seven patients with pituitary adenomas operated by EETS were retrospectively evaluated. VA, VF and visual impairment score (VIS) calculated from VA and VFs were determined pre‐ and postoperatively. Tumors’ SSD and chiasmal contact were evaluated and correlation of tumor volume and SSD with pre‐ and postoperative visual function (VA, VF and VIS) was assessed.ResultsVA improved in 42% of eyes (n = 21) after EETS and 79% (n = 38) had normal VA postoperatively. Postoperative recovery in VF was observed in 86.5% (n = 32) eyes with VF defect. Mean VIS change was 11.6 (95% CI 7.3–16.0) and it improved in 96.0% of the patients (n = 24) with preoperative visual impairment. The mean SSD in patients with VF defect (n = 20) was 16.3 mm (95% CI 13.2–19.3) and in patients with no VF defects (n = 23) 7.5 mm (95% CI 5.9–9.2) (p < 0.001). A cut‐off value of 10 mm for visual perturbations was determined for SSD and 5.1 ml for tumor volume (p < 0.001 for both). A significant correlation between the tumor's SSD and volume with pre‐ and postoperative visual function was found.ConclusionsThe visual outcome after EETS for pituitary adenomas was excellent and significant complications were rare. The size (suprasellar dimension and volume) of pituitary adenoma was the most important predictor of visual outcome after EETS.