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

Abstract

The objective of the study was to evaluate the preoperative visual field defect, the postoperative outcome and the possible prognostic factors in patients with pituitary macroadenoma, using a quantitative method (the mean deviation = MD), and to review the literature. A total of 73 patients, operated trough trans-sphenoidal approach, were selected, and data in single eyes were analysed by calculating the frequency and the degree of postoperative improvement (relative improvement). The visual field defect improved in 95.7% of eyes: The recovery was complete in 48.9% and partial in 46.8%. Multivariate logistic regression showed that factors, independently predictive for complete recovery, were as follows: low preoperative MD absolute value (p = 0.008), low cranio-caudal diameter of tumour (p = 0.02) and young age (p = 0.0001). The mean relative improvement in visual field defect (dMD%) was correlated with the preoperative visual acuity (p = 0.0001) and inversely related with the preoperative MD (p = 0.007) and the age (p = 0.017). The relative improvement was higher in tumours with a smaller cranio-caudal diameter (p = 0.0185). In conclusion, using a quantitative method, we can measure the degree of the postoperative visual field defect improvement. Predictive factors for a complete recovery were good preoperative visual function, young age and low cranio-caudal tumour.

Prediction of Postoperative Visual Field Size from Preoperative Optic Chiasm Shape in Patients with Pituitary Adenoma

“…Symptoms of the visual eld in pituitary tumor cases involve prominently the peripheral visual eld [3][4][5][6][7][8][9]. Therefore, experienced technicians measured the visual eld with Goldmann kinetic perimetry (GP; L-1560, Inami, Japan), which can measure the peripheral visual eld.…”

“…This could be explained anatomically; the center of the optic chiasm includes the bers for the temporal visual elds. This part is primarily compressed by pituitary tumors just below the chiasm [3][4][5][6][7][8][9]. Therefore, the pituitary tumors probably affect the temporal rather than the nasal visual eld, and surgical intervention could signi cantly affect the temporal visual eld.…”

“…Decompression of the optic chiasm by tumor removal results in visual eld recovery [1][2][3][4][5][6][7][8]. Pituitary surgeons have tried to predict postoperative visual outcome using observations.…”

“…Several previous studies have discussed the factors that affect postoperative visual elds [1][2][3][4][5][6] but were unable to predict postoperative visual elds using preoperative data. Yoneoka et al [1] focused on the relationship between the visual eld and retinal thickness, and stated that early intervention would result in good postoperative visual eld outcome.…”

Potencial evocado visual multifocal em olhos com hemianopsia temporal por compressão quiasmática. Correlação com a perimetria computadorizada e a tomografia de coerência óptica

“…Outro dado que se correlaciona com melhor resposta ao tratamento cirúrgico é idade mais jovem e menor tempo de duração dos sintomas [9][10][11][12] . Estes dados demonstram que é Introdução 4 fundamental o conhecimento da disposição geral das CFNR em indivíduos normais e as alterações que nela ocorrem nas afecções da via óptica anterior.…”