Visual Disorders Outcome after Endoscopic Endonasal Trans-Sphenoidal Surgery of Pituitary Macroadenomas

Abstract

Objective: Describe the outcome of visual disorders after endonasal transsphenoidal (EET) surgery of pituitary macroadenomas with preoperative chiasmal compression. Patients and Methods: From 2009 to 2013, 225 patients underwent EET surgery for sellar tumor. Among them, 168 suffered from visual disorders induced by chiasmatic compression, of which 88 met the inclusion criteria for this study. Average duration of follow up was 1.8 yrs ± 0.4 yrs. All patients had sellar MRI before surgery and yearly postoperatively, visual acuity (VA) and/or visual field (VF) measurements before, 3 months after surgery and yearly postoperatively. Results: All tumors were macroadenomas with a mean preoperative MRI-estimated volume of 10.0 {plus minus} 9.07 cm3. Preoperative VA was impaired with an average of 0.43 ± 0.13 LogMAR (left eye) and 0.36 ± 0.14 LogMAR (right eye) and VF was disturbed in 99% ± 2% of the cases with the most frequent disorder being bitemporal hemianopsia (38 patients). Post-operatively, the mean residual MRI-estimated tumor volume was 3.15 ± 3.71 cm3. Mean tumor volume reduction was 62% ± 9% (p < 0.001). Optic chiasmal compression resolved in 72% ± 10% of the cases. Visual function improved in 86% ± 7% of cases (p < 0.001). Conclusion: Endoscopic endonasal management of pituitary gland neoplasms is effective to reduce tumor volume. This technique achieved significant visual improvement in the majority of cases presenting with chiasmal compression syndrome.