Visual Findings in Patients Undergoing Endoscopic Resection of Mid Skull Base Lesions

Abstract

Introduction: While trans-sphenoidal surgery for pituitary tumors has been around since the first decade of the 20th century and has been successfully brought into the 21st century, the possibility of resecting the tumors endoscopically has become increasingly popular. We undertook to evaluate the neuro-ophthalmologic findings in a series of patients undergoing trans-sphenoidal endoscopic resection. Materials and Methods: A series of 15 patients undergoing endoscopic resection were evaluated for evidence of afferent and efferent visual system pathology. Results: Of the 15 patients, 13 had evidence of pituitary tumors, 1 had an arachnoid cyst, and 1 had a craniopharyngioma. There were 9 females and 6 males. Four patients had no significant ocular findings related to the tumor. One patient had oscillopsia but no evidence of ocular motor problems. Four patients had evidence of bitemporal visual field defects and there were homonymous defects in 4. Three patients had evidence of junctional scotoma. Complications included meningitis in 1 and a bleed in 1 who had undergone previous surgery resulting in a IIIrd nerve palsy and dense homonymous defect. Conclusions: Resection of sellar and parasellar lesions is possible to perform entirely endoscopically. These patients have significant neuro-ophthalmic findings and will need to be followed. Whether in fact this will prove to have equal or better results than traditional trans-sphenoidal surgery remains to be seen.