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J Neurol Surg B Skull Base 2021; 82(S 03): e79-e87
DOI: 10.1055/s-0039-3402020
Original Article

Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience

Max J. van Essen
1   Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Ivo S. Muskens
1   Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
2   Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, California, United States
,
Nayan Lamba
3   Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Stephan F.J. Belunek
4   Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Arthur T.J. van der Boog
5   Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
,
G. Johan Amelink
1   Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Peter H. Gosselaar
1   Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Tristan P.C. van Doormaal
1   Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Aline M.E. Stades
6   Department of Internal medicine, University Medical Center Utrecht, Utrecht, The Netherlands
,
Joost J.C. Verhoeff
7   Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
,
Maria M. van Genderen
4   Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Christine A.E. Eenhorst
4   Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Marike L.D. Broekman
3   Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States
8   Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands
9   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Funding No funding was received for this research.
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Abstract

Objectives Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes.

Methods One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al.

Results Sixty-six (66/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively (p = 0.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort (p = 0.02 and p < 0.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD (p = 0.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p = 0.04).

Conclusion EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.

Keywords

pituitary adenoma - transsphenoidal - endoscopy - visual field - visual acuity - visual outcome

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors. Our institutional ethical board exempted this study from the requirement of formal consent, due to its retrospective nature.


Supplementary Material



Publication History

Received: 20 March 2019

Accepted: 09 November 2019

Article published online:
03 February 2020

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