Abstract
Purpose
To describe the functional impairment caused by chiasma syndromes (CS) prior to and following transsphenoidal pituitary adenoma surgery.
Methods
Pertinent data of a successive series of patients operated transsphenoidally for the first time for pituitary adenoma were retrospectively analyzed. The degree of functional impairment caused by the impairment of vision was quantified according to the resulting degree of disability (DOD). A DOD of ≥30 is considered substantial.
Results
None of the 197 of 304 (64.9%) patients without preoperative chiasma syndrome (CS) experienced postoperative worsening of their visual acuity or their visual fields. Thus, no change of their vision-related DOD (V-DOD) did occur. One hundred and seven (35.1%) of the patients presented preoperatively with CS. Postoperatively, 42.9% of the CS remitted completely, 38.3% improved, 11.2% remained unchanged, and 7.4% worsened. Accordingly, the median V-DOD improved significantly from 30 (0; 100) to 0 (0; 100). The prevalence of patients with V-DOD ≥30 dropped significantly from 51.4% preoperatively to 16.4% postoperatively. Postoperatively, the median V-DOD improved significantly up to 3 months postoperatively. Thereafter, no further significant changes occurred. However, in patients with preoperative CS, the median V-DOD as well as the prevalence of patients with a V-DOD ≥30 remained postoperatively significantly higher compared to patients without preoperative CS.
Conclusions
Visual impairments due to CS frequently caused substantial DOD preoperatively. Postoperatively, the median degree of V-DOD as well as the prevalence of substantial V-DOD improved significantly. However, in patients with preoperative CS, V-DOD remained postoperatively significantly higher than V-DOD of patients without preoperative CS.
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The authors present a crystal clear study. The outcome of vision after transsphenoidal adenomectomy was retrospectively analyzed. Visual acuity and visual fields were classified by the degree of disability. The results are not astonishing. Vision did not decline in patients without visual deficit before surgery. In the majority of patients with visual deficit prior to surgery, vision improved thereafter. Remarkable is the visual grading system. With these numbers, statistical analysis can be performed. The degree of disability should become the standard for comparing vision before and after treatment of pituitary adenomas.
Jens Lehmberg
Munich, Germany
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Kristof, R.A., Kirchhofer, D., Handzel, D. et al. Functional impairments caused by chiasma syndromes prior to and following transsphenoidal pituitary adenoma surgery. Acta Neurochir 152, 1283–1290 (2010). https://doi.org/10.1007/s00701-010-0654-1
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DOI: https://doi.org/10.1007/s00701-010-0654-1