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Visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors: A retrospective cohort study

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Acta Neurochirurgica Aims and scope

Abstract

Objective

To investigate the visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors (PitNETs).

Methods

A retrospective study was conducted on 28 patients who developed evident postoperative hematoma out of a total of 9,010 patients. The hematomas were classified into three types based on their CT appearance. Type 1a - mild high density with no tension, Type 1b - thin-layer high density; Type 2a - solid high density with large empty cavities, Type 2b - solid high density with small empty cavities; Type 3 –solid high density with no cavity showing high tension. Patient data were collected for analysis.

Results

The study cohort comprised 10 female and 18 male patients, with a mean age of 51.5±11.9 years. Most patients presented with large adenomas (median diameter 36mm). Postoperative visual sight improved in 12 patients, remained stable in 11 patients, and worsened in 5 patients. Notably, no patients experienced worsened visual sight beyond twenty-four hours after the operation. Among the five patients with visual deterioration, four had CT type 3 hematoma (4/6, 66.7%), and one had CT type 2b hematoma (1/9, 11.1%). Patients in the type 3 CT group were significantly more prone to experience visual deterioration compared to those in the type 2 group (odds ratio [OR] 2.154 [95% CI 1.858-611.014], P=.027). Four patients underwent repeat surgery after visual deterioration, resulting in visual improvement following a prolonged recovery period. Postoperative hematoma had limited impact on pituitary dysfunction and hyponatremia.

Conclusion

Our study reveals a significant association between postoperative hematoma CT types and visual deterioration. For patients with stable visual sight and type 1 or 2a hematoma, conservative strategies may be considered. Conversely, type 2b and 3 patients are at higher risk of visual deterioration, especially within the first 24 hours after the operation. Consequently, early reoperation before vision worsens may be a prudent approach to reduce risks and improve visual outcomes, particularly in type 3 patients.

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Data availability

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by National Natural Science Foundation of China (grant number 82003023) and Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (grant number 2022-JKCS-06).

Author information

Author notes

  1. Peng Li and Pinan Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Zhe Zhang, Shiwei Li, Zhenmin Wang, Xingchao Wang, Bo Wang, Zhijun Yang, Pinan Liu & Peng Li

  2. Neural Reconstruction Department, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

    Ying Wang

Authors
  1. Zhe Zhang
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  2. Shiwei Li
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  3. Ying Wang
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  4. Zhenmin Wang
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  5. Xingchao Wang
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  6. Bo Wang
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  7. Zhijun Yang
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  8. Pinan Liu
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  9. Peng Li
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Contributions

Peng Li: Conceptualization, Methodology. Zhe Zhang, Shiwei Li, Ying Wang, Zhenmin Wang: Data curation, Writing- Original draft preparation. Xingchao Wang, Bo Wang: Visualization, Investigation. Zhijun Yang: Supervision. Pinan Liu: Writing- Reviewing and Editing.

Corresponding authors

Correspondence to Pinan Liu or Peng Li.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by institutional review boards of Beijng Tiantan Hospital, Capital Medical University (KY2023-170-02).

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Waiver of informed consent was granted because of the retrospective nature of this study.

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Zhang, Z., Li, S., Wang, Y. et al. Visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors: A retrospective cohort study. Acta Neurochir 166, 127 (2024). https://doi.org/10.1007/s00701-024-06027-9

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  • DOI: https://doi.org/10.1007/s00701-024-06027-9

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