transsphenoidal hypophysectomy and visual deficits

transsphenoidal hypophysectomy and visual deficits

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  Influence On VisualDeficit After Transsphenoidal Hypophysectomy For Pituitary Adenomas Shahid Ayub, Mumtaz Ali, Fakhar Hayat, Muhammad Usman, Naeem ul Haq, Muhammad Ishaq, Azam Khan Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar • Transsphenoidal route is a safe and effective route with extremely good outcome for removal of intrasellar pituitary lesions. • The presenting symptoms are commonly; visual deterioration, neuroendocrine abnormalities or raised intracranial pressure. • The visual symptoms include deterioration of visual acuity, visual field defects and occulomotor symptoms. Visual field defects range from complete blindness to uni-ocular or binocular small scotoma, quadrantonomas and bi-temporal hemianopia. • A sudden bleed inside the pituitary tumour is called pituitary apoplexy and it leads to severe headache and episodes of acute blindness. Study Type: Retrospective Setting: PGMI, LRH Duration: January 2006 to January 2011 Sample: 61 patients who underwent transsphenoidal surgery for pituitary adenoma were included. Data regarding age, sex, visual symptoms, ophthalmological findings, hormonal assay, CT and MR findings collected. Visual symptoms and ophthalmological findings were compared both pre- and post-operatively to a period of 12 months. Visual acuity was measured by Snellen chart and post op visual acuity checked after 2 days, and follow up 10 days, 6 months and 12 months Data analysis was done using SPSS v10.0. • 25 (40.98%) patients out of total 61presented with visual acuity between 6/6 and 6/12, out of these, 17 (27.86%) had partial improvement, 7 improved to normal and one had no improvement • 10 (16.39%) patients presented with visual acuity between 6/12 and 6/24. 8 (13.11%) had partial improvement and 2 had no improvement. • 8 (13.11%) patients presented with visual acuity between 6/24 and 6/60. 3 improved to normal and 5 had partial improvement, total 13.11% improvement. • 8 (13.11%) patients presented with visual acuity from 6/60 and counting fingers (CF). Out of these, 3 patients had improved to normal and 4 had partial improvement, total 11.47% improvement. • Total 5 patients presented between CF and hand movement (HM) and had 4.91% improvement in visual acuity. • Total 5 patients presented with no perception of light and complete blindness, 2 (3.27%) of these had partial improvement over time. • Therefore, there was total or partial improvement in 52 (85.24%) patients in term of visual acuity • 33 (54.09%) of the total 61 patients had bitemporal hemianopia, 10 (16.39%) had single quadrantanopia in temporal fields. Four (6.55%) were totally blind. Visual field improved in 74% of cases with different patterns of defects, 64% improved partially while 10% had complete improvement whereas 26% had no improvement in visual field • Younger age, male sex, short duration of symptoms, small tumors without suprasellar/parasellar extensions, pituitary apoplexy and hemorrhage findings during operation were some favorable variables noted in our study for better outcome and improvement of visual defects. • A large number of patients with pituitary adenoma and visual defects improved after transsphenoidal surgical procedure, showing that visual defects are not irreversible in these cases as previously thought. Visual improvement was observed in 80% of the cases. There was significant Improvement in 40% of cases. • Excellent visual improvement can be achieved in severely affected eyes if early intervention is taken into account. 1. Yoshifumi Okamoto, Fumiki Okamoto, Shozo Yamada, Maiko Honda,Takahiro Hiraoka, and Tetsuro Oshika;Vision-Related Quality of Life after Transsphenoidal Surgery for Pituitary Adenoma IOVS July 2010 51:3405-3410; 2. Ashish Suri, Karanjit Singh Narang, Bhawani Shankar Sharma, and Ashok Kumar Mahapatra;Visual outcome after surgery in patients with suprasellar tumors and preoperative blindness J Neurosurg, 108:19-25,2008. 3. Essam A. Elgamal, Essam A. Osman, Sherif M.F. El-Watidy, Zain B. Jamjoom, Nuha Al-Khawajah, Noha Jastaniyah, Molhem Al-Rayess: Pituitary Adenomas: Visual Presentation And Outcome After Transsphenoidal Surgery - An Institutional Ex, The Internet Journal of Ophthalmology and Visual Science. 2007. 4. Naoya Takeda, Katsuzo Fujita, Shigenori Katayama, Nobuyuki Akutu, Shigeto Hayashi and Eiji Kohmura; Effect of transsphenoidal surgery on decreased visual acuity caused by pituitary apoplexy, Medicine, pituitary,2007;13/2:154-9. 5. Jallu A, Kanaan I, Rahm B, Siqueira E: Suprasellar meningioma and blindness: a unique experience in Saudi Arabia. Surg Neurol 45:320–323, 1996. Introduction Aims & Objectives Methods Results References This study aims to emphasize the outcome of transsphenoidal surgery with regard to improvements in visual symptoms, and the factors which may influence the visual outcome after surgery. Conclusion 13 39 9 Vision Recovery in patients Complete Recovery Partial Recovery No Recovery