Visual acuity and its postoperative outcome after transsphenoidal adenoma resection
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ORIGINAL ARTICLE
Visual acuity and its postoperative outcome after transsphenoidal adenoma resection Vicki M. Butenschoen 1 & Nina Schwendinger 1 & Alexander von Werder 2 & Stefanie Bette 3 & Maximilian Wienke 1 & Bernhard Meyer 1 & Jens Gempt 1 Received: 20 May 2020 / Revised: 28 September 2020 / Accepted: 30 September 2020 # The Author(s) 2020
Abstract Transsphenoidal surgery (TSS) represents the gold standard of pituitary adenoma resection, providing a safe and minimal invasive treatment for patients suffering from symptoms of mass effect. The aim of this study is to analyze the postoperative improvement of visual function after adenoma resection and to identify prognostic factors for the postoperative clinical recovery. We performed a retrospective analysis of all consecutive patients treated via a transsphenoidal approach for pituitary adenomas from April 2006 to December 2019 in a high-volume neurosurgical department. Our primary outcome was postoperative visual acuity and visual field impairment; the clinical findings were followed up to 3 months after surgery and correlated with clinical and radiographic findings. In total, 440 surgeries were performed in our department for tumors of the sella region in a time period of 13 years via transsphenoidal approach, and 191 patients included in the analysis. Mean age was 55 years, and 98% were macroadenomas. Mean preoperative visual acuity in patients with preoperative impairment (n = 133) improved significantly from 0.64/0.65 to 0.72/0.75 and 0.76/0.8 (right eye R/left eye L) postoperatively and at 3 months follow-up (p < 0.001). Visual acuity significantly depended on Knosp classification but not Hardy grading. The strongest predictor for visual function recovery was age. Transsphenoidal pituitary tumor resection remains a safe and effective treatment in patients with preoperative visual impairment. It significantly improves visual acuity and field defects after surgery, and recovery continues at the 3 months follow-up examination. Keywords Pituitary adenoma . Transsphenoidal surgery . Visual acuity
Introduction Pituitary adenomas present benign lesions with a close spatial relationship to the optic chiasm. Larger tumors growing beyond the sella can affect peripheral vision and even cause
elevated intracranial pressure [16, 26, 27]. While the indication for surgical resection of nonfunctioning incidentalomas is often a matter of debate and varies from its timing and treatment strategy [23, 24], adenomas leading to visual impairment are usually treated surgically, in order to improve or halt
* Vicki M. Butenschoen [email protected]
Bernhard Meyer [email protected] Jens Gempt [email protected]
Nina Schwendinger [email protected] Alexander von Werder [email protected]
1
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
Stefanie Bette [email protected]
2
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universitä
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