Functional impairments caused by chiasma syndromes prior to and following transsphenoidal pituitary adenoma surgery

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...

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Bibliographic Details
Published in:Acta neurochirurgica 2010-08, Vol.152 (8), p.1283-1290
Main Authors: Kristof, Rudolf A., Kirchhofer, Daniel, Handzel, Daniel, Neuloh, Georg, Schramm, Johannes, Mueller, Christian-Andreas, Eter, Nicole
Format: Article
Language:English
Subjects:
Adenoma - complications
Adenoma - pathology
Adenoma - surgery
Adolescent
Adult
Aged
Aged, 80 and over
Clinical Article
Female
Humans
Hypophysectomy - adverse effects
Hypophysectomy - instrumentation
Hypophysectomy - methods
Interventional Radiology
Male
Medicine
Medicine & Public Health
Middle Aged
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Optic Chiasm - blood supply
Optic Chiasm - injuries
Optic Chiasm - pathology
Pituitary Neoplasms - complications
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Retrospective Studies
Surgical Orthopedics
Young Adult
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Summary: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.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-010-0654-1