gms | German Medical Science

To evaluate the ophthalmologic results after surgery of Non Functional Pituitary Adenoma in a cohort of 183 patients in order to determine predictive factor of postoperative visual evolution.

183 patients (sexe ratio 1.3; mean age: 54 years) bearing Non Functional Pituitary Adenomas (180 macroadenomas, 3 microadenomas) were operated on between 1974 and 2004 at our institution by trans sphenoidal approach for 164 patients or by intracranial or combined approach for 21 others. The duration of symptoms and the delay between diagnosis and surgery were collected. An ophthalmologic exam including study of visual acuity, visual field and retinal examination was performed before surgery, around 8 days, three months and one year after the surgery. The ophthalmologic follow-up was continued for symptomatic patients after this delay. The predictive value of visual postoperative evolution of: patient’s age, duration of symptoms before diagnosis, the delay between diagnosis and treatment, the tumor size, the severity of preoperative visual impairment and the surgical approach, was studied for the last 62 patients.

Visual symptoms was the initial sign for 64% of patients but 78% of them presented visual impairment on the preoperative exam (visual field defects alone 36 %, decrease of visual acuity alone 2% and both 62%).

Postoperative worsening occurred in 7% (13 patients) and was definitive in 6% (11 cases). 29% of patients who have preoperative visual disturbance didn’t recovered after surgery and 67% improved, completely for 39%. The visual acuity recovered rapidly after decompression (few days in 50% of the cases) and more slowly for visual field defect (mean of recuperation, 3 months). Only 11% of patients continued to improve after three months. Definitive ophthalmologic results were obtained in 95% of cases at one year.

The duration of symptoms, the delay for surgery, the severity of visual disturbances as well the surgical approach performed have no predictive value for postoperative visual evolution. Papilla atrophy or paleness was confirmed to be negative factor of recuperation. Visual recovery wasn’t correlated with the tumor size.

In our series of Non Functional Pituitary Adenoma, ophthalmologic symptoms were the initial clinical presentation for almost all patients.

Two third of patients improved postoperatively. Apart from papilla atrophy or paleness, there was no predictive factor of postoperative ophthalmologic improvement in this study.