gms | German Medical Science

Objective: First description of functional impairment in patients due to chiasmal syndrome caused by pituitary adenomas, before and after transsphenoidal surgery.

Methods: Data from a series of patients with first-time transsphenoidal surgery of pituitary adenomas were collected retrospectively. The functional impact of a visual acuity impairment and/or visual field defect was quantified on the basis of the resulting reduced earning capacity (determined according to the recommendations of the German Federal Association of Ophthalmologists (Bundesverband der Augenärzte, BVA) and the German Ophthalmologic Society (Deutsche Ophthalmologische Gesellschaft, DOG) of 1994). A reduced earning capacity ≥30% is considered significant.

Results: The series included 304 patients (median age 50 years, 53.3% male). In 54.6% of cases, the pituitary adenoma was non-functioning. The mean maximum tumor diameter was 20mm. In 35.1% of patients, a chiasmal syndrome was present pre-operatively. In the patients without a pre-operative chiasmal syndrome, no new post-operative visual acuity and/or visual field defect occurred. In the patients with a pre-operative chiasmal syndrome, normalization occurred in 42.9% and improvement in 38.3%, while no changes were observed in 11.2% and worsening of the chiasmal syndrome in 7.4% of cases. No significant changes in reduced earning capacity(due to visual acuity and/or visual field defect) were observed in the patients without pre-operative chiasmal syndrome. In patients with a pre-operative chiasmal syndrome, a significant improvement in the total reduced earning capacity from 30 (0; 100)% to 0 (0; 100)% was observed. Also the percentage of patients with a reduced earning capacity ≥30% decreased significantly after operation from 51.4% to 16.4%. However, in the group of patients without a pre-operative chiasmal syndrome, the total reduced earning capacity as well as the percentage of patients with a reduced earning capacity ≥30% remained significantly lower after the operation than in the group of patients with a pre-operative chiasmal syndrome.

Conclusions: After operation, a significant improvement in the percentage as well as in the extent of reduced earning capacity was observed in patients with a pre-operative chiasmal syndrome. However, in this patient group, the reduced earning capacity remains higher than in patients without pre-operative chiasmal syndrome. Therefore, patients with present or impending chiasmal syndrome should be operated on as early as possible.