Dynamics of visual functions recovery after endoscopic transnasal surgery of macroadenomas
Keywords:Skull base tumors, pituitary macroadenoma, chiasmal syndrome, compression optic neuropathy, stages of visual functions improvement, endoscopic transnasal surgery.
Introduction. Tumors in optochiasmal area cause the compressive optic neuropathy (CON) manifesting with the visual acuity loss, visual field defects and development of primary optic nerve atrophy (ONA). The tumor mass-effect on the anterior visual pathway structures occurs on the ophthalmic stage of the disease and is an absolute indication for surgical treatment. Transsphenoidal surgery leads to decompression of the anterior visual pathway and suchwise to improvement of vision, proceeding in several stages: rapid and deferred recovery. Studies of speed and volume of such visual functions recovery regarding the time slots are published sporadically.
Goal. To analyze the stages of postoperative of visual functions recovery in patients with compressive optic neuropathy caused by pituitary macroadenomas after endoscopic transnasal surgery.
Material and methods. We examined 225 primary patients with pituitary adenoma before and after endoscopic transnasal surgical removal underwent in Transsphenoidal department of Romodanov Neurosurgery Institute from 2017 to 2019. Those cohort of 225 patients (450 eyes) with visual disturbances (reduced visual acuity and / or visual field defects) have been ophthalmologically exanimated several times: first, within 2 days on admittance, the second - on the 5-7th day postop (early postoperative period), third - 1 month, fourth - 3 months, the fifth - 6 months, the sixth - 1 year after the operation.
Results. Improvement or full visual function recovery have been observed in most patients as a result of surgical OHC decompression. Statistically significant decrease has revealed between the average indicators of visual acuity (0.74 ± 0.02 and 0.8 ± 0.01), the mean defects (7.85 ± 0.29 dB and 6.37 ± 0.28 dB) in early postoperative period and 3 months after surgery (p<0.05). A statistically significant decrease in the mean defects was received in comparison with the data received in the early postoperative period (7.85 ± 0.29 dB), after 1 month (6.37 ± 0.28 dB) and after 6 months (6.08 ± 0.28 dB).
Conclusions. After surgical decompression of the OHC, several stages of visual functions improvement have been observed: rapid recovery (few days postop) and delayed recovery (up to 6 months). In the later time slot, after 6 months, there were no signs of recovery.
Keywords. Skull base tumors, pituitary macroadenoma, chiasmal syndrome, compression optic neuropathy, stages of visual functions improvement, endoscopic transnasal surgery.