Post-operative vision loss: analysis of 587 patients undergoing endoscopic surgery for pituitary macroadenoma

Abstract

Purpose

Vision loss following surgery for pituitary adenoma is poorly described in the literature and cannot be reliably predicted with current prognostic models. Detailed characterization of this population is warranted to further understand the factors that predispose a minority of patients to post-operative vision loss.

Materials and methods

The medical records of 587 patients who underwent endoscopic transsphenoidal surgery at the Mount Sinai Medical Centre between January 2013 and August 2018 were reviewed. Patients who experienced post-operative vision deterioration, defined by reduced visual acuity, worsened VFDs, or new onset of blurry vision, were identified and analysed.

Results

Eleven out of 587 patients who received endoscopic surgery for pituitary adenoma exhibited post-operative vision deterioration. All eleven patients presented with preoperative visual impairment (average duration of 13.1 months) and pre-operative optic chiasm compression. Seven patients experienced visual deterioration within 24 h of surgery. The remaining four patients experienced delayed vision loss within one month of surgery. Six patients had complete blindness in at least one eye, one patient had complete bilateral blindness. Four patients had reduced visual acuity compared with preoperative testing, and four patients reported new-onset blurriness that was not present before surgery. High rates of graft placement (10/11 patients) and opening of the diaphragma sellae (9/11 patients) were found in this series. Four patients had hematomas and four patients had another significant post-operative complication.

Conclusions

While most patients with pituitary adenoma experience favourable ophthalmological outcomes following endoscopic transsphenoidal surgery, a subset of patients exhibit post-operative vision deterioration. The present study reports surgical and disease features of this population to further our understanding of factors that may underlie vision loss following pituitary adenoma surgery. Graft placement and opening of the diaphragma sellae may be important risk factors in vision loss following ETS and should be an area of future investigation.

Keywords:

• Endoscopic transsphenoidal surgery
• pituitary adenoma
• diaphragma sellae
• suprasellar tumour
• vision loss

Acknowledgments

We would like to thank Jill Gregory, a Medical Illustrator for Mount Sinai, for her illustrations included in this manuscript.

Disclosure statement

Dr. Joshua Bederson (a Significant Contributor in this study and Chair of the Department of Neurosurgery) owns equity in Surgical Theater, LLC. (manufacturer of the Surgical Navigation Advanced Platform (SNAP) system that may be used for intraoperative image guidance in the study). The remaining authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Data availability statement

The data that support the findings of this study are available from the corresponding author, JTD, upon reasonable request.