Dynamics of Visual Functions in Patient with Pituitary Tumors before and after Surgery
Object: To analyze frequency and dynamics of visual disturbances in patients with pituitary tumors before and postoperative.
Materials and Methods: A total 256 patients were operated between Februarys 2007and July 2013 in the clinic of neurological surgery of Interregional clinical diagnostic center, Kazan via transnasal approach. According to gender there were 106 males and 150 females. Patient's age was between 18–77 years, with mean age of 47,18 years.
With regard to tumor size there were: microadenoma (up to 15mm) – 49(19,14%); small adenoma(16–25mm) – 84(32,8%); mid-size adenoma (26–35mm) – 77(30%); large adenoma(36–59mm) – 46(18%). Prior to surgery and postoperatively all patients underwent ophthalmological examination including: visometry, pyrometry, byomicroscopy, tonometry (if indicated) and ophthalmoscopy. A dynamics of visual disturbances in patients with pituitary tumors was analyzed retrospectively.
Results and Discussion: Prior to surgery a chiasmal syndrome was determined in 157(61,33%) patients. Postoperatively 137(87,27%) patients showed expansion in fields of view, 15(9,56%) patients were without any changes and in 5(3,19%) cases further deterioration of fields of view was determined. In 3(1,91%) patients a chiasmal syndrome appeared after surgery. 54(21,1%) patients had a decreased visual acuity before surgery. After tumor removal 46(85,19%) patients showed visual acuity improvement, 6(11,12%) patients without any changes and 2(3,71%) patients had visual acuity impairment post surgery. In 11(4,30%) patients an eye-movement disturbance was determined. After surgery 4(36,37%) patients showed further impairment and 7(63,63%) patients had improvement. In 10(3,91%) cases a signs of increased intracranial pressure were revealed with completely resolve after surgery.
Actually, late admission for surgery lowing functional outcomes in visual preserving and improvement. Among the reasons of that we can select a low level of public biological education and low circumspection in neurooncology among physicians (ophthalmologists, neurologists, endocrinologists and therapeutics) to whom patients comes in disease onset.
Conclusions: Visual disturbances were determined in 65% of patient with pituitary tumors in our series.
Recovery of visual function after surgery depends on tumor size, disease duration and grade of tumor resection.
Choice of treatment tactic in patients with pituitary tumors could be take on only by a team – ophthalmologist, endocrinologist and neurosurgeon.