Czech T, Wolfsberger S, Reitner A, Görzer H
Department of Neurosurgery, University of Vienna Medical School, Austria.
Acta Neurochir (Wien). 1999;141(1):45-51. doi: 10.1007/s007010050265.
Despite its description in the literature there remains uncertainty about the incidence, the pathophysiological basis and the best management of a delayed visual deterioration in the presence of an empty sella after surgery for pituitary adenomas. Out of a series of 501 patients with pituitary adenomas operated on at our institution between 1984 and 1996, four patients (0.8%) developed a worsening of their visual function 3 to 37 months after surgery in the absence of tumour recurrence. None of the patients had received radiotherapy. Magnetic resonance imaging (MRI) ruled out compression by tumour and showed herniation of suprasellar structures into an empty sella. In three cases re-operation by a subfrontal approach with freeing of the optic structures from tethering scar tissue led to an improvement of visual deficits. In one case a spontaneous recovery was initiated by a minor head injury. Although apparently a rare event, our cases provide evidence for the occurrence of a potentially reversible delayed deterioration of visual function after surgery for pituitary adenomas. Based on our operative findings and our outcome we recommend re-operation by a transcranial approach in patients in whom repeated ophthalmological testing does not show spontaneous improvement within a short period of time.
尽管文献中有相关描述，但对于垂体腺瘤手术后空蝶鞍情况下视力延迟恶化的发生率、病理生理基础及最佳治疗方法仍存在不确定性。在1984年至1996年间于我院接受垂体腺瘤手术的501例患者中，有4例（0.8%）在术后3至37个月出现视力功能恶化，且无肿瘤复发。所有患者均未接受过放疗。磁共振成像（MRI）排除了肿瘤压迫，并显示鞍上结构疝入空蝶鞍。3例患者通过额下入路手术，松解视神经结构与束缚瘢痕组织，视力缺损得到改善。1例患者因轻微头部损伤后视力自发恢复。尽管这显然是罕见事件，但我们的病例为垂体腺瘤手术后视力功能可能出现可逆性延迟恶化提供了证据。基于我们的手术发现及结果，我们建议对于经反复眼科检查在短时间内未显示自发改善的患者，采用经颅入路再次手术。
