Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
World Neurosurg. 2020 Sep;141:e60-e69. doi: 10.1016/j.wneu.2020.04.151. Epub 2020 Apr 27.
Factors associated with visual outcomes after transcranial surgery for large-to-giant pituitary adenomas have not been fully elucidated.
We recruited 37 patients with large-to-giant pituitary adenomas between January 2014 and December 2016 and assessed their tumor characteristics and surgical outcomes. Visual acuity and visual field were evaluated by visual impairment score before and 3-6 months after transcranial surgery. Multivariable logistic regression analysis was applied to show the factors associated with visual outcomes after surgery.
The severity levels of visual impairment before surgery were mild, moderate, severe, and complete in 24.3% (9/37), 24.3% (9/37), 35.1% (13/37), and 16.2% (6/37), respectively. After surgery, the visual function was improved, stabilized, and worsened in 43.2% (16/37), 43.2% (16/37), and 13.5% (5/37) of patients, respectively. Multivariable logistic regression analysis showed that subarachnoid space invasion was the only independent prognostic factor adversely influencing the postoperative visual outcomes. Patients with subarachnoid space invasion had a higher possibility of visual deterioration (36.4% vs. 3.8%; P = 0.021) after transcranial surgery, compared with those without subarachnoid space invasion.
Visual compromise is still an unignorable complication during transcranial surgery for large-to-giant pituitary adenomas. Subarachnoid space invasion indicated by preoperative magnetic resonance imaging was an independent negative predictor for visual outcomes after surgery.
经颅手术治疗大-巨大型垂体腺瘤患者术后视觉结局的相关因素尚未完全阐明。
我们招募了 2014 年 1 月至 2016 年 12 月间的 37 例大-巨大型垂体腺瘤患者，并评估了他们的肿瘤特征和手术结果。术前和经颅手术后 3-6 个月，通过视力障碍评分评估视力和视野。多变量逻辑回归分析显示与术后视力结果相关的因素。
术前视力损害严重程度分别为轻度、中度、重度和完全性，占比分别为 24.3%（9/37）、24.3%（9/37）、35.1%（13/37）和 16.2%（6/37）。术后，43.2%（16/37）、43.2%（16/37）和 13.5%（5/37）的患者视力功能改善、稳定和恶化。多变量逻辑回归分析表明，蛛网膜下腔侵犯是唯一对术后视觉结果产生不利影响的独立预后因素。与无蛛网膜下腔侵犯的患者相比，蛛网膜下腔侵犯的患者经颅手术后视力恶化的可能性更高（36.4%比 3.8%；P=0.021）。
在经颅手术治疗大-巨大型垂体腺瘤时，视力损害仍然是一个不可忽视的并发症。术前磁共振成像显示的蛛网膜下腔侵犯是术后视觉结果的独立负预测因子。
