Incidence and dynamics of visual disturbances in hypothalamus and pituitary mass lesions after transphenoidal surgery in the Republic of Uzbekistan
Said Ismailov, Ashley Grossman, Michael Powell, Zamira Khalimova, Yulduz Urmanova, Kozim Makhkamov, Gulchekhra Narimova & Alisher Akbutaev
Aim of the research: To study the visual complications rate in patients with different pituitary adenomas.
Patients and methods: We observed 24 patients with different pituitary adenomas, among them 14 women and 10 men. Mean age of patients was 36.4 years-old. According to the ethiology pattern patients were divided as follow; 17 patients with non-functioning pituitary adenomas, 1 patient with craniopharingioma, 2 patients with Cushing disease, 2 patients with prolactinoma, 1 patient with astrocytoma and 1 patient with meningioma. All 24 patients underwent transphenoidal surgery (TSS). During the period from 2007 to 2009 there were 33 surgeries done one of which was bifrontal craniotomy and 32 TSS. Three patients underwent 2 TSS, 3 patients underwent 3 TSS and 4 patients received radiotherapy after TSS.
Evaluations including hormonal (RIA GH. IGF1, prolactin, LH, FSH, TSH, ACTH, cortisol), eye examinations (fundus, visual fields) and imaging (CT, MRI) were performed in all patients before and after TSS.
Results: In pre-operative period 19 patients (79.1%) were presented with bitemporal hemianopsia, 4 patients (16.6%) with unilateral quadrant hemianopsia, 10 patients (41.6%) with concentric visual narrowing, 2 patients (8.3%) with unilateral amaurosis, and 7 (29.1%) and 1 (8.3%) patients with partial optic nerves atrophy and paracentral absolute scotoma respectively.
Postoperativel vision significantly improved in operated patients. Complete recovery was observed in 22 patients (91.6%), whereas visual acuity improvement observed in 91.6% of patients.
Conclusions: i) The most common visual disturbance in patients with pituitary adenomas in preoperative period was bitemporal hemianopsia (19 cases (79.1%)). ii) after TSS visual recovery was observed in 22 of 24 patients (91.6%).