Visual outcomes of pituitary adenoma surgery. St. Vincent's Hospital 1968-1987

Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients with histologically verified pituitary adenoma and visual defects (fields and/or acuity) were reviewed. The patients' ages ranged from 19 to 80 years with a mean of 52.4 years. Ophthalmologists referred 76% of the patients for neurosurgical opinion. Bitemporal field defects were present in 89%. Twenty-three patients underwent transfrontal craniotomy prior to 1984, and the remaining twenty-two subsequently had transsphenoidal microsurgery. Of those eyes with abnormal visual acuity preoperatively, 74% had improvement noted postoperatively (p less than 0.001). Of those eyes with preoperatively abnormal visual fields, 68% improved (p less than 0.001). For transsphenoidal surgery the rate of improvement for fields was 81%. Preoperative visual acuity, visual field score, and patient age, were not predictive of postoperative acuity. Optic disc pallor was associated with poorer postoperative fields and acuity compared to eyes without preoperative pallor. Transsphenoidal surgery is effective treatment for visual compromise due to pituitary adenoma, and the need for early diagnosis is emphasized.