Optico-Chiasmatic Distortions in Pituitary Adenomas: Correlation Between Postoperative Morphological Reversal and...

Area of Science:

• Ophthalmology
• Neurosurgery
• Medical Imaging

Background:

• Pituitary adenomas can compress the optic apparatus, leading to visual impairment.
• Trans-sphenoidal surgery is a common treatment for pituitary adenomas.
• Objective correlation of morphological changes with visual function is crucial for surgical planning and outcome prediction.

Purpose of the Study:

• To objectively correlate optic apparatus morphology distortions with visual function in patients with pituitary adenomas.
• To evaluate the predictive value of pre- and post-operative imaging measures on visual outcomes.
• To establish thresholds for predicting normal visual function post-surgery.

Main Methods:

• Retrospective analysis of 71 eyes from patients undergoing trans-sphenoidal surgery for pituitary adenomas.
• Objective scoring of visual acuity (VA), visual field (VF), and total visual (TV) function.
• Pre- and post-operative measurement of chiasm area, mid-chiasm height (CH), optic nerve-canal bending angle (BA), and optic nerve kinking angle (ONKA).
• Receiver operator characteristic (ROC) analysis to determine predictive thresholds.

Main Results:

• Significant improvement in VA, VF, and TV scores at 3 months and 1 year post-surgery (P < 0.001).
• Cranio-caudal tumor dimension correlated significantly with visual scores pre- and post-operatively.
• Significant changes observed in CH, BA, and ONKA at 3 months post-surgery.
• Preoperative ONKA demonstrated acceptable discrimination (AUC >0.7) for predicting normal TV score at 1 year.
• Chiasm sag occurred in 45.8% but was not associated with delayed visual deterioration.

Conclusions:

• Anatomic realignment of the optic apparatus 3 months post-surgery predicts 1-year VF scores.
• Preoperative ONKA >139.3° offers a 76% chance of achieving normal TV scores at 1 year.
• Postoperative chiasm sag appears clinically insignificant in the short term.