Factors affecting visual outcomes of pituitary macroadenoma following transsphenoidal surgery

Objective: 1. To provide quantitative objective measurement of the efficacy of surgery for pituitary macroadenoma. 2. To discuss different factors that could affect visual outcomes of pituitary macroadenoma Method: This is a single centre prospective study, conducted at DEPARTMENT OF NEUROSURGERY SMS MEDICAL COLLEGE AND HOSPITAL JAIPUR over one year (May 2021-May 2022), 50 cases of sellar, suprasellar tumours were included were treated with surgery. Our study excluded pituitary apoplexy and included both functioning and non-functioning pituitary adenomas. We analyzed how various factors impacted vision outcomes, including post-surgical tumour height reduction (vertical decompression) and changes in Knosp grade (lateral decompression). Vision results were assessed using the Visual Impairment Score (VIS), combining visual acuity and visual field deficits. Results: Preoperative tumour height and supracarotid height significantly affect VIS (p < 0.005) and Knosp grading also showed a significant correlation with VA (p =0 .03) and VF (p=0.03). Our study found significant impact of tumour height reduction on VIS improvement. Change in supracarotid height showed a trend towards correlation with VIS change (p = 0.054). Additionally, there were no significant differences in complications between groups, with a marginal trend observed in diabetes insipidus (p = .372) Conclusion: The research highlights that the degree of optic nerve compression, particularly measured from the bend of the internal carotid artery, is crucial for predicting vision outcomes. Endoscopic surgery is preferred for treating these tumours because it allows for better sideways decompression, which is essential for relieving nerve pressure in both vertical and horizontal directions. This approach is pivotal in achieving optimal vision recovery and maximizing vision improvement compared to other surgical methods.