Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study|
Sriram, Prabu Rau; Sellamuthu, Puliventhan & Izani Ghani, Abdul Rahman
Background: Despite the broad category of differentials for sellar region, most of them
present with similar clinical signs and symptoms. Headache and visual disturbance are among
the frequently seen as presenting symptom. Visual field (VF) assessment is one of the crucial
component of neuroophtalmologic assessment and mean deviation (MD) value from automated
perimetry allows quantification of the visual field defect. We formulated a study to look into the
factors that affect the visual field outcome after surgery.
Methods: All patients with sellar region tumor who has underwent surgery in Queen
Elizabeth Hospital from July 2010 to July 2016 were retrospectively analysed through hospital
notes. VF assessment via Humphrey visual assessment for these patient pre and post-surgery were
reviewed for MD value.
Results: Eighty four patients were recruited and out of them, 151 eyes were taken into
analysis after excluding eyes with missing data. Mean age of patients were 45.4 years with 70.2% of
them were male. Visual disturbance is the commonest presenting symptom with mean duration of
symptom prior to surgery is 9.7 months. Majority of them were pituitary adenomas (75%) followed
by sellar meningioma (19%), craniopharyngioma (4.8%), and rathke cleft cyst (1.2%). 70.9% of
patients showed improvement in VF based on MD outcome. Mean MD for pre surgery and post-surgery
were -14.0 dB and -12.4 dB, respectively. Univariate analysis reveals younger age, female
sex, shorter duration of symptom, pituitary adenoma, transsphenoidal approach, and transcranial
approach favours improvement in VF. Multivariate analysis shows only shorter symptom duration,
transphenoidal approach, and transcranial approach are significant for favourable VF outcome
when other factors adjusted.
Conclusion: Symptom duration and surgical approach were independent factors that
affects the visual field after surgery in patients with sellar region tumors.
visual field; perimetry; sellar tumor; pituitary adenoma