2025 Proffered Presentations
S127: PREDICTOR OF NEW POSTOPERATIVE VISUAL DETERIORATION AND DEFICIT POST ENDOSCOPIC ENDONASAL PITUITARY ADENOMA RESECTION
Sami Khairy, MD; Mouaz Saymeh, MD; Jessica Rabski, MD; Shaun Kilty, MD; Fahad AlKherayf, MD; Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
BACKGROUND: Postoperative visual deterioration following endoscopic endonasal transsphenoidal surgery for pituitary adenoma is very rare yet significant morbidity. Iatrogenic injury, compression, and ischemic insults are the principal mechanisms but timely diagnosis and intervention can potentially improve the outcome; however, the predictors and their correlation with intervention outcome remain poorly elucidated. The aim of this study to investigate the predictors of visual deterioration in patients who underwent endoscopic endonasal pituitary adenoma resection.
STUDY DESIGN AND METHODS: We reviewed 790 patients in our database for the last 10 years (2014- 2024). We included all the patients with pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery and had Postoperative visual deterioration. Demographic data, preoperative, intraoperative, postoperative clinical data and patients' outcomes were retrospectively collected and analyzed.
RESULTS: Nine patients (1.13%) experienced early postoperative visual deterioration. None of the patient has intraoperative report of direct injury to the optic apparatus, ischemic etiology was seen in five patients. Four patients (44%) underwent early reoperation to explore and decompress the optic apparatus. Vision was restored to baseline after reoperation in all 4 compressive cases. In the ischemic group (n = 5), three patients improved with supplemental oxygen and hypervolemic-hypertensive therapy (p = 0.03). mean arterial pressure elevation after surgery were significantly higher (p = 0.04) in those ischemic patients who recovered some vision compared with those with persistent visual deficits.
CONCLUSIONS: Postoperative visual deterioration following endoscopic endonasal surgery for pituitary adenoma is very rare but serious complication. Visual deterioration can be treated if underline cause was identified and intervention was done. Compressive etiology has a favorable prognosis when identified and managed with reoperation and decompression. Ischemic etiology potentially treatable with supplemental oxygen, hypervolemic-hypertensive and high mean arterial pressure in almost half of cases.