• Ming Shen, Zhengyuan Chen, Xuefei Shou, Zengyi Ma, Zhao Ye, Wenqiang He, Yichao Zhang, Nidan Qiao, Qilin Zhang, Yue Shen, Keyi Zhang, Xiang Zhou, Xiaoyun Cao, Yao Zhao, Shiqi Li, and Yongfei Wang.
• Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
• World Neurosurg. 2020 Sep 1; 141: e60-e69.

BackgroundFactors associated with visual outcomes after transcranial surgery for large-to-giant pituitary adenomas have not been fully elucidated.MethodsWe recruited 37 patients with large-to-giant pituitary adenomas between January 2014 and December 2016 and assessed their tumor characteristics and surgical outcomes. Visual acuity and visual field were evaluated by visual impairment score before and 3-6 months after transcranial surgery. Multivariable logistic regression analysis was applied to show the factors associated with visual outcomes after surgery.ResultsThe severity levels of visual impairment before surgery were mild, moderate, severe, and complete in 24.3% (9/37), 24.3% (9/37), 35.1% (13/37), and 16.2% (6/37), respectively. After surgery, the visual function was improved, stabilized, and worsened in 43.2% (16/37), 43.2% (16/37), and 13.5% (5/37) of patients, respectively. Multivariable logistic regression analysis showed that subarachnoid space invasion was the only independent prognostic factor adversely influencing the postoperative visual outcomes. Patients with subarachnoid space invasion had a higher possibility of visual deterioration (36.4% vs. 3.8%; P = 0.021) after transcranial surgery, compared with those without subarachnoid space invasion.ConclusionsVisual compromise is still an unignorable complication during transcranial surgery for large-to-giant pituitary adenomas. Subarachnoid space invasion indicated by preoperative magnetic resonance imaging was an independent negative predictor for visual outcomes after surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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