Risk factors and prognosis of visual and cranial nerve deficits in patients operated for pituitary tumor - with a focus on intrasellar pressure.

Purpose: The aim of this study was to evaluate if intrasellar pressure (ISP) is associated with the risk of visual impairment in patients with a pituitary tumor, and the prognosis for visual function after tumor surgery.

Method: Retrospective, single-center study including 100 consecutive patients operated for a pituitary tumor, who had their ISP measured. Data on patient and tumor characteristics, pre- and postoperative visual acuity, visual fields, and cranial nerve III, IV, and VI deficits were collected from patient files.

Results: Before surgery, 64% had visual acuity impairment and 65% visual field deficits. Postoperatively, the frequencies were 40% for visual acuity impairment and 41% for visual field deficits. Risk factors for preoperative visual impairment were tumor volume, suprasellar tumor extension (SIPAP grade 3-4), and female sex. ISP was associated with higher risk of visual acuity impairment at postoperative follow up. No other correlations between ISP and pre- or postoperative visual and cranial nerve outcome were found. Age was associated with lower chance of visual acuity improvement and increased risk of visual field deficits postoperatively.

Conclusion: Overall, ISP does not seem to play an important role as a risk factor or prognostic factor for visual and cranial nerve impairment in pituitary tumor disease. However, ISP showed an association with postoperative visual acuity impairment. The clinical relevance of this results is not straight-forward. Tumor size, suprasellar growth pattern, and female sex are confirmed risk factors for preoperative visual symptoms. High age appears to negatively influence visual outcome after surgery.