Introduction: Previous attempts to search risk factors that predict visual recovery after transsphenoid pituitary adenoma resection have been limited. We sought to develop a clinical score system that could identify patients with poor post-operative visual recovery.
Methods: 35 patients with pituitary adenoma comprised the risk score development group. The score was then applied to 30 additional patients in a validation group. Thorough ophthalmic and image examination was performed. The following data were recorded for each patient: age, gender, visual acuity, pathology, tumor height on MRI, course of disease, static automated perimetry (SAP), multi-focal visual evoked potential (mfVEP), retinal nerve fiber layer (RNFL) and functional magnetic resonance image (fMRI). Univariate and multivariate analysis were performed to construct the score system. Risk scores were developed by assigning points based on ß-coefficients.
Results: FMRI was included in the univariate analysis but excluded in the multivariate analysis. Finally independent predictors of poor visual recovery included SAP, RNFL and mfVEP. Low-, moderate-, and high-risk ranges of 1 to 3, 4 to 6, and 7 to 9 points, respectively, best predicted poor visual recovery (C statistic = 0.898). The recovery degree of visual field ranged from 72.6% to 92.6% (low risk score), from 51.7 to 63.7% (moderate risk score) and from 1.6% to 43.0% (high risk score).
Conclusions: A clinical score have been developed and successfully validated for predicting visual recovery after transsphenoidal pituitary adenoma resection.
Patient Care: The newly designed score method will provide neurosurgeons new method to predict visual recovery in patients with pituitary adenomas.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the newly designed score, 2) Discuss, in small groups, the usage of this score in our routine diagnosis of pituitary adenomas. 3) Identify an more efficient way to improve the score method.