目的:客观地将患者的视器形态畸变与接受经蝶入路手术的垂体腺瘤(PAs)患者的视觉结果相关联。
方法:在本回顾性分析中,视敏度(VA),在从PA的机构队列中选择的患者中,对视野(VF)和总体视觉(TV)功能进行客观评分。术后3个月:交叉区(CA),中交叉高度(CH),视神经管弯曲角(BA),和视神经扭结角(ONKA)。进行了接收器操作员特征(ROC)分析,以建立最佳阈值,以在1年的随访中达到200的“正常”电视评分。
结果:对71只眼进行了单独研究。VA,术后VF和TV评分显著改良,在3个月和1年随访时(p<0.001)。颅尾肿瘤尺寸与VA显著相关,VF和电视得分,术前和术后。CH有显著变化(p<0.001),手术后3个月的BA(p<0.001)和ONKA(p<0.001),但在CA中没有(p=0.061)。基线VA,VF和TVS评分与术前CH和ONKA呈正相关,而VF和TV评分也显示与术前BA呈显著负相关。1年随访时VF评分与术前和BA值变化显著相关,以及术前和ONKA值的变化。ROC分析显示,只有术前ONKA具有可接受的鉴别(AUC>0.7)来预测“正常”电视评分。在一年的随访中,有45.8%的患者出现Chiasm凹陷,但在任何情况下都与延迟视力恶化无关。
结论:经蝶入路手术3个月后,对光学装置的解剖重新对准可预测VF评分,但不是1年随访时的VA或TV评分。术前ONKA值大于139.3°的患者在手术后一年有76%的机会达到正常的TV评分。术后交叉凹陷在短期随访中似乎与临床无关。
OBJECTIVE: To objectively correlate distortions of optic apparatus morphology in patients with visual outcomes in patients with pituitary adenomas (PAs) undergoing trans-sphenoidal surgery.
METHODS: In this retrospective analysis, visual acuity (VA), visual field (VF) and total visual (TV) function was objectively scored in patients selected from an institutional cohort of PAs The following imaging measures of optico-chiasmatic morphology were recorded preoperatively, and at 3 months after surgery: chiasm area (CA), mid-chiasm height (CH), optic nerve-canal bending angle (BA), and optic nerve kinking angle (ONKA). Receiver operator characteristic (ROC) analysis was performed to establish optimal thresholds for achieving a \'normal\' TV score of 200 at 1-year follow-up.
RESULTS: Seventy-one eyes were individually studied. VA, VF and TV scores significantly improved after surgery, both at the 3-month and at the 1-year follow-up visits (p<0.001). Cranio-caudal tumor dimension was significantly associated with VA, VF and TV scores, both pre- and post-operatively. There were significant changes in CH (p<0.001), BA (p<0.001) and ONKA (p<0.001) at 3 months after surgery, but not in CA (p=0.061). Baseline VA, VF and TVS scores were positively correlated with preoperative CH and ONKA, while VF and TV scores also demonstrated significant negative correlations with preoperative BA. VF scores at 1-year follow-up were significantly correlated with preoperative and change in BA values, as well as with preoperative and change in ONKA values. ROC analysis revealed that only the preoperative ONKA was found to have acceptable discrimination (AUC>0.7) for predicting \'normal\' TV score. Chiasm sag was noted in 45.8% of patients at one year follow-up, but was not associated with delayed visual deterioration in any case.
CONCLUSIONS: Anatomic realignment of the optic apparatus 3 months following trans-sphenoidal surgery predicts VF scores, but not VA or TV scores at 1 year follow-up. Patients with preoperative ONKA values of more than 139.3° have a 76% chance of achieving normal TV scores one year after surgery. Postoperative chiasm sag appears to be clinically irrelevant at short term follow-up.