title: Early morphological recovery of the optic chiasm is associated with excellent visual outcome in patients with compressive chiasmal syndrome caused by pituitary tumors.
abstract: OBJECTIVE
  The study objectives are (1) to identify factors predicting the excellent visual recovery after transsphenoidal removal of pituitary tumors and (2) to describe the association of excellent visual recovery and early restoration of symmetry of the decompressed optic chiasm.
  
  
  METHODS
  Thirty-five patients with visual symptoms due to pituitary tumors underwent endoscopic endonasal surgery. All patients received perioperative diagnostic magnetic resonance (MR) imaging and ophthalmological assessments within 2 weeks before surgery, within 2 weeks after surgery, and 3 months or later after surgery. Preoperative best-corrected visual acuity (BCVA ≧ 20/20), degree of visual field deficit (VFD, less than half of VF), thickness of retinal nerve fiber layer (RNFL) measured by optical coherence tomography (OCT), and thickness of ganglion cell complex (GCC) measured by OCT were considered for statistical analysis as predictive factors of VF outcome. Multivariate logistic regression models were used in statistical evaluation of data.
  
  
  RESULTS
  In the multivariate analysis, RNFL (odds ratio  =  62.137, P < 0.001) and preoperative VFD (odds ratio  =  8.244, P < 0.02) proved to be effective as factors predicting sufficient VF recovery. Postoperative restoration of symmetry of the optic chiasm was related to sufficient VF recovery (P < 0.0001, Fisher's exact test) and RNFL (P < 0.0001, Fisher's exact test).
  
  
  CONCLUSIONS
  Early decompression is crucial for sufficient VF recovery, in particular, while RNFL preserves normal or borderline thickness and while VFD keeps within hemianopia. Morphological reversibility is associated with functional reversibility in the optic chiasm compressed by a pituitary tumor. In particular, early morphological recovery suggests functional recovery, which indicates neurocyte reserve in the compressed optic pathway with functional recovery.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yoneoka
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Hatase
authors.forename: Naoto
authors.initials: N
authors.lastname: Watanabe
authors.forename: Shinya
authors.initials: S
authors.lastname: Jinguji
authors.forename: Masayasu
authors.initials: M
authors.lastname: Okada
authors.forename: Mineo
authors.initials: M
authors.lastname: Takagi
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D044583:Neuroendoscopy / Q000009:adverse effects*; D009897:Optic Chiasm / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011379:Prognosis; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D014792:Visual Acuity
keywords: Early visual field outcome,; Functional reversibility; Morphological reversibility,; Optical coherence tomography,; Pituitary tumor,; Retinal nerve fiber layer,; Transsphenoidal surgery,