title: Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma.
abstract: OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.
authors.affiliation: Divisions of 1 Neurosurgery and.
authors.forename: Amparo
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Divisions of 1 Neurosurgery and.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Coros
authors.affiliation: Divisions of 1 Neurosurgery and.
authors.forename: Joel
authors.initials: J
authors.lastname: Bierer
authors.affiliation: Divisions of 1 Neurosurgery and.
authors.forename: Sandy
authors.initials: S
authors.lastname: Goncalves
authors.affiliation: Neurology, and.
authors.forename: Paul
authors.initials: P
authors.lastname: Cooper
authors.affiliation: Division of Endocrinology and Metabolism.
authors.forename: Stan
authors.initials: S
authors.lastname: Van Uum
authors.affiliation: Department of Medical Imaging, London Health Sciences Centre; and.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Ivey Eye Institute, and.
authors.forename: Alain
authors.initials: A
authors.lastname: Proulx
authors.affiliation: Neurology, and.
authors.forename: David
authors.initials: D
authors.lastname: Nicolle
authors.affiliation: Neurology, and.|Department of Ophthalmology, Ivey Eye Institute, and.
authors.forename: J Alexander
authors.initials: JA
authors.lastname: Fraser
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, St. Joseph's Hospital, London, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.affiliation: Divisions of 1 Neurosurgery and.
authors.forename: Neil
authors.initials: N
authors.lastname: Duggal
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D059026:Diagnostic Self Evaluation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D013100:Sphenoid Bone; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014785:Vision, Ocular
keywords: HR-QOL = health-related QOL; NEI-VFQ-25 = National Eye Institute Visual Function Questionnaire-25; QOL = quality of life; SF-36 = 36-Item Short Form Health Survey; VR-QOL = vision-related QOL; endoscopic transsphenoidal surgery; pituitary adenoma; pituitary surgery; vision-related quality of life