VISUAL FIELD DEFECTS;

THE COMPARISON BEFORE AND AFTER EXCISION OF SELLA SUPRA SELLAR TUMORS BY PERFORMING THE PRE AND POST-OP COMPUTERIZED PERIMETRY

Abstract

Objectives: To obtain and compare the exact visual status before and after
excision of sella supra sellar tumors using the computerized perimetry as a standard measuring
tools and then compare with the international studies. Background: Sella suprasellar tumors
are though not so common but affect visual acuity of patients and their quality of life drops.
These tumors include pituitary adenoma commonest in the adult population, meningioma,
Craniopharyngioma, astrocytic glioma, Optic nerve Glioma, Germinoma, Dermoid, Pituitary
metastases. We planned a descriptive case series study to compare the pre and post excision
visual field defects using computerized perimetry. Study Design: Case series study. Setting:
Department of Neurosurgery, Pakistan Institute of Medical Sciences, SZABMU, and Islamabad.
Period: 2 years from January 2015 to December 2016. Methods: A total of 73 patients with
sella suprasellar tumors were identified and enrolled. Patients between the age of 10 and
55 years were selected on the basis of having sella supra sellar tumor on CT/MRI brain with
contrast. Patients whose age was less than 10 years and more than 55 years were excluded.
Moreover, patients with post radiation necrosis diagnosed on MRI and MR spectroscopy brain,
those operated for other eye pathology and patients with sella supra sellar SOL having comorbidities
like diabetes mellitus, hypertension etc. were also excluded from the study. The
study outcome was measured in terms of comparison of visual field defects after excision of
sella suprasellar tumors using computerized perimetry. Results: The average age of patients
was 42.1 + 6.8 years ranging from 10 to 55 years. Female gender was predominant; there
were 40 (54.8%) female patients. The mean computerized perimetry was 0.65 + 0.34 LogMAR
before surgery which improved to 0.19 + 0.12 LogMAR after surgery. Overall, of the 73 cases,
63 (86.4%) had improvement whereas 10 (13.6%) study cases had no improvement in the
visual field on follow-up. Conclusion: It can be concluded that after craniotomy and excision
of sella suprasellar tumors, perimetry showed improvement in the majority of the study cases.