시야 결손이 있는 뇌하수체샘종 환자에서 수술 후 시야 변화
Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma
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목적: 시야결손이 발생한 뇌하수체샘종 환자에서 수술 후 시야 변화를 분석하였다. 대상과 방법: 2001년 7월부터 2010년 2월 사이 시야결손을 동반한 뇌하수체샘종으로 수술 받은 48명 96안을 대상으로 후향적 고찰을시행하였다. 의무기록을 통해 수술 전후 나이, 종양의 부피, 교정시력, 수술방법, 시야검사 수치를 비교하였다. 결과: 전체 환자에서 평균 1.85개월 동안 mean deviation (MD)는 15.79% (p=0.001), pattern standard deviation (PSD)는 3.98%(p=0.003) 호전되었다. 나비뼈경유 샘종 제거술을 시행 받은 환자군에서 MD는 26.99% (p=0.000), PSD은 12.92% (p=0.003) 유의하게 호전되었으며, 수술 전 MD는 수술 후 MD와 양의 상관 관계(Pearson=0.762, p=0.000)를 보였고, MD 회복량과는 음의 상관 관계(Pearson=-0.231, p=0.046)를 보였다. 머리뼈경유 샘종 제거술을 받은 경우 유의미한 시력 회복이 일어나지 않았다. 결론: 뇌하수체샘종에 의한 시야결손은 수술적 치료에 의해 일부 호전되며, 수술 전 시야결손이 적을수록 시야 예후가 좋다. 나비뼈경유수술을 시행한 경우 머리뼈경유수술을 시행한 경우보다 시야 예후가 더 좋다.
Abstract
Purpose: To evaluate visual field (VF) changes in patients with pituitary adenoma after surgical treatment. Methods: The present study retrospectively evaluated 96 eyes of 48 patients with pituitary adenoma who received surgical tumor removal between July 2001 and February 2010. Preoperative and postoperative clinical data including age, tumor volume, logMAR BCVA, surgical technique (transsphenoidal surgery and transcranial surgery), static perimetry scores (mean deviation [MD], pattern standard deviation [PSD], and visual field defect [VFD] scores) were reviewed. Results: The MD (15.79%, p = 0.001) and PSD (3.98%, p = 0.003) improved postoperatively (mean postoperative follow-up period 1.85 months). Transsphenoidal surgery for tumor removal showed significant MD (26.99%, p = 0.000) and PSD (12.92%, p = 0.003) improvements. A multivariate regression analysis of the transsphenoidal surgery patient group revealed that the preoperative MD was related to the postoperative MD (Pearson = 0.762, p = 0.000), but negatively correlated to the amount of postoperative improvement in MD score (Pearson = -0.231, p = 0.046). Transcranial surgery did not significantly improve the MD (p = 0.419), PSD (p = 0.562), VFD score (p = 0.135), or logMAR BCVA (p = 0.708). Conclusions: Visual filed defects in patients with pituitary adenoma improved after neurosurgical treatment. Better postoperative visual field outcomes were achieved in patients who had smaller preoperative visual field defects. Transsphenoidal surgery significantly improved the visual field defects and visual acuity in patients with non-functioning pituitary adenoma, compared to the transcranial surgery patients.
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