Visual status after transsphenoidal surgery at the Mayo Clinic, 1971-1982.

In 1,003 patients who underwent transsphenoidal surgery for sellar and parasellar lesions, the surgical mortality was 0.7% (seven patients). Only 25 patients experienced visual complications. Pituitary adenomas were found in 851 patients, of whom 714 underwent visual acuity and visual field testing both before and after their transsphenoidal operations. Among this group, visual acuity had been reduced in 115; postoperatively it was restored to normal or improved in 53, remained the same in 60, and became worse in two. Visual fields, which had been abnormal preoperatively in 230 cases, were restored to normal or improved in 168, remained the same in 52, and became worse in ten. There were also five patients whose vision was normal preoperatively but not postoperatively; thus, the total of those whose sight became worse after transsphenoidal surgery was 17. Surgical mortality in the group with adenomas was 0.5% (four of 851 patients). Nine adenomas recurred during follow-up. Of 40 patients with craniopharyngiomas, 21 had abnormal vision preoperatively; postoperatively, nine were improved and two were worse. In 40 cases surgical exploration failed to disclose any abnormality. There were 12 patients with chordomas and 60 with miscellaneous sellar and parasellar tumors.