Objective: To investigate the association of microsurgical anatomy and growth of pituitary tumors with the recovery of visual pathway, and describe the intraoperative protection of the pituitary stalk and visual pathway.
Methods: A total of 113 patients undergoing pituitary tumor surgery were retrospectively analyzed, including 102 with visual disorder and 106 with pituitary dysfunction with the tumor size ranging from 1.9 to 6.8 cm. All the operations were performed via a transpterygoid approach or transfrontal approach.
Results: Radical resection of the tumors was performed in 86 cases, subtotal resection in 21 cases, and partial resection in 5 cases. After operation, 133 eyes showed vision improvement (77.8%), 29 showed no vision changes (17%) and 9 had deteriorated vision. Two patients died due to hypothalamic disorder and multiple organ failure.
Conclusion: The arachnoid barrier between the pituitary tumor and visual pathway is an important structure for visual pathway protection during operation. Total separation of the tumor from the visual pathway allows total removal of the tumor. The preoperative localization and intraoperative identification of the pituitary stalk are critical for pituitary stalk protection.