Risk Factors for Irreversible Vision Loss in Tumors of the Sellar Region

Introduction. The compressive effect on the chiasm is characteristic of skull base tumors of the middle and anterior cranial fossae, among which pituitary adenoma, tuberculum sellae meningioma and supradiaphragmatic craniopharyngioma are most common. The goal of treatment of skull base tumors is to decompress the anterior visual pathway and to improve or restore visual function; however, in some patients, visual deficits persist despite successful surgical intervention. For the prevention of irreversible vision loss and blindness, early diagnosis of tumors and determination of risk factors for the development of irreversible vision loss in skull base tumors play an important role. Prediction of the ophthalmic outcome after removal of skull base tumors remains a difficult and important issue. Aim. To analyze risk factors for the development of irreversible vision loss in tumors of the sellar region. Materials and methods. The results of diagnosis and treatment of 300 patients (600 eyes) with skull base tumors, who were treated at the National Academy of Medical Sciences of Ukraine Romodanov Neurosurgery Institute from 2017 to 2023. Depending on the ophthalmological result after the removal of the skull base tumors and decompression of the chiasm, the patients were divided into 2 subgroups: I – recovery of visual functions (100 patients, 33.3%, 200 eyes), II – without recovery of visual functions (200 patients, 66.7 %, 400 eyes). Neurological, ophthalmological and neurovisualization was used for an observation. Results. In our study, an analysis of risk factors for the development of irreversible vision loss in patients with skull base tumors was conducted. The analysis showed that the following factors: age, gender, histological type of tumor, the presence of strongly asymmetric chiasmal syndrome had no prognostic negative influence on the outcome of compressive optic neuropathy (p>0.05). It was found that the duration of symptoms, the level of preoperative visual acuity and visual field, changes in the morphostructural parameters of the optic nerve and retina, and the size of the tumors have a significant negative prognostic value for the ophthalmological outcome (p<0.05). Conclusions. The interaction of many factors, including the duration of symptoms, tumor volume, preoperative visual acuity level, visual field, morphostructural parameters of the optic nerve and retina, can have an effect on the functional visual outcome after the removal of the skull base tumors.