Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma

Restricted access

OBJECTIVE

Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%–90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas.

METHODS

The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery.

RESULTS

Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery.

CONCLUSIONS

Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.

ABBREVIATIONS HR-QOL = health-related QOL; NEI-VFQ-25 = National Eye Institute Visual Function Questionnaire-25; QOL = quality of life; SF-36 = 36-Item Short Form Health Survey; VR-QOL = vision-related QOL.
Article Information

Contributor Notes

Correspondence Neil Duggal, London Health Sciences Centre, University Hospital, 339 Windermere Rd., London, ON N6A 5A5, Canada. email: neil.duggal@lhsc.on.ca.INCLUDE WHEN CITING Published online October 7, 2016; DOI: 10.3171/2016.7.JNS16200.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Biermasz NRvan Thiel SWPereira AMHoftijzer HCvan Hemert AMSmit JWA: Decreased quality of life in patients with acromegaly despite long-term cure of growth hormone excess. J Clin Endocrinol Metab 89:536953762004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Dekkers OMvan der Klaauw AAPereira AMBiermasz NRHonkoop PJRoelfsema F: Quality of life is decreased after treatment for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 91:336433692006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Fraser CLBiousse VNewman NJ: Visual outcomes after treatment of pituitary adenomas. Neurosurg Clin N Am 23:6076192012

  • 4

    Gall CFranke GHSabel BA: Vision-related quality of life in first stroke patients with homonymous visual field defects. Health Qual Life Outcomes 8:332010

  • 5

    Hayashi YKita DIwato MFukui IOishi MTsutsui T: Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement. Pituitary 19:1751822016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hazer DBIşık SBerker DGüler SGürlek AYücel T: Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg 119:146714772013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Johnson MDWoodburn CJVance ML: Quality of life in patients with a pituitary adenoma. Pituitary 6:81872003

  • 8

    Kayan AEarl CJ: Compressive lesions of the optic nerves and chiasm. Pattern of recovery of vision following surgical treatment. Brain 98:13281975

  • 9

    Kerkhoff G: Restorative and compensatory therapy approaches in cerebral blindness—a review. Restor Neurol Neurosci 15:2552711999

  • 10

    Mangione CMLee PPGutierrez PRSpritzer KBerry SHays RD: Development of the 25-Item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 119:105010582001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    McCoul EDBedrosian JCAkselrod OAnand VKSchwartz TH: Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection. J Neurosurg 123:8138202015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    McHorney CAWare JE JrRaczek AE: The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:2472631993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Okamoto YOkamoto FYamada SHonda MHiraoka TOshika T: Vision-related quality of life after transsphenoidal surgery for pituitary adenoma. Invest Ophthalmol Vis Sci 51:340534102010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Peter MDe Tribolet N: Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 9:1511571995

  • 15

    Rotenberg BTam SRyu WHADuggal N: Microscopic versus endoscopic pituitary surgery: a systematic review. Laryngoscope 120:129212972010

  • 16

    Shin SSGardner PANg JFaraji AHAgarwal NChivukula S: Endoscopic endonasal approach for ACTH-secreting pituitary adenomas: outcomes and analysis of remission rates and tumor biochemical activity with respect to tumor invasiveness.. World Neurosurg [epub ahead of print]2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Tanemura ENagatani TAimi YKishida YTakeuchi KWakabayashi T: Quality of life in nonfunctioning pituitary macroadenoma patients before and after surgical treatment. Acta Neurochir (Wien) 154:189519022012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Ware JE JrGandek B: Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 51:9039121998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Wolf AGoncalves SSalehi FBird JCooper PVan Uum S: Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma. J Neurosurg 124:162716332016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 704 620 114
PDF Downloads 314 228 27
EPUB Downloads 0 0 0
PubMed
Google Scholar