Nuances in Visual Rehabilitation After Pituitary Surgery

Patients with pituitary lesions often present with visual deficits attributable to mass effect along the optic pathway or on the cranial nerves controlling extraocular muscles. While symptoms often improve after treatment, persistent symptoms negatively impact quality of life. We reviewed the literature on emerging concepts in visual monitoring and recovery during and after pituitary surgery. Rigorous preoperative laboratory testing, neuro-ophthalmologic examination, and imaging abets planning of safe surgery. Intraoperative visual evoked potentials may provide an adjunct to monitor impending damage to vision during surgery, particularly for recurrent tumors that may have scarred onto visual structures. Treatment of persistent visual deficits depends on the physiological cause of the deficit, the duration of symptoms, and the degree and pace of spontaneous recovery. Management ranges from observation to corrective oculoplastic surgery, often in the context of a multidisciplinary team. There are several gaps in knowledge on the reasons why visual deficits remain after adequate decompression during surgery, and further study will reveal new therapies and devices. Postoperative visual deficits following pituitary surgery can cause a considerable reduction in quality of life. Multidisciplinary neurosurgery, neuro-ophthalmologic, and neuro-endocrine teams should work in concert to provide an individualized approach for each patient.