Visual Impairment Due to Optic Chiasm Herniation Following Endoscopic Transsphenoidal Surgery: A Collection of Case Studies

Abstract

Background: The pituitary gland is prone to various lesions, and the endoscopic transsphenoidal approach is a minimally invasive surgical technique for removing such lesions. Surgical removal of part or all pituitary lesions can result in an empty sella turcica, potentially causing herniation of the optic chiasm. This report presents three cases of patients who developed visual impairment following pituitary surgery and were diagnosed with herniation of the optic chiasm into an empty sella turcica. Case Series: We report three cases of visual deterioration following transsphenoidal resection, with MRI findings indicating optic chiasm herniation. These cases underscore the complexity of post-surgical outcomes and the potential mechanical impact on the optic chiasm. Case 1: A 65-year-old man underwent surgery for a Rathke’s cleft cyst, resulting in initial unchanged vision, followed by worsening bitemporal hemianopia despite successful cyst removal. Post-operative imaging suggested optic chiasm herniation, with subsequent hormonal disturbances developing 4 weeks after surgery. Case 2: A 62-year-old man with a history of macroprolactinoma, initially treated with dopamine agonists, experienced progressive vision loss despite medical therapy, leading to surgical intervention. Post-surgery, prolactin levels improved, but visual acuity continued to decline, with imaging showing persistent optic chiasm herniation 6 weeks post-operation. Case 3: A 37-year-old man, previously treated for a pituitary adenoma via transsphenoidal surgery, presented with worsening bitemporal hemianopia 96 weeks post-surgery. MRI revealed downward traction of the optic chiasm, suggesting long-term mechanical effects impacting vision. Conclusion: This case series highlights that patients presenting with visual changes and a history of recent pituitary gland surgery should be investigated for herniation of the optic chiasm into the sella turcica.