Eyesight Loss Due To Pituitary Surgery
Removal of a tumour from the pituitary gland can help resolve visual problems. However, the delicate surgery required can also cause problems which might lead to permanent sight loss.
What is pituitary surgery?
The pituitary gland is found at the base of the brain behind the nose. It is fundamental to the successful functioning and regulation of the body in that it produces a range of hormones which send messages around the body. It controls many of the functions of growth, reproduction, survival and metabolism.
If a tumour or growth develops in or around the pituitary gland, it can affect the production and release of these hormones, subsequently impacting on many of the body's functions. A small tumour may not require surgery but pituitary tumours can grow to a significant size where they begin to impact on surrounding nerves and arteries.
This type of surgery can thus cause loss of vision due to the proximity of the optic nerves.
How is pituitary surgery carried out?
Pituitary surgery is a common, generally successful form of surgery. It is often carried out through endoscopic transsphenoidal surgery. This means that a small lighted tube (an endoscope) is inserted via the nose and (sphenoid) sinus behind the nose to reach the pituitary gland. Small surgical instruments are inserted via the endoscope to remove the tumour piece by piece.
Sight-related risks of pituitary surgery
The risks of pituitary surgery, as with any surgery, should be discussed with the patient before the decision is made to go ahead. These risks need to be balanced against the possible on-going development of the problems being caused by the presence of the tumour.
One of the rare risks of pituitary gland surgery is double vision or complete loss of sight. This may be caused by one or two factors related to the operation due to the closeness of the optic nerves to the pituitary gland.
Damage during surgery
If surgery is carried out via an endoscope, the surgeon does not have full, open access and vision of the surgical site. Using this method, it can difficult to extract the entire tumour and further, more invasive exploration to find remaining segments of the growth may put the nerves and blood vessels at risk.
The pituitary gland is located close to the optic nerves and the optic chiasm where they cross. It is possible for damage to be done to either structure during endoscopic surgery, resulting in visual damage and possible loss of sight.
Post-operative haemotoma
Localised clotting of blood in the area of the wound and associated swelling can cause compression on one of the optic nerves, leading to loss of function and loss of sight.
It is also, of course, possible that the patient's vision had already been compromised by the growth of the tumour and loss of sight is not related to the surgery.
Due to the proximity of the optic nerves, monitoring of visual functioning is an important aspect of post-operative care and any abnormalities need prompt investigation.
Medical Negligence
It has frequently been observed that this type of surgery must be undertaken by a neurosurgeon experienced in this field of work. An ENT specialist may also be involved.
Where irreversible damage has been caused, leading to permanent loss of sight, the patient may have been the victim of medical negligence.
It is also necessary for the patient to have been fully aware of the risks involved in this type of surgery before consenting to it.
As mentioned above, post-operative monitoring is also vital in observing and responding to any signs of visual disturbance.
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