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Background: The aim of this work was to determine predictors that may contribute to surgical success or failure. Relevant pre- and postoperative baseline data were analyzed, and temporal structures underwent a volumetric analysis., Methods: A total of 207 patients (107 female) underwent complete evaluation for epilepsy surgery. Prospectively collected data used for this analysis included the clinical and demographic data. Classic prognostic factors (e.g., gender, age at operation, age at epilepsy manifestation, duration of epilepsy, education, side of pathology, intracranial EEG recordings, secondarily generalized tonic-clonic seizures, etiological factors, histology) and a volumetric analysis of 12 temporal lobe subregions were used in a regression analysis to identify possible prognostic factors in surgery for TLE. Primary outcome measure was seizure freedom at 1 year and during the full first year expressed as class I in the ILAE outcome scale., Results: In the univariate analysis, we identified one negative predictor for a less favorable seizure outcome: intracranial EEG recordings (p = 0.010), hippocampal sclerosis as histological finding trended toward statistical significance (p = 0.054). No statistical outcome significance was found for preoperative temporal lobe compartment volume loss or postoperative lateral atrophy after mesial resection., Conclusions: Necessity for intracranial EEG recording is an independent factor of not optimal seizure control in the 1-year follow-up. Preoperative temporal lobe volume differences including smaller mesial subcompartments did not correlate with poorer seizure outcome.

Background: It is not known whether following transsphenoidal surgery for pituitary adenomas the vision of patients with preoperative chiasma syndromes (CS) does improve to the degree of vision of patients without preoperative CS., Objective: The purpose of this study is to answer the question above., Methods: Pertinent data of a successive series of patients operated transsphenoidally for the first time for pituitary adenoma were retrospectively analysed., Results: Of the 304 patients, 35.1% presented preoperatively with CS. The median visual acuity (VA) of these patients improved significantly from preoperative (right eye, 0.63 (0; 1.25); left eye, 0.56 (0; 1.4)) to postoperative (right eye, 0.8 (0; 1.25); left eye, 0.74 (0; 1.25)). The median number of impaired quadrants of the binocular visual fields (VF) improved significantly from preoperative (2 (0; 8)) to postoperative CS (0 (0; 4)). In patients without preoperative CS, postoperative vision (VA as well as VF) remained unchanged. Postoperatively, VA of patients with preoperative CS remained significantly lower than that of patients without preoperative CS (right eye, 0.96 (0.2; 1.4); left eye, 0.94 (0.05; 1.4)). Postoperatively, the number of impaired quadrants of the binocular VF of patients with preoperative CS remained significantly higher than in patients without preoperative CS (0 (0; 1))., Conclusion: In this unselected patient series, the vision (VA as well as VF) of patients with preoperative CS did not improved postoperatively to the degree of the vision of patients without preoperative CS. Thus, in patients with adenomatous chiasma compression transsphenoidal surgery may be indicated before CS develops.

Purpose: To describe the functional impairment caused by chiasma syndromes (CS) prior to and following transsphenoidal pituitary adenoma surgery., Methods: Pertinent data of a successive series of patients operated transsphenoidally for the first time for pituitary adenoma were retrospectively analyzed. The degree of functional impairment caused by the impairment of vision was quantified according to the resulting degree of disability (DOD). A DOD of > or =30 is considered substantial., Results: None of the 197 of 304 (64.9%) patients without preoperative chiasma syndrome (CS) experienced postoperative worsening of their visual acuity or their visual fields. Thus, no change of their vision-related DOD (V-DOD) did occur. One hundred and seven (35.1%) of the patients presented preoperatively with CS. Postoperatively, 42.9% of the CS remitted completely, 38.3% improved, 11.2% remained unchanged, and 7.4% worsened. Accordingly, the median V-DOD improved significantly from 30 (0; 100) to 0 (0; 100). The prevalence of patients with V-DOD > or =30 dropped significantly from 51.4% preoperatively to 16.4% postoperatively. Postoperatively, the median V-DOD improved significantly up to 3 months postoperatively. Thereafter, no further significant changes occurred. However, in patients with preoperative CS, the median V-DOD as well as the prevalence of patients with a V-DOD > or =30 remained postoperatively significantly higher compared to patients without preoperative CS., Conclusions: Visual impairments due to CS frequently caused substantial DOD preoperatively. Postoperatively, the median degree of V-DOD as well as the prevalence of substantial V-DOD improved significantly. However, in patients with preoperative CS, V-DOD remained postoperatively significantly higher than V-DOD of patients without preoperative CS.