Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

Abstract

PurposePatients with pituitary adenomas often present with visual deficits. While the aim of endoscopic endonasal transsphenoidal surgery (EETS) is to improve these deficits, permanent worsening is a possible outcome. The aim of this meta-analysis was to evaluate the effect of EETS for pituitary adenomas on visual outcomes.MethodsA meta-analysis was conducted according to the PRISMA guidelines. Pooled prevalence was calculated for complete recovery, improvement, and deterioration of visual field deficits, visual acuity and unspecified visual function in fixed- and random-effect models, including assessment of heterogeneity (I2) and publication bias (Begg’s test).ResultsOut of 2636 articles, 35 case series were included in the meta-analysis. Results are described for fixed-effect models. For patients with impaired visual acuity, only one study reported complete recovery (27.2%). Pooled prevalence for improvement was 67.5% (95% CI = 59.1–75.0%), but with considerable heterogeneity (I2: 86.0%), and 4.50% (95% CI = 1.80–10.8%) for patients experiencing deterioration. For patients with visual field deficits, the prevalence was 40.4% (95% CI = 34.8–46.3%) for complete recovery, 80.8% (95% CI = 77.7–83.6%) for improvement, and 2.3% (95% CI = 1.1–4.7%) for deterioration. For the unspecified visual outcomes, pooled prevalence of complete recovery was 32.9% (95% CI: 28.5–37.7%), but with considerable heterogeneity (I2 = 84.2%). The prevalence was 80.9% (95% CI = 77.9–83.6) for improvement and 2.00% (95% CI = 1.10–3.40%) for deterioration. Random-effect models yielded similar results. Publication bias was non-significant for all the outcomes.ConclusionWhile visual deficits improved after EETS in the majority of patients, complete recovery was only achieved in less than half of the patients and some patients even suffered from visual deterioration.Electronic supplementary materialThe online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users.

Endoscopic transsphenoidal approach to skull base lesions

“…In another study performed by Shigetoshi Yano et al 12 of 74 cases, total gross removal was achieved in pituitary adenomas and in 68% of meningiomas. 13 Macro-adenoma was noted in 67% of cases in our study, which is comparable to studies in which 70% of their cases were macroadenomas. 11,12 Visual function improvement was achieved in 82% of patients in this study, and this improvement was nearly the same as in other studies in which 90% of cases showed visual improvement after surgery.…”

“…11,12 Visual function improvement was achieved in 82% of patients in this study, and this improvement was nearly the same as in other studies in which 90% of cases showed visual improvement after surgery. 12,13 In both studies, the majority of cases that developed better visual results complained of pituitary macroadenomas.…”

ICAR: endoscopic skull‐base surgery

“…A recent meta‐analysis evaluating visual outcome in endoscopic transsphenoidal surgery by Muskens et al . found that pooled rate of VA improvement was 67.5% and pooled rate of VF deficit improvement was 80.8%.…”

“…Postoperative VF deterioration after transsphenoidal surgery occurs in up to 4% of cases . The mechanism can be either direct surgical damage, vascular compromise, postoperative bleeding, overpacking in sealing a CSF leak, or as a consequence of optic nerve and chiasm prolapse into an empty sella .…”

Pituitary adenomas

“…Timely intervention can result in improvement in vision within hours of waking from trans-sphenoidal surgery such that patients are able to read and drive where previously limited. A meta-analysis of visual outcomes after pituitary surgery found that complete recovery was probably less likely if the pre-operative visual defect was severe and of longer duration,14 with one study finding worse outcomes if the visual field deficit had been present for more than a year 15. Visual field defects caused by a macroprolactinoma can also improve rapidly with dopamine agonist therapy 1617…”