Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysisReportar como inadecuado

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First Online: 22 June 2017DOI: 10.1007-s11102-017-0815-9

Cite this article as: Muskens, I.S., Zamanipoor Najafabadi, A.H., Briceno, V. et al. Pituitary 2017. doi:10.1007-s11102-017-0815-9


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 I 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 I: 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 I = 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.

KeywordsEndonasal endoscopic surgery Pituitary adenoma Visual outcomes Meta-analysis Ivo S. Muskens and Amir H. Zamanipoor Najafabadi have shared first authorship.

Electronic supplementary materialThe online version of this article doi:10.1007-s11102-017-0815-9 contains supplementary material, which is available to authorized users.

Autor: Ivo S. Muskens - Amir H. Zamanipoor Najafabadi - Vanessa Briceno - Nayan Lamba - Joeky T. Senders - Wouter R. van Furth


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