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

Authors:
Ivo S Muskens
Ivo S Muskens
Brain Center Rudolf Magnus
Vanessa Briceno
Vanessa Briceno
MCPHS University
Boston | United States
Nayan Lamba
Nayan Lamba
Columbia University
Joeky T Senders
Joeky T Senders
University Medical Center Utrecht
Utrecht | Netherlands

Pituitary 2017 Oct;20(5):539-552

Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

Purpose: Patients 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.

Methods: A 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).

Results: Out 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.

Conclusion: While 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.

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Source
http://link.springer.com/10.1007/s11102-017-0815-9
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http://dx.doi.org/10.1007/s11102-017-0815-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606952PMC
October 2017
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