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Pituitary
Published in: Pituitary 5/2017

Open Access 01-10-2017

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

Authors: Ivo S. Muskens, Amir H. Zamanipoor Najafabadi, Vanessa Briceno, Nayan Lamba, Joeky T. Senders, Wouter R. van Furth, Marco J. T. Verstegen, Timothy R. S. Smith, Rania A. Mekary, Christine A. E. Eenhorst, Marike L. D. Broekman

Published in: Pituitary | Issue 5/2017

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Abstract

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 (I2) 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 (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.

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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Metadata
Title
Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
Authors
Ivo S. Muskens
Amir H. Zamanipoor Najafabadi
Vanessa Briceno
Nayan Lamba
Joeky T. Senders
Wouter R. van Furth
Marco J. T. Verstegen
Timothy R. S. Smith
Rania A. Mekary
Christine A. E. Eenhorst
Marike L. D. Broekman
Publication date
01-10-2017
Publisher
Springer US
Published in
Pituitary / Issue 5/2017
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-017-0815-9

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