Long-Term Visual Field Outcomes following Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

Background: Visual field outcomes following endoscopic transsphenoidal surgery (ETS) for pituitary adenomas are important for evaluating treatment efficacy and patient quality of life. While immediate postoperative improvements are well-documented, there is a notable lack of literature on visual outcomes beyond one year. Long-term outcomes are a critical measure of patient care as late deterioration or continued improvement can impact patient management and prognosis. Recent studies highlight the need for extended follow-up, with some reporting visual field changes occurring up to five years post-surgery, with some patients who initially improved postoperatively deteriorating in the subsequent years. This review aims to address this gap by compiling available evidence on long-term visual field outcomes (>1 year) after ETS for pituitary adenomas.

Materials and Methods: A comprehensive search was conducted on July 22, 2024, in the databases PubMed, Embase, and Scopus. The search strategy included terms related to “pituitary neoplasms,” “visual fields,” and “treatment outcomes,” while excluding studies focused on “pituitary apoplexy,” “case reports,” and “reviews.” Studies published before 2004 were excluded to ensure that the surgical techniques and treatment outcomes discussed were relevant. This initial search resulted in 32 articles, of which six studies reported visual field outcomes more than one year after endoscopic transsphenoidal surgery (ETS) for pituitary adenomas.

Results: In these six studies, sample sizes ranged from 26 to 237 patients, with a mean follow-up of 38.4 months (range: 17–52 months). The pooled prevalence of visual improvement was 91.6% (95% CI: 89.5–93.7%), with rates varying from 62% to 97.8%. The pooled prevalence of visual deterioration was 2.1% (95% CI: 0.5–3.6%, n = 2), and the pooled prevalence of stable or no change in visual field was 18.1% (95% CI: 13.9–22.2%, n = 2). Visual acuity improvement was observed in 39.7% of cases (95% CI: 31–48.3%, n = 2) with a mean follow-up of 34.6 months. Despite these improvements, there remains limited data on long-term visual outcomes.

Conclusion: This review highlights the need for more detailed long-term follow-up data on visual field outcomes post-ETS. This issue is partly due to a lack of standardization of visual field outcomes; only two of the six studies included visual acuity data along with general visual field outcomes. Additionally, these studies did not clearly differentiate between immediate postoperative results and long-term outcomes. Instead, they imply sustained improvement by reporting initial recovery and providing general long-term follow-up information. Future research should provide more granular, standardized data beyond the one-year mark to improve patient prognosis and management.

Publication History

Article published online:
07 February 2025