Cargando…

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

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 a...

Descripción completa

Detalles Bibliográficos
Autores principales: Muskens, Ivo S., Zamanipoor Najafabadi, Amir H., Briceno, Vanessa, Lamba, Nayan, Senders, Joeky T., van Furth, Wouter R., Verstegen, Marco J. T., Smith, Timothy R. S., Mekary, Rania A., Eenhorst, Christine A. E., Broekman, Marike L. D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606952/
https://www.ncbi.nlm.nih.gov/pubmed/28643208
http://dx.doi.org/10.1007/s11102-017-0815-9
_version_ 1783265216705855488
author Muskens, Ivo S.
Zamanipoor Najafabadi, Amir H.
Briceno, Vanessa
Lamba, Nayan
Senders, Joeky T.
van Furth, Wouter R.
Verstegen, Marco J. T.
Smith, Timothy R. S.
Mekary, Rania A.
Eenhorst, Christine A. E.
Broekman, Marike L. D.
author_facet Muskens, Ivo S.
Zamanipoor Najafabadi, Amir H.
Briceno, Vanessa
Lamba, Nayan
Senders, Joeky T.
van Furth, Wouter R.
Verstegen, Marco J. T.
Smith, Timothy R. S.
Mekary, Rania A.
Eenhorst, Christine A. E.
Broekman, Marike L. D.
author_sort Muskens, Ivo S.
collection PubMed
description 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(2)) 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(2): 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(2) = 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5606952
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-56069522017-10-04 Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis Muskens, Ivo S. Zamanipoor Najafabadi, Amir H. Briceno, Vanessa Lamba, Nayan Senders, Joeky T. van Furth, Wouter R. Verstegen, Marco J. T. Smith, Timothy R. S. Mekary, Rania A. Eenhorst, Christine A. E. Broekman, Marike L. D. Pituitary Article 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(2)) 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(2): 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(2) = 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users. Springer US 2017-06-22 2017 /pmc/articles/PMC5606952/ /pubmed/28643208 http://dx.doi.org/10.1007/s11102-017-0815-9 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Article
Muskens, Ivo S.
Zamanipoor Najafabadi, Amir H.
Briceno, Vanessa
Lamba, Nayan
Senders, Joeky T.
van Furth, Wouter R.
Verstegen, Marco J. T.
Smith, Timothy R. S.
Mekary, Rania A.
Eenhorst, Christine A. E.
Broekman, Marike L. D.
Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title_full Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title_fullStr Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title_full_unstemmed Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title_short Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
title_sort visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606952/
https://www.ncbi.nlm.nih.gov/pubmed/28643208
http://dx.doi.org/10.1007/s11102-017-0815-9
work_keys_str_mv AT muskensivos visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT zamanipoornajafabadiamirh visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT bricenovanessa visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT lambanayan visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT sendersjoekyt visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT vanfurthwouterr visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT verstegenmarcojt visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT smithtimothyrs visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT mekaryraniaa visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT eenhorstchristineae visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis
AT broekmanmarikeld visualoutcomesafterendoscopicendonasalpituitaryadenomaresectionasystematicreviewandmetaanalysis