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Updated: Jun 30, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Visual outcomes after pituitary adenoma surgery: Associated factors and longitudinal progression in a prospective
Mathieu Lozouet1, Audrey Saadoun2, Audrey Ménard3
1Department of Neurosurgery, Rouen University Hospital, Rouen F-76000, France; Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France.
Objective:
To identify preoperative clinical, ophthalmological, and radiological predictors of visual recovery after pituitary adenoma surgery.
Methods:
In this prospective single-centre cohort (2017-2022), adults undergoing pituitary adenoma surgery received standardized ophthalmological evaluation (visual acuity, visual fields, OCT) and MRI pre- and postoperatively (3, 6, 12 months). The primary outcome was ≥ 50% improvement in visual field mean deviation at 6 months. Logistic mixed models accounted for inter-eye correlation.
Results:
Of the 50 included patients, 35 (61 eyes) met eligibility criteria. At 6 months, 64% of affected eyes showed ≥ 50% visual field improvement. In univariate analysis, thinner temporal RNFL (p = .035) and reduced GCC volume (p = .004) were associated with poorer recovery, though these associations disappeared after adjustment for baseline mean deviation and symptom duration. Longitudinal analysis revealed substantial visual field improvement within 3 months, followed by stabilization and mild gains up to 12 months. In contrast, OCT parameters (RNFL thickness, GCC volume) progressively decreased throughout the first postoperative year, irrespective of functional recovery. Surgical morbidity was low, with cerebrospinal fluid leak occurring in 11.4% of cases.
Conclusion:
Most visual recovery after pituitary adenoma surgery occurs within the first three postoperative months. Structural OCT degeneration may continue despite functional improvement, reflecting dissociation between anatomical and functional recovery. These findings highlight the importance of early diagnosis and support the safety and effectiveness of pituitary adenoma surgery when performed by experienced teams. NCT03567486.
