Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA.
Pituitary. 2017 Oct;20(5):539-552. doi: 10.1007/s11102-017-0815-9.
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.
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).
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.
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.
患有垂体腺瘤的患者常出现视力缺损。虽然内镜经鼻蝶窦垂体瘤切除术（EETS）的目的是改善这些缺损，但视力恶化也是一种可能的结果。本荟萃分析的目的是评估 EETS 治疗垂体腺瘤对视觉结果的影响。
根据 PRISMA 指南进行荟萃分析。采用固定效应和随机效应模型，计算完全恢复、改善和视野缺损、视力和未指定视觉功能恶化的汇总患病率，包括评估异质性（I）和发表偏倚（Begg 检验）。
在 2636 篇文章中，有 35 项病例系列研究被纳入荟萃分析。结果以固定效应模型描述。对于视力受损的患者，只有一项研究报告完全恢复（27.2%）。改善的汇总患病率为 67.5%（95% CI=59.1-75.0%），但存在很大的异质性（I：86.0%），恶化的患者为 4.50%（95% CI=1.80-10.8%）。对于视野缺损的患者，完全恢复的患病率为 40.4%（95% CI=34.8-46.3%），改善的患病率为 80.8%（95% CI=77.7-83.6%），恶化的患病率为 2.3%（95% CI=1.1-4.7%）。对于未指定的视觉结果，完全恢复的汇总患病率为 32.9%（95% CI：28.5-37.7%），但存在很大的异质性（I=84.2%）。改善的患病率为 80.9%（95% CI=77.9-83.6%），恶化的患病率为 2.00%（95% CI=1.10-3.40%）。随机效应模型得出了类似的结果。所有结果的发表偏倚均无统计学意义。
虽然 EETS 后大多数患者的视力缺损得到改善，但只有不到一半的患者完全恢复，一些患者甚至视力恶化。
