Surgical Outcomes and OCT RNFL-Based Structure-Function Assessment of Pituitary Macroadenomas after Endoscopic Endonasal Transsphenoidal Surgery
DOI:
https://doi.org/10.37018/CVDS95637Keywords:
Pituitary Neoplasms, Endoscopy, Visual Acuity, Optical Coherence Tomography, Treatment OutcomeAbstract
Background: This study assessed the effects of endoscopic endonasal transsphenoidal surgery (EETS) on visual and surgical outcomes in pituitary macroadenoma patients, focusing on tumor resection rates, visual improvement, and postoperative complications.
Methods: This quantitative retrospective study included 30 patients who underwent EETS for pituitary macroadenomas. Preoperative assessments included demographics, tumor size, Knosp grade (MRI), visual acuity (Snellen), visual fields (perimetry), and retinal nerve fiber layer (RNFL) thickness (OCT). At 12 weeks postoperatively, visual tests, RNFL thickness, and contrast-enhanced MRI were repeated to assess resection. Complications such as CSF leak, hemorrhage, infection, and neurological deficits were recorded. Paired t-tests compared pre- and postoperative visual and RNFL outcomes, while chi-square tests analyzed associations between Knosp grade, resection extent, and complications.
Results: Of the 30 patients, 63.3% were male and 36.7% female, with a mean tumor size of 3.8 ± 1.1 cm. Higher Knosp grades were significantly linked to incomplete resection (p <0.05). Complete tumor removal was achieved in 66.7% of cases, while 46.7% experienced postoperative complications-most commonly hemorrhage (20%) and CSF leak (10%). Visual acuity improved significantly (p <0.05), with severe impairment (≤6/60) decreasing from 23.3% to 6.7% in the right eye and from 26.7% to 6.7% in the left. RNFL thickness also increased significantly, indicating optic nerve recovery.
Conclusion: EETS markedly enhances visual function and optic nerve integrity in pituitary macroadenoma patients. However, higher Knosp grades correlate with incomplete resection and greater complication rates, highlighting the need for careful case selection and surgical planning.
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Copyright (c) 2026 Usman Ahmad, Syed Shahzad Hussain Shah, Muhammad Irfan, Hafiz Muhammad Irfan Razzaq, Danish Shafique, Laiba Fatima, Tehreem Asif
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