Postoperative Visual Outcomes and the Influence of Optic Nerve Status on Visual Acuity in Endoscopic Endonasal Surgery of Non-functioning Pituitary Macroadenoma Patients

OBJECTIVE: To evaluate postoperative visual outcomes including visual acuity (VA) and visual field (VF), and the relationship of optic nerve status and postoperative VA improvement in non-functioning pituitary macroadenoma (NFPA) patients who underwent endoscopic endonasal surgery (EES).METHODS: Data of NFPA patients with visual impairment who underwent EES with tumor removal were retrospectively reviewed from 2017 to 2021. The postoperative visual outcomes (at least 6 months after surgery), and the relationship between optic nerve status and postoperative VA improvement were analyzed. The extent of resection, postoperative complications, and mortality were evaluated.RESULTS: Twenty-three patients were included in this study with 86.9% favorable vision after surgery. The VA and VF were separately analyzed. The postoperative VA showed 75.8% improved, 9% stable, and 15.2% worsened in preoperative VA impairment eyes. The optic nerve atrophy group had 65.3% improved, 13% stable, and 21.7% worsened VA. The normal optic nerve group had 52.9% improved, 35.4% stable, and 11.8% worsened VA. The p-value was 0.677 between the 2 groups. The postoperative VF examination showed 68.4% improved and 31.6% stable in VF defective eyes. The gross total resection of tumor provided more improvement of VA (72.2%) but not VF comparison with near-total and subtotal resection of tumor.CONCLUSION: The EES in NFPAs is considered safe with a satisfactory visual improvement rate. Optic nerve atrophy tends to have a higher rate of postoperative VA deterioration.