Visual outcomes following endoscopic endonasal approach for tuberculum sellae meningiomas a systematic review and meta-analysis

Background and objectives: This systematic review and meta-analysis assessed visual outcomes following tuberculum sellae meningiomas (TSM) resection using the endoscopic endonasal approach (EEA). TSM are frequently managed surgically, with vision restoration or preservation as a primary goal. Methods: A systematic search of PubMed, EMBASE, and Cochrane CENTRAL identified studies published before September 2024 that reported postoperative vision status following TSM resection via EEA, with or without comparisons to traditional transcranial approach (TCA). Primary outcomes included rates of improved or stable vision and improved vision alone after EEA. Secondary outcomes compared EEA and TCA visual results. Subgroup and sensitivity analyses were performed to explore the source of heterogeneity. Analyses were conducted using R Studio (PROSPERO: blinded for review). Results: Thirty-two retrospective studies were included, covering 1174 TSM patients receiving EEA and 1199 receiving TCA. Preoperative visual impairment was reported in 56%–100% of patients. After EEA, the pooled rate of improved or stabilized vision, including both patients with improvement and those whose vision remained stable, was 0.93 (95% CI: 0.90–0.94). The rate of improved vision alone was 0.77 (95% CI: 0.71–0.82). Compared to TCA, EEA demonstrated significantly higher odds of achieving visual improvement or stability (OR: 2.09, 95% CI: 1.41–3.08) and improved vision alone (OR: 2.28, 95% CI: 1.77–2.93). No significant publication bias was detected. Conclusion: EEA appears to be an effective approach for achieving favorable visual outcomes in patients with TSM. While pooled data suggest a potential advantage over TCA, these findings should be interpreted cautiously given the limitations of the available retrospective evidence. Further prospective studies with standardized visual assessments are needed to confirm these findings.