Risk factors and visual outcomes for postoperative optic neuropathy following pituitary adenoma surgery: a multicenter retrospective cohort study.

INTRODUCTION: Pituitary adenomas are common intracranial neoplasms and postoperative optic neuropathy (PON) is a severe and potentially irreversible complication of pituitary adenoma surgery. OBJECTIVE: PON is a devastating complication of pituitary adenoma surgery, leading to irreversible visual loss in severe cases. This multicenter retrospective cohort study aimed to investigate the incidence, independent risk factors, and prognostic factors of PON after pituitary adenoma resection. METHODS: We retrospectively analyzed clinical data of 2000 patients who underwent pituitary adenoma surgery at 5 tertiary hospitals between 2015 and 2023. Baseline characteristics, tumor imaging features, surgical details, postoperative complications, and follow-up data were collected. RESULTS: The overall incidence of PON was 3.2% (64 cases), with a significantly lower incidence in the transsphenoidal surgery group (2.5%, 42/1680) than in the craniotomy group (5.8%, 22/380; χ² = 4.12, p = 0.043). We observed that 82% of PON cases occurred within 24 h postoperatively, presenting as sudden visual acuity decline (65%) or visual field defect (35%). Micro-adenomas (< 1 cm) constituted ~ 8% of the cohort, however, they did not develop PON. Reoperation was not associated with PON risk (OR = 1.32, 95% CI: 0.58-2.99, p = 0.312). Hardy-Wilson Grade II/III + Type D (OR = 2.92, 95% CI = 1.58-5.42, p < 0.001) and Grade III/IV + Type E (OR = 2.56, 95% CI = 1.21-5.42, p = 0.014) as well as intraoperative cerebrospinal fluid (CSF) leakage (OR = 2.15, 95% CI: 1.28-3.62, p = 0.003) are independent risk factors for PON. CONCLUSIONS: Transsphenoidal surgery is associated with a lower risk of PON compared to craniotomy for pituitary adenomas. Hardy-Wilson Grade II/III + Type D and Grade III/IV + Type E as well as intraoperative CSF leakage are independent risk factors for PON.