Improved visual outcomes after endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas: a single-arm meta-analysis.

Abstract

Visual impairment due to optic chiasm compression is a frequent complication of pituitary macroadenomas and substantially impacts quality of life. Reported postoperative visual field (VF) results after endoscopic endonasal transsphenoidal surgery (EETS) vary across series. We performed a single-arm meta-analysis to quantify postoperative VF outcomes after EETS for pituitary macroadenomas. PubMed/MEDLINE, Scopus, and Web of Science were searched in accordance with PRISMA through September 2025. Eligible studies were prospective or retrospective clinical series of pituitary macroadenomas (≥ 5 patients) undergoing EETS with extractable postoperative VF outcomes. Pooled proportions for VF improvement, normalization, stability, deterioration, and cerebrospinal fluid (CSF) leak were calculated using random-effects models with Freeman-Tukey double-arcsine transformation. Heterogeneity was assessed using I² and prediction intervals were reported. Twenty nine studies involving 2,943 patients met criteria. Across studies, the combined rate of postoperative VF improvement was 79% (95% CI: 73-84%), while normalization was achieved in 41% (95% CI: 29-53%). VFs remained unchanged in 19% (95% CI: 14-25%) of patients, and deterioration following surgery was infrequent (1%; 95% CI: 0-1%). The pooled postoperative CSF leak rate was 7% (95% CI: 4-10%). In pooled single-arm data, EETS for pituitary macroadenomas is associated with high rates of VF improvement and rare postoperative deterioration. Because VF testing and follow-up were heterogeneous across studies, these pooled results should be interpreted as benchmark outcome rates rather than standardized recovery "patterns." Standardized VF reporting is needed to enable stronger prognostic and time-course analyses.