{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:36:33Z","timestamp":1790620593203,"version":"4.1.0"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"S 03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objectives\u2003Visual dysfunction in patients with pituitary adenomas is a clear indication for endoscopic endonasal transsphenoidal surgery (EETS). However, the visual outcomes vary greatly among patients and it remains unclear what tumor, patient, and surgical characteristics contribute to postoperative visual outcomes.<\/jats:p><jats:p>\n          Methods\u2003One hundred patients with pituitary adenomas who underwent EETS between January 2011 and June 2015 in a single institution were retrospectively reviewed. General patient characteristics, pre- and postoperative visual status, clinical presentation, tumor characteristics, hormone production, radiological features, and procedural characteristics were evaluated for association with presenting visual signs and visual outcomes postoperatively. Suprasellar tumor extension (SSE) was graded 0 to 4 following a grading system as formulated by Fujimoto et al.<\/jats:p><jats:p>\n          Results\u2003Sixty-six (66\/100) of all patients showed visual field defects (VFD) at the time of surgery, of whom 18% (12\/66) were asymptomatic. VFD improved in 35 (35%) patients and worsened in 4 (4%) patients postoperatively. Mean visual acuity (VA) improved from 0.67 preoperatively to 0.84 postoperatively (p\u2009=\u20090.04). Nonfunctioning pituitary adenomas (NFPAs) and Fujimoto grade were independent predictors of preoperative VFD in the entire cohort (p\u2009=\u20090.02 and p\u2009&lt;\u20090.01 respectively). A higher grade of SSE was the only factor independently associated with postoperative improvement of VFD (p\u2009=\u20090.03). NFPA and Fujimoto grade 3 were independent predictors of VA improvement (both p\u2009=\u20090.04).<\/jats:p><jats:p>\n          Conclusion\u2003EETS significantly improved both VA and VFD for most patients, although a few patients showed deterioration of visual deficits postoperatively. Higher degrees of SSE and NFPA were independent predictors of favorable visual outcomes.<\/jats:p>","DOI":"10.1055\/s-0039-3402020","type":"journal-article","created":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T00:06:42Z","timestamp":1580774802000},"page":"e79-e87","source":"Crossref","is-referenced-by-count":5,"special_numbering":"S","title":["Visual Outcomes after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas: Our Institutional Experience"],"prefix":"10.1055","volume":"82","author":[{"given":"Max J.","family":"van Essen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo S.","family":"Muskens","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands"},{"name":"Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayan","family":"Lamba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan F.J.","family":"Belunek","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur T.J.","family":"van der Boog","sequence":"additional","affiliation":[{"name":"Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Johan","family":"Amelink","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Gosselaar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan P.C.","family":"van Doormaal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline M.E.","family":"Stades","sequence":"additional","affiliation":[{"name":"Department of Internal medicine, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost J.C.","family":"Verhoeff","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria M.","family":"van Genderen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A.E.","family":"Eenhorst","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marike L.D.","family":"Broekman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Computational Neurosurgical Outcome Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands"},{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11102-010-0253-4","article-title":"Demographic differences in incidence for pituitary adenoma","volume":"14","author":"B D McDowell","year":"2011","journal-title":"Pituitary"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1136\/jcp.56.8.561","article-title":"Best Practice No 172: pituitary gland pathology","volume":"56","author":"J W Ironside","year":"2003","journal-title":"J Clin Pathol"},{"key":"ref3","volume-title":"Walsh & Hoyt\u2019s Clinical Neuro-Ophthalmology: The Essentials. 3rd ed","author":"N R Miller","year":"2005"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.beem.2009.05.005","article-title":"Non-functioning pituitary adenomas","volume":"23","author":"Y Greenman","year":"2009","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.ando.2015.04.006","article-title":"Neuro-ophthalmologic exploration in non-functioning pituitary adenoma","volume":"76","author":"L Abouaf","year":"2015","journal-title":"Ann Endocrinol (Paris)"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jocn.2014.01.005","article-title":"Visual acuity and pattern of visual field loss at presentation in pituitary adenoma","volume":"21","author":"S Ogra","year":"2014","journal-title":"J Clin Neurosci"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.wneu.2017.05.144","article-title":"Factors affecting the visual outcome of pituitary adenoma patients treated with endoscopic transsphenoidal surgery","volume":"105","author":"T Luomaranta","year":"2017","journal-title":"World Neurosurg"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/j.1365-2265.2012.04457.x","article-title":"Predictors for visual dysfunction in nonfunctioning pituitary adenomas\u2014implications for neurosurgical management","volume":"77","author":"K Schmalisch","year":"2012","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s11102-017-0815-9","article-title":"Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis","volume":"20","author":"I S Muskens","year":"2017","journal-title":"Pituitary"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.wneu.2012.06.024","article-title":"Pituitary tumor surgery: review of 3004 cases","volume":"79","author":"M Loyo-Varela","year":"2013","journal-title":"World Neurosurg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2010.7.FOCUS10167","article-title":"Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center","volume":"29","author":"J A Gondim","year":"2010","journal-title":"Neurosurg Focus"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s00701-008-1581-2","article-title":"Transsphenoidal surgery for pituitary adenoma in elderly patients","volume":"150","author":"J M Sheehan","year":"2008","journal-title":"Acta Neurochir (Wien)"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3109\/02688697.2013.872225","article-title":"Transsphenoidal pituitary surgery in the elderly is safe and effective","volume":"28","author":"E AC Pereira","year":"2014","journal-title":"Br J Neurosurg"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4103\/sni.sni_189_17","article-title":"Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: surgical and follow-up results","volume":"8","author":"K Fujimoto","year":"2017","journal-title":"Surg Neurol Int"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s11102-012-0437-1","article-title":"Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases","volume":"16","author":"A N Mamelak","year":"2013","journal-title":"Pituitary"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"596","DOI":"10.3171\/2015.4.JNS15102","article-title":"Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma","volume":"124","author":"H A Zaidi","year":"2016","journal-title":"J Neurosurg"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/MED.0b013e32833ab069","article-title":"Radiation therapy and stereotactic radiosurgery for the treatment of Cushing's disease: an evidence-based review","volume":"17","author":"R M Starke","year":"2010","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.wneu.2012.10.008","article-title":"Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas: experience on a 59-patient series","volume":"80","author":"L M Cavallo","year":"2013","journal-title":"World Neurosurg"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"621","DOI":"10.3171\/2012.11.JNS121190","article-title":"Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations","volume":"118","author":"M Koutourousiou","year":"2013","journal-title":"J Neurosurg"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/SCS.0000000000001240","article-title":"Endoscopic endonasal transsphenoidal surgery for pituitary adenomas","volume":"26","author":"E Pinar","year":"2015","journal-title":"J Craniofac Surg"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/194589240101500411","article-title":"Endoscopic transnasal pituitary surgery: report on 180 cases","volume":"15","author":"S S Nasseri","year":"2001","journal-title":"Am J Rhinol"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"350","DOI":"10.3171\/jns.2003.98.2.0350","article-title":"Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions","volume":"98","author":"G Zada","year":"2003","journal-title":"J Neurosurg"},{"issue":"04","key":"ref23","first-page":"438","article-title":"Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas","volume":"28","author":"A Rudnik","year":"2007","journal-title":"Neuroendocrinol Lett"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e409","DOI":"10.1016\/j.wneu.2017.09.194","article-title":"Endoscopic transsphenoidal surgery outcomes in 331 nonfunctioning pituitary adenoma cases after a single surgeon learning curve","volume":"109","author":"J H Kim","year":"2018","journal-title":"World Neurosurg"},{"issue":"04","key":"ref25","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/cen.12967","article-title":"Health-related quality of life in patients treated for nonfunctioning pituitary adenomas during the years 2000-2010","volume":"84","author":"A Karppinen","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1038\/sj.eye.6700165","article-title":"Criteria for early detection of temporal hemianopia in asymptomatic pituitary tumor","volume":"16","author":"N Fujimoto","year":"2002","journal-title":"Eye (Lond)"},{"issue":"07","key":"ref27","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.jocn.2015.02.001","article-title":"Optical coherence tomography predicts visual outcome for pituitary tumors","volume":"22","author":"H V Danesh-Meyer","year":"2015","journal-title":"J Clin Neurosci"},{"issue":"04","key":"ref28","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"E Knosp","year":"1993","journal-title":"Neurosurgery"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3928\/1081-597X-19970701-16","article-title":"Proper method for calculating average visual acuity","volume":"13","author":"J T Holladay","year":"1997","journal-title":"J Refract Surg"},{"issue":"05","key":"ref30","first-page":"W512-8","article-title":"Visual defects in patients with pituitary adenomas: the myth of bitemporal hemianopsia","volume":"205","author":"I H Lee","year":"2015","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/1793-5482.149995","article-title":"Predictors of visual outcome with transsphenoidal excision of pituitary adenomas having suprasellar extension: a prospective series of 100 cases and brief review of the literature","volume":"12","author":"A K Thotakura","year":"2017","journal-title":"Asian J Neurosurg"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1227\/01.NEU.0000159647.64275.9D","article-title":"Results of transsphenoidal surgery in a large series of patients with pituitary adenoma","volume":"56","author":"P Mortini","year":"2005","journal-title":"Neurosurgery"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3171\/jns.1977.46.6.0717","article-title":"Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients","volume":"46","author":"E R Laws Jr","year":"1977","journal-title":"J Neurosurg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1080\/02688699550041377","article-title":"Recovery of vision following transsphenoidal surgery for pituitary adenomas","volume":"9","author":"M Powell","year":"1995","journal-title":"Br J Neurosurg"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/BF01401176","article-title":"Recovery of vision following treatment of pituitary tumours: application of a new system of assessment to patients treated by transsphenoidal operation","volume":"68","author":"G Findlay","year":"1983","journal-title":"Acta Neurochir (Wien)"},{"issue":"06","key":"ref36","first-page":"1224","article-title":"Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study","volume":"8","author":"F-F Yu","year":"2015","journal-title":"Int J Ophthalmol"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s11060-016-2227-5","article-title":"Predictive model for recovery of visual field after surgery of pituitary adenoma","volume":"130","author":"J Lee","year":"2016","journal-title":"J Neurooncol"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3340\/jkns.2015.57.1.23","article-title":"The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases","volume":"57","author":"R W Ho","year":"2015","journal-title":"J Korean Neurosurg Soc"},{"issue":"03","key":"ref39","first-page":"219","article-title":"Vision loss in older adults","volume":"94","author":"A L Pelletier","year":"2016","journal-title":"Am Fam Physician"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ncl.2016.08.012","article-title":"Optical coherence tomography in neuro-ophthalmology","volume":"35","author":"F Costello","year":"2017","journal-title":"Neurol Clin"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-3402020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T23:01:21Z","timestamp":1626735681000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-3402020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,3]]},"references-count":40,"journal-issue":{"issue":"S 03","published-online":{"date-parts":[[2021,7,19]]},"published-print":{"date-parts":[[2021,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-3402020","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,3]]}}}