Predictor of New Postoperative Visual Deterioration and Deficit Post Endoscopic Endonasal Pituitary Adenoma Resection
Bibliographic record
Abstract
Background: Postoperative visual deterioration following endoscopic endonasal transsphenoidal surgery for pituitary adenoma is very rare yet significant morbidity. Iatrogenic injury, compression, and ischemic insults are the principal mechanisms but timely diagnosis and intervention can potentially improve the outcome; however, the predictors and their correlation with intervention outcome remain poorly elucidated. The aim of this study is to investigate the predictors of visual deterioration in patients who underwent endoscopic endonasal pituitary adenoma resection. Study Design and Methods: We reviewed 790 patients in our database for the last 10 years (2014–2024). We included all the patients with pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery and had postoperative visual deterioration. Demographic data, preoperative, intraoperative, postoperative clinical data and patients’ outcomes were retrospectively collected and analyzed. Results: Nine patients (1.13%) experienced early postoperative visual deterioration. None of the patient has intraoperative report of direct injury to the optic apparatus; ischemic etiology was seen in five patients. Four patients (44%) underwent early reoperation to explore and decompress the optic apparatus. Vision was restored to baseline after reoperation in all 4 compressive cases. In the ischemic group ( n = 5), three patients improved with supplemental oxygen and hypervolemic-hypertensive therapy ( p = 0.03). Mean arterial pressure elevation after surgery was significantly higher ( p = 0.04) in those ischemic patients who recovered some vision compared with those with persistent visual deficits. Conclusion: Postoperative visual deterioration following endoscopic endonasal surgery for pituitary adenoma is very rare but serious complication. Visual deterioration can be treated if underline cause was identified and intervention was done. Compressive etiology has a favorable prognosis when identified and managed with reoperation and decompression. Ischemic etiology was potentially treatable with supplemental oxygen, hypervolemic–hypertensive, and high mean arterial pressure in almost half of cases. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".