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Cohort studyNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026

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

Ruiyi Jiang, Xingzhi Liu, Jun Lei … Zhigang Lan

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OphthalmologyCohort study

Transsphenoidal surgery linked to lower rate of postoperative optic neuropathy than craniotomy

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

Ruiyi Jiang … Zhigang Lan

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026

Background

Pituitary adenomas are common intracranial neoplasms and postoperative optic neuropathy (postoperative optic neuropathy) is a severe and potentially irreversible complication of pituitary adenoma surgery.

Purpose

This multicenter retrospective cohort study aimed to investigate the incidence, independent risk factors, and prognostic factors of postoperative optic neuropathy 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.

n = 2000 patients

Results

checked for vision nerve injury after surgery, transsphenoidal was lower

2.5%

Transsphenoidal

5.8%

Craniotomy

More results

We observed that 82% of postoperative optic neuropathy 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 postoperative optic neuropathy.

More results

Reoperation was not associated with postoperative optic neuropathy risk (OR = 1.32, 95% CI: 0.58-2.99, p = 0.312).

“

Conclusion · 1 of 2

Transsphenoidal surgery is associated with a lower risk of postoperative optic neuropathy compared to craniotomy for pituitary adenomas.

Conclusion · 2 of 2

Hardy-Wilson Grade II/III + Type D and Grade III/IV + Type E as well as intraoperative cerebrospinal fluid leakage are independent risk factors for postoperative optic neuropathy.

Post

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

Transsphenoidal surgery linked to lower rate of postoperative optic neuropathy than craniotomy

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