The Natural History and Underlining Mechanism of New Visual Deterioration Post Endoscopic Endonasal Pituitary Adenoma Resection

Background: Postoperative visual deterioration following endoscopic endonasal transsphenoidal surgery for pituitary adenoma is very rare yet significant morbidity. While mechanisms such as iatrogenic injury, compressive effects, and ischemic insults have been reported, the natural history and underlying pathophysiology remain incompletely understood and their correlation with intervention outcome remain poorly understood as well. The aim of this study to investigate the the natural course, mechanisms and outcome 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 new Postoperative visual deterioration. Demographic data, preoperative, intraoperative, postoperative clinical data and patients' outcomes were retrospectively collected and analyzed. Results: Nine patients (1.13%) developed early postoperative visual deterioration. No intraoperative documentation of direct optic apparatus injury was found. Ischemic mechanisms were identified in five cases. Four patients (44%) underwent early reoperation for optic apparatus decompression, with full visual recovery in all compressive cases. Among the ischemic group (n = 5), three patients showed improvement following supplemental oxygen and hypervolemic-hypertensive therapy (p = 0.03). Postoperative elevation in mean arterial pressure was significantly associated with partial visual recovery in ischemic cases (p = 0.04). Conclusion: Postoperative visual deterioration following endoscopic endonasal surgery for pituitary adenoma is very rare but serious complication. Outcomes are closely correlated to the underlying mechanism and intervention. In Compressive mechanism patients has a favorable prognosis when identified and managed with reoperation and decompression. In Ischemic mechanism the deficit can be partially reversible with aggressive medical management in form of supplemental oxygen, hypervolemic-hypertensive and high mean arterial pressure in almost half of cases. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany