Intraoperative monitoring of visual evoked potentials in patients undergoing transsphenoidal surgery for pituitary adenoma: a systematic review

Abstract Background Transsphenoidal surgery is the gold standard for pituitary adenoma resection. Although rare, a serious complication of worsened vision post-operatively. Objective To determine whether, in patients undergoing transsphenoidal adenoma, intraoperative monitoring visual evoked potentials (VEP) safe, reproducible, and effective technological adjunct predicting postoperative function. Methods The PubMed OVID platforms were searched between January 1993 December 2020 to identify publications that (1) featured (2) used optic nerve with VEP (3) reported on safety or effectiveness. Reference lists cross-checked expert opinion sought further publications. Results Eleven studies included comprising ten case series one prospective cohort study. All employed techniques improve reliability. No issues reported. only comparative study described statistically significant improvement post-operative field testing when was used. remaining case-series varied conclusion. In nine studies, surgical manipulation halted event amplitude decrease suggesting widespread consensus this warning sign injury anterior apparatus. Conclusions Despite limited low-quality published evidence regarding intra-operative monitoring, our review suggests it increasingly technique deficits. Further specific are required its utility protecting function resection complex tumours.