title: The impact of transsphenoidal surgery on neurocognitive function: A systematic review.
abstract: BACKGROUND
  Cognitive impairment following transsphenoidal surgery (TSS) among patients with pituitary tumors has been intermittently reported and is not well established. We performed a systematic review to summarize the impact of TSS on cognitive function.
  
  
  METHODS
  We conducted a systematic search of the literature using the PubMed, Cochrane, and Embase databases through October 2014. Studies were selected if they reported cognitive status after surgery and included at least 10 adult patients with pituitary tumors undergoing either endoscopic or microscopic TSS.
  
  
  RESULTS
  After removing 69 duplicates, 758 articles were identified, of which 24 were selected for full text review after screening titles and abstracts. After reviewing full texts, nine studies with a combined total of 682 patients were included in the final analysis. Eight studies were cross-sectional and one was longitudinal. These studies used a wide variety of neurocognitive tests to assess memory, attention and executive function post-operatively. Of the eight studies, six reported impairments in verbal and non-verbal memory post-operatively, while others found no association related to memory, and some reported an improvement in episodic, verbal, or logical memory. While four studies found an impaired association between TSS and attention or executive function, another four studies did not.
  
  
  CONCLUSIONS
  The current literature on cognitive impairments after TSS is limited and inconsistent. This review demonstrates that patients undergoing TSS may experience a variety of effects on executive function and memory post-operatively, but changes in verbal memory are most common.
authors.affiliation: MCPHS University, 179 Longwood Ave., Boston, MA, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Alsumali
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA. Electronic address: david_cote@hms.harvard.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, 1249 Boylston St., Boston, MA 02215, USA.
authors.forename: Quentin R
authors.initials: QR
authors.lastname: Regestein
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Crocker
authors.affiliation: MCPHS University, 179 Longwood Ave., Boston, MA, USA.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Alzarea
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Wenya Linda
authors.initials: WL
authors.lastname: Bi
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Hassan Y
authors.initials: HY
authors.lastname: Dawood
authors.affiliation: Department of Neurosurgery, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Marike L
authors.initials: ML
authors.lastname: Broekman
authors.affiliation: Department of Neurosurgery, University Medical Centre, Utrecht, The Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
authors.forename: Martine J E
authors.initials: MJE
authors.lastname: van Zandvoort
authors.affiliation: MCPHS University, 179 Longwood Ave., Boston, MA, USA; Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Rania A
authors.initials: RA
authors.lastname: Mekary
authors.affiliation: Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
mesh_terms: D000236:Adenoma / Q000601:surgery*; D001288:Attention; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008568:Memory; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D014705:Verbal Behavior
keywords: Neurocognitive function; Pituitary tumors; Transsphenoidal surgery