Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary tumors: systematic review and meta-analysis of randomized and non-randomized controlled trials

Abstract

We conducted a systematic review and meta-analysis of randomized and non-randomized controlled trials that compared pure endoscopic with microscopic transsphenoidal surgery (TSS) in the resection of pituitary tumors. Embase, PubMed, Lilacs, and Central Cochrane were used as our data sources. The outcomes were total tumor resection, achievement of biochemical control of functioning adenomas, hospital stay and surgery complications. The randomized trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Two randomized and three prospective controlled non-randomized studies were included. Two studies, including 68 patients, evaluated total tumor resection and the meta-analysis did not show differences between the groups [RR: 1.45 (95% CI: 0.87, 2.44)]. Three studies involving 65 patients analyzed the achievement of biochemical control and no statistical difference was found [RR: 0.94 (95% CI: 0.7, 1.26)]. All five studies compared the frequency of postoperative complications between intervention and control group and meta-analysis favored for a low rate of postoperative complications in the endoscopic TSS group [(RR: 0.37 (95% CI: 0.16, 0.83)]. Due to the low evidence level and low number of observations, the results of our meta-analysis should not be viewed as a final proof of inferiority or superiority of one approach in relation to the other. More data including higher numbers of observations are needed.

Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm

“…[131][132][133][134][135][136][137][138] Few prospective trials comparing EEA and microsurgery have been completed, with five meeting criteria for inclusion in a recent meta-analysis. [139][140][141][142][143][144][145] Although the overall evidence level and data quality were quite low, the study concluded that EEA is associated with significantly lower complication rates, but not biochemical cure, as compared with microscopic TSR. Further prospective study is clearly required to answer this question more definitively, particularly in children.…”

Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review

“…Because the influence of surgical technique was the primary interest of comparison, patient-related risk factors were not investigated in these reviews. Typically, gross-total resection and complications have been compared between microscopy and endoscopy, most showing equal or superior results in favor of endoscopy; however, patient-related risk factors have not been further determined [ 1 – 10 ]. In the undivided (microscopic and endoscopic combined) literature, the following preoperative risk factors were found for delayed symptomatic hyponatremia by Cote [ 13 ]: higher age, female gender, larger tumor size, and Cushing disease.…”

“…Over the past two and a half decades, pituitary surgery has undergone major technical developments, the introduction of the endoscope perhaps being the most important one. Several systematic reviews show relatively better results in terms of gross total resection, with reduced complication rates for endoscopic surgery compared to microscopic surgery [ 1 – 10 ]. These complication rates in endoscopic transsphenoidal surgery (ETS) are relatively low; however, they can still be significant.…”

Adenomas Hipofisários Operados por Via Transesfenoidal em Maringá - PR: comparação entre as técnicas microscópica e endoscópica

“…A técnica endoscópica traz o grande benefício de expandir a visão do neurocirurgião na cirurgia transesfenoidal 14 , melhorando a visualização e remoção de tumores que antes não eram acessados. Sua característica de invasão mínima explica os resultados positivos e menor proporção de complicações pós-operatórias em comparação com a abordagem microscópica, e consequentemente, menor morbimortalidade.…”

“…Sua característica de invasão mínima explica os resultados positivos e menor proporção de complicações pós-operatórias em comparação com a abordagem microscópica, e consequentemente, menor morbimortalidade. Apresenta também maior taxa de sucesso na remoção completa dos tumores 10,12 , provavelmente por permitir uma melhor visualização das estruturas 14 , e menor tempo de internamento intra-hospitalar 15 , possivelmente devido à não necessidade de uso do tamponamento nasal, o que ocorre pela melhora da visualização intra-operatória e, consequentemente, uma hemostasia mais apropriada.…”