Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis

Abstract

BackgroundEndoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas.MethodsWe performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Web of Science between January 1992 and May 2013. Studies with consecutive patients that explicitly and fully compared endoscopic and microscopic approaches in the treatment of pituitary adenomas were included.ResultsA total of 15 studies (n = 1,014 patients) met the inclusion criteria among 487 studies that involved endoscopic surgery and 527 studies that dealt with microscopic surgery. The rate of gross tumor removal was higher in the endoscopic group than in the microscopic group. The post-operative rates of septal perforation were less frequent in patients who underwent endoscopic surgery. There was no significant difference between the two techniques in the incidence rates of meningitis, diabetes insipidus, cerebrospinal fluid leak, epistaxis or hypopituitarism. The post-operative hospital stay was significantly shorter for the endoscopic surgery group compared with the microscopic surgery group (P < 0.05). There was no significant difference in the length of the operation (P > 0.05).ConclusionsThe present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas.

Extended endoscopic endonasal approach for pituitary adenoma: a single-center experience of 171 patients

“…The GTR rate of endoscopic surgery for PA varies widely from 62% to 94%, with most reports around 70% [14,15,[27][28][29][30][31][32]. In our study, the assessment of resection was determined by the postoperative MR images, and GTR was achieved in 126 patients (73.68%), similar to that reported by other studies.…”

“…Over the last two decades, following the development of optical techniques, endoscopic endonasal surgery for PAs has been progressively accepted by many neurosurgeons and has become popular in many clinical centers. Increasing numbers of neurosurgeons now choose the endoscopic endonasal approach as the first option to resect PA, due to the wider visualization and reduced trauma [13][14][15][16]. However, the standard transsphenoidal approach fails to expose PAs invading the anterior cranial base, cavernous sinus, and clivus [17].…”

Endoscopic Versus Microscopic Approach in Pituitary Surgery

“…There were no significant differences between the 2 approaches for meningitis, epistaxis, diabetes insipidus, CSF leak, hypopituitarism, and the overall length of operation time. 12 It is generally accepted that the success rates of pituitary resection are related to tumor size and that less good results are achieved with the more extensive macroadenomas. In our study, the higher GTR rates are achieved with macroadenomas than microadenomas in both endoscopic and microscopic groups, which further indicates that the tumor size is an important factor that influences the results.…”

Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery

“…There is currently a lack of high-level evidence supporting one pituitary surgery technique over another, with some studies showing a benefit to endoscopic approaches [2] and others showing a higher rate of complications [1, 3]. Yet national data show a clear and rapid increase in the use of endoscopic surgery over the past decade, coupled to a decline in microscopic transsphenoidal surgery (Figure 1).…”