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

Abstract

Background: Endoscopic 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.

Methods: We 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.

Results: A 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).

Conclusions: The present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas.

Figure 1

Flowchart diagram of the study selection process.

Figure 2

Forest plot of the odd ratios and 95% CI for GTR and septal perforation in patients who had endoscopic and microscopic pituitary adenoma surgery. CI, confidence interval; GTR, gross tumor removal.

Figure 3

Sensitivity analyses of GTR, epistaxis and septal perforation. GTR, gross tumor removal.

Figure 4

Forest plot of the odd ratios and 95% CI for CSF leak, DI who had endoscopic and microscopic pituitary adenoma surgery. CI, confidence interval; CSF, cerebrospinal fluid; DI, diabetes insipidus.

Figure 5

Sensitivity analyses of CSF leak and DI. CSF, cerebrospinal fluid; DI, diabetes insipidus.

Figure 6

Forest plot of the odd ratios and 95% CI for hypopituitarism, meningitis and epistaxis in patients who had endoscopic and microscopic pituitary adenoma surgery. CI, confidence interval.