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Meta-Analysis
. 2017 May:101:186-195.
doi: 10.1016/j.wneu.2017.01.110. Epub 2017 Feb 6.

Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas

Yoshua Esquenazi  1 , Walid I Essayed  2 , Harminder Singh  3 , Elizabeth Mauer  4 , Mudassir Ahmed  2 , Paul J Christos  5 , Theodore H Schwartz  6
Affiliations
Meta-Analysis

Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas

Yoshua Esquenazi et al. World Neurosurg. 2017 May.

Abstract

Objective: Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches.

Methods: A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications.

Results: Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P < 0.001) macroadenomas (P < 0.001) with higher rates of cavernous sinus invasion (P = 0.012). The pooled rate of gross total tumor resection was 53.5% for the endoscopic group and 46.6% for the microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group.

Conclusion: This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option.

Keywords: Endonasal endoscopic; Microscopic; Pituitary adenoma; Pituitary surgery; Recurrent; Skull base; Transsphenoidal.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram for the literature search and study selection reported. A total of 21 studies comprising 976 patients met our eligibility criteria.
Figure 2.
Figure 2.
Graphic representation showing pooled rates of gross total resection. (A) Endoscopic. (B) Microscopic.
Figure 3.
Figure 3.
Graphic representation showing pooled hormone resolution rates. (A) Endoscopic. (B) Microscopic.
Figure 4.
Figure 4.
Graphic representation showing pooled visual improvement rates. (A) Endoscopic. (B) Microscopic.
Figure 5.
Figure 5.
Funnel plot of endoscopic pituitary insufficiency.
See this image and copyright information in PMC

References

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