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Meta-Analysis
. 2018 Jan;160(1):59-75.
doi: 10.1007/s00701-017-3390-y. Epub 2017 Nov 10.

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis

Ivo S Muskens  1   2   3 , Vanessa Briceno  4 , Tom L Ouwehand  5   6 , Joseph P Castlen  7 , William B Gormley  7 , Linda S Aglio  8 , Amir H Zamanipoor Najafabadi  9 , Wouter R van Furth  9 , Timothy R Smith  7 , Rania A Mekary  7   4 , Marike L D Broekman  5   6   7   10
Affiliations
Meta-Analysis

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis

Ivo S Muskens et al. Acta Neurochir (Wien). 2018 Jan.

Abstract

Object: In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes.

Methods: A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values.

Results: Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results.

Conclusion: In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.

Keywords: Complications; Endoscopic transsphenoidal surgery; Gross total resection; Meta-analysis; Microscopic transcranial surgery; Olfactory groove meningioma; Tuberculum sellae meningioma.

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Conflict of interest statement

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Human participants

This article does not contain any studies with human participants performed by any of the authors.

Ethical approval

Ethical approval was not necessary because of the nature of the study (meta-analysis).

Informed consent

Not applicable as this study did not involve individual patient data.

Figures

Fig. 1
Fig. 1
Flowchart. Abreviations: OGM: olfactory groove meningioma, TSM: tuberculum sellae meningioma
Fig. 2
Fig. 2
Pooled prevalence of gross total resection by approach for olfactory groove meningioma resection: endoscopic transsphenoidal approach vs. microscopic transcranial approach. P-interaction value < 0.01. eTSA, endoscopic transsphenoidal approach; mTCA, microscopic transcranial approach
Fig. 3
Fig. 3
a Pooled prevalence of cerebrospinal fluid leak by approach for tuberculum sellae meningioma resection: endoscopic transsphenoidal approach vs. microscopic transcranial approach. P-interaction value < 0.01. CSF, cerebrospinal fluid; eTSA, endoscopic transsphenoidal approach; mTCA, microscopic transcranial approach. b Pooled prevalence rates of cerebrospinal fluid leak by approach for olfactory groove meningioma resection: endoscopic transsphenoidal approach vs. microscopic transcranial approach. P-interaction value < 0.01; CSF, cerebrospinal fluid; eTSA, endoscopic transsphenoidal approach; mTCA, microscopic transcranial approach
Fig. 4
Fig. 4
Pooled prevalence rates of intraoperative arterial injury by approach for tuberculum sellae meningioma resection: endoscopic transsphenoidal approach vs. microscopic transcranial approach. P-interaction value: 0.03. eTSA, endoscopic transsphenoidal approach; mTCA, microscopic transcranial approach
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Comment in

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