Artikel
Endoscopic vs. microscopic transsphenoidal tumor resection of pituitary adenomas: a systematic review and meta-analysis
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: The endonasal transsphenoidal approach to treat pituitary tumors is widely used. For the past 15 years, the endoscopic endonasal technique is used increasingly. However, there is no systematic review or meta-analysis comparing the rate of gross total tumor removal and complications between the microscopic and the endoscopic transsphenoidal technique.
Methods: In this paper, the authors report a systematic review and meta-analysis of gross tumor removal, mean operative time, postoperative complications such as the occurrence rate of cerebrospinal fluid leak, diabetes insipidus, hypopituitarism, epistaxis, comparing two techniques of pituitary adenoma resection. Randomized controlled trials and non-randomized cohort studies comparing the endonasal transsphenoidal microscopic technique to the endoscopic technique were considered for inclusion.
Results: Seven published reports of eligible studies involving 613 participants met the inclusion criteria. 277 patients were treated microsurgically and 336 endoscopically. Compared to the microscopic technique (M), the endoscopic technique (E) showed a significantly higher rate of gross tumor removal (63,8% versus 77,3%, P=0.004). However, there were no significant differences in mean operative time (M mean: 75.5min versus E mean: 64.5min, P=0.43), occurrence rate of cerebrospinal fluid leak (4.6% (M) vs. 4.8% (E), P=0.64), postoperative diabetes insipidus (4.8% (M) vs. 4.4% (E) (P=0.69), postoperative hypopituitarism (14.5% (M) vs. 9.6%(E) (P=0.2) or epistaxis (1.8% (M) vs. 0.6% (E), P=0.44).
Conclusion: Compared to the transsphenoidal microscopic technique, the endoscopic technique may have an advantage on achieving gross total tumor removal. Neither of the techniques seemed to have an advantage on the mean operative time, or the occurrence of postoperative complications.