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06.01.2018 | Review Article - Brain Tumors | Ausgabe 5/2018

Acta Neurochirurgica 5/2018

Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis

Zeitschrift:
Acta Neurochirurgica > Ausgabe 5/2018
Autoren:
Reem D. Almutairi, Ivo S. Muskens, David J. Cote, Mark D. Dijkman, Vasileios K. Kavouridis, Erin Crocker, Kholoud Ghazawi, Marike L. D. Broekman, Timothy R. Smith, Rania A. Mekary, Hasan A. Zaidi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-017-3438-z) contains supplementary material, which is available to authorized users.
Reem D. Almutairi and Ivo S. Muskens are shared first author
Rania A. Mekary and Hasan A. Zaidi are shared last author

Presentation at conference

Contents of this manuscript were presented at the North American Skull Base Society meeting, New Orleans, March 3–5, 2017

Abstract

Background

Microscopic transsphenoidal surgery (mTSS) is a well-established method to address adenomas of the pituitary gland. Endoscopic transsphenoidal surgery (eTSS) has become a viable alternative, however. Advocates suggest that the greater illumination, panoramic visualization, and angled endoscopic views afforded by eTSS may allow for higher rates of gross total tumor resection (GTR). The aim of this meta-analysis was to determine the rate of GTR using mTSS and eTSS.

Methods

A meta-analysis of the literature was conducted using PubMed, EMBASE, and Cochrane databases through July 2017 in accordance with PRISMA guidelines.

Results

Seventy case series that reported GTR rate in 8257 pituitary adenoma patients were identified. For all pituitary adenomas, eTSS (GTR=74.0%; I2 = 92.1%) was associated with higher GTR as compared to mTSS (GTR=66.4%; I2 = 84.0%) in a fixed-effect model (P-interaction < 0.01). For functioning pituitary adenomas (FPAs) (n = 1170 patients), there was no significant difference in GTR rate between eTSS (GTR=75.8%; I2 = 63.9%) and mTSS (GTR=75.5%; I2 = 79.0%); (P-interaction = 0.92). For nonfunctioning pituitary adenomas (NFPAs) (n = 2655 patients), eTSS (GTR=71.0%; I2 = 86.4%) was associated with higher GTR as compared to mTSS (GTR=60.7%; I2 = 87.5%) in a fixed-effect model (P-interaction < 0.01). None of the associations were significant in a random-effect model (all P-interaction > 0.05). No significant publication bias was identified for any of the outcomes.

Conclusion

Among patients who were not randomly allocated to either approach, eTSS resulted in a higher rate of GTR as compared to mTSS for all patients and for NFPA patients alone, but only in a fixed-effect model. For FPA, however, eTSS did not seem to offer a significantly higher rate of GTR. These conclusions should be interpreted with caution because of the nature of the included non-comparative studies.

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Zusatzmaterial
ESM 1 Search Strategy (DOCX 134 kb)
701_2017_3438_MOESM1_ESM.docx
ESM 2 Studies excluded in the Analysis of Gross Tumor Resection (GTR). CS, Case series; RT, Randomized Trail; ETSS, Endoscopic Transsphenoidal surgery; MTSS, Microscopic Transsphenoidal Surgery; EATSS, Endoscope-Assisted Endonasal Trans-sphenoidal microsurgery; PA, Pituitary Adenomas; GTR, Gross Tumor Resection; NS, Not specified; NA, Not Available; (DOCX 30 kb)
701_2017_3438_MOESM2_ESM.docx
ESM 3 Analysis of Gross Tumor Resection (GTR) In Pituitary Adenoma Patients according to Tumor Characteristic in the selected studies. ETSS, Endoscopic Transsphenoidal surgery; MTSS, Microscopic Transsphenoidal Surgery; PA, Pituitary Adenomas; GTR, Gross Tumor Resection; NA, No Available; FPA, Functional Pituitary Adenoma; NFPA, Non- Functional Pituitary Adenoma ACTH, Cushing Disease; PRL, Prolactinoma; GH, Growth Hormone Hypersecretion (DOCX 41 kb)
701_2017_3438_MOESM3_ESM.docx
ESM 4 Funnel plot for publication bias for overall pituitary adenoma (PNG 55 kb)
701_2017_3438_MOESM4_ESM.png
ESM 5 Funnel plot for publication bias for functional pituitary adenoma (PNG 39 kb)
701_2017_3438_MOESM5_ESM.png
ESM 6 Funnel plot for publication bias for non-functional pituitary adenoma (PNG 51 kb)
701_2017_3438_MOESM6_ESM.png
Literatur
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