Original ArticleEndoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis
Introduction
Pituitary adenomas account for approximately 10% of all primary intracranial tumors.1 They are classified based on hormonal activity: nonsecreting, prolactinoma, and adrenocorticotropic hormone, growth hormone, and thyroid-stimulating hormone producing, respectively.2 Because medication usually yields unacceptable side effects in patients with pituitary adenoma, transsphenoidal surgery is a well-established choice in the treatment of this tumor and has continuously improved in the past decade.3 Microsurgery via a transsphenoidal approach is widely used for pituitary surgery and has become the gold standard, merging microscopy and intraoperative fluoroscopy.4, 5 Over the past decade, endoscopic transsphenoidal surgery has been increasingly used to remove pituitary tumors and other lesions of the sella.6, 7, 8 However, how these 2 surgical methods compare remains controversial.
Ammirati et al.9 performed a meta-analysis to evaluate the short-term effects of endoscopic and microscopic pituitary adenoma surgeries and found that endoscopic removal of pituitary adenomas does not seem to confer any advantages over the microscopic technique; in addition, vascular complications were significantly more common in the endoscopy group compared with the microscopy group. However, Gao et al.10 indicated that endoscopic surgery is associated with higher gross tumor removal (GTR), with a lower risk of septal perforation, yielding inconsistent results from the 2 interventions. Recently, several studies investigating endoscopic versus microscopic surgeries have been reported. To evaluate the potential benefits and complications of the 2 transsphenoidal surgery types, a comprehensive systematic review and meta-analysis of pooled data were performed, including the latest efficacy and safety findings of endoscopic versus microscopic methods in the treatment of pituitary adenomas.
Section snippets
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of Weifang People's Hospital research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Data Sources and Search Strategy
This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement issued in 2009 (Checklist
Results
The study selection process is presented in Figure 1. A total of 410 articles were identified in the initial electronic search; of these, 364 were excluded after removal of duplicates and irrelevant studies during an initial review based on titles and abstracts. Then, full texts were retrieved for the remaining 46 studies. After detailed evaluation, 23 studies met the inclusion criteria and were selected for final analysis.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37,
Discussion
The current standard interventions for pituitary adenomas are transsphenoidal surgery by endoscopic or microscopic approaches. However, the efficacy and safety of the 2 surgical procedures remain controversial. Previous meta-analyses do not provide certain evidence for intervention effects. An increasing number of trials have evaluated endoscopic and microscopic surgeries for efficacy and safety in the treatment of pituitary adenomas and acquired varying data, and doctors have few
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Conflict of interest statement: This study was supported by the Shandong Medical Science and Technology Development Plan (no. 2014WS0265).