Introduction
Methods
Search strategy
Inclusion of articles
Selection of studies
Data extraction
Risk of bias
Authors | Study participation | Study attrition | Prognostic factor measurement | Outcome measurement | Study confounding | Statistical analysis and reporting | Overall risk of bias |
---|---|---|---|---|---|---|---|
Ajlan 2016 | Moderate | Moderate | Moderate | Moderate | High | High |
High
|
Bokhari 2013 | Moderate | Moderate | Moderate | Moderate | High | High |
High
|
Boling 2016 | Low | Moderate | Moderate | Moderate | Moderate | Low |
High
|
Cavallo 2014 | Moderate | Moderate | Moderate | Moderate | High | High |
High
|
Cerina 2016 | Moderate | Moderate | Low | Low | Low | Low |
Low
|
Chabot 2015 | Low | Moderate | Low | Moderate | High | Moderate |
High
|
Chi 2013 | Moderate | Moderate | Low | Moderate | Moderate | Moderate |
High
|
Chohan 2016 | Moderate | Low | Moderate | Moderate | Moderate | Moderate |
High
|
Dallapiaza 2014 | Moderate | High | Moderate | Moderate | High | Moderate |
High
|
Dlouhy 2012 | Moderate | Moderate | Low | Moderate | Low | Low |
Moderate
|
Gondim 2011 | Moderate | Low | Moderate | Low | High | Low |
High
|
Gondim 2015 | Moderate | Low | Moderate | Moderate | High | Moderate |
High
|
Hofstetter 2012 | Moderate | Low | Low | Low | High | Moderate |
High
|
Jakimovski 2014 | Moderate | Moderate | Moderate | Moderate | High | Moderate |
High
|
Jang 2016 | Moderate | Low | Moderate | Low | Moderate | Moderate |
High
|
Karnezis 2016 | Low | Moderate | Moderate | Moderate | Moderate | Low |
High
|
Leach 2010 | Moderate | Low | Moderate | Moderate | High | Moderate |
High
|
Qureshi 2016 | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate |
High
|
Senior 2008 | Low | Moderate | Moderate | Low | High | Moderate |
High
|
Sigounas 2008 | Moderate | Moderate | Moderate | Low | Low | Low |
Moderate
|
Thawani 2017 | Moderate | Moderate | Moderate | Moderate | Moderate | Moderate |
High
|
Zhan 2015 | Moderate | Moderate | Moderate | Moderate | High | Moderate |
High
|
Zhang 2014 | Moderate | Moderate | Moderate | Moderate | Moderate | Low |
High
|
Results
Search
Study characteristics
Authors, institution | Study design | Study interval | Number of patients (n) | Adenomas (%) | Females (%) | Mean age (years) | Complications |
---|---|---|---|---|---|---|---|
Ajlan et al. [28] California, USA | Retro | 2007–2012 | 176 | 100 | 52 | 50 (median) | Postoperative CSF leak 4.5%, bleeding 1.7%, epistaxis 1.1%, visual deterioration 1.1%, permanent DI 10.2% |
Bokhari et al. [19]
Kogarah, Australia | Retro | 1998–2010 | 79 | 100 | 56 | 56.7 | Postoperative CSF leak 2.5%, meningitis 0, bleeding 1.3%, visual deterioration 1.3%, transient DI 10%, permanent DI 2.5%, death 1.3% |
Boling et al. [20] 6 international centers* | Retro | 2002–2014 | 982 | 100 | 56 | 52 | Postoperative CSF leak 5.5%, meningitis 2.7%, bleeding 3.7%, death 0.5% |
Cavallo et al. [21] Naples & Bologna, Italy | Retro | 1997–2012 | 83 | 0 | 53 | 50.4 | Postoperative CSF leak 16.9%, meningitis 1.2%, bleeding 4.8%, visual deterioration 2.4%, overall DI 36.1%, SIADH 3.6%, death 2.4% |
Cerina et al. [16] Zagreb, Croatia | Pro | 2012–2013 | 70 | 100 | 60 | 44.4 | Adrenal insufficiency 51.4% |
Chabot et al. [22] NY (3) & Illinois, USA†
| Retro | 2009–2014 | 39 | 100 | 36 | 56.3 | Postoperative CSF leak 10.3%, meningitis 2.6%, visual deterioration 0, overall DI 7.7% |
Chi et al. [23] Renji, China | Retro | 2011–2012 | 80 | 100 | 44 | 50.9 | Postoperative CSF leak 5%, meningitis 1.3%, bleeding 0, visual deterioration 0, transient DI 11.3%, permanent DI 3.8%, death 0 |
Chohan et al.[29] NY, USA (1) | Retro | 2003–2014 | 62 | 100 | 34 | 54.2 (median) | Postoperative CSF leak 1.6%, bleeding 1.6%, visual deterioration 9.7%, permanent DI 17.7%, death 0 |
Dallapiazza et al. [36] Virginia, USA | Retro | 2010–2013 | 56 | 100 | 52 | 56.2 | Postoperative CSF leak 7.1%, meningitis 0, epistaxis 10.7%, visual deterioration 3.6%, adrenal insufficiency 14.3%, transient DI 17.9%, permanent DI 0, SIADH 8.9% |
Dlouhy et al. [24] Iowa, USA | Retro | 2005–2010 | 92 | 92 | 52 | 53.0 | Postoperative CSF leak 13.5% |
Gondim et al.[37] Fortaleza, Brazil | Retro | 1998–2009 | 301 | 100 | 55 | 42.4 | Postoperative CSF leak 2.6%, meningitis 0.6%, bleeding 1.7%, epistaxis 2.0%, visual deterioration 0.3%, permanent DI 1.3%, death 1.0% |
Gondim et al. [30] Fortaleza, Brazil | Retro | 2000–2012 | 374 | 100 | 59 | 51 | Postoperative CSF leak 3.7%, bleeding 1.6%, permanent DI 2.7%, death 1.1% |
Hofstetter et al. [17] NY, USA (1) | Pro | 2004–2010 | 71 | 100 | 46 | 49.9 | Postoperative CSF leak 1.4%, bleeding 1.4%, visual deterioration 1.4%, permanent DI 4.2%, death 1.4% |
Jakimovski et al. [18] NY, USA (1) | Pro | 2003–2011 | 203 | 100 | 49 | – | Postoperative CSF leak 3.0%, meningitis 1.0%, bleeding 1.5%, visual deterioration 1.0%, adrenal insufficiency 2.0%, overall DI 3.9% |
Jang et al. [31] Changwon, South Korea | Retro | 1998–2014 | 331 | 100 | 56 | 47.4 | Postoperative CSF leak 1.8%, meningitis 0.6%, bleeding 0.6%, epistaxis 1.2%, transient DI 4.2%, permanent DI 0.9%, SIADH 2.7%, death 0.3% |
Karnezis et al. [34] 7 international centers** | Retro | 2002–2014 | 1161 | 95 | 54 | 51 | Postoperative CSF leak 5.9% |
Leach et al. [35] Salford, UK | Retro | 2005–2007 | 125 | 87 | 44 | 51 | Postoperative CSF leak 3.2%, bleeding 1.6%, epistaxis 1.6%, visual deterioration 1.6%, overall DI 4.8%, death 0 |
Qureshi et al. [32]Illinois, USA | Retro | 2006–2012 | 78 | 100 | 45 | 52.6 | Postoperative CSF leak 1.3%, transient DI 11.5%, permanent DI 2.6% |
Senior et al. [25] N.C., USA | Retro | 2000–2007 | 176 | 84 | 54 | 46 | Postoperative CSF leak 11.4%, meningitis 1.1%, bleeding 0.5%, epistaxis 3.1%, visual deterioration 0, overall DI 20.2%, death 0.5% |
Sigounas et al. [26] N.C., USA | Retro | 2000–2005 | 110 | 85 | 52 | – | Postoperative CSF leak 10.0%, transient DI 13.6%, permanent DI 2.7% |
Thawani et al. [33] Pennsylvania, USA | Retro | 2009–2014 | 203 | 100 | 49 | 55.7 | Postoperative CSF leak 10.3%, meningitis 1.0%, bleeding 0.5%, visual deterioration 1.5%, transient DI 3.9%, permanent DI 4.4%, SIADH 5.9%, death 1.0% |
Zhan et al. [27] Shandong, China | Retro | 2008–2014 | 313 | 100 | 40 | 60.1 | Postoperative CSF leak 3.8%, meningitis 1.6%, bleeding 0.6%, visual deterioration 1.9%, transient DI 15.4%, permanent DI 3.8%, death 0 |
Zhang et al. [38] Wenzhou, China | Retro | 2007–2011 | 326 | 100 | 46 | 33.3 | Meningitis 9.8% |
Risk of bias
Complication rates
Complications in general | Postoperative CSF leak | Intracranial infection | Bleeding | Adrenal insufficiency | Transient DI | Permanent DI | Overall DI | |
---|---|---|---|---|---|---|---|---|
Demographics | ||||||||
Age | +
30,31
| =25,33,27, −
20,20,24,34
| =27
| =27
| =16
| =27
| =27
| =27,33
|
Gender (female*) | =31
| =24,25,33, +
20,34
| =16
| =25,33
| ||||
BMI | =25, +
20,24,34
| |||||||
Diabetes mellitus | +
38
| |||||||
Race | =34
| =26
| ||||||
Peptic ulcer disease | +
34
| |||||||
Various comorbidities | =34
| |||||||
Volumetric parameters | ||||||||
Tumor size | =22, +
17,31
| =18,25,33, +
25
| +
16
| =26,29,29,29
+
29
| =25,26,33
| |||
Tumor volume | +
17
| =18,24,36
| =29
| |||||
Intraventricular extension | +
20
| +
20,21,34
| +
20
| +
20
| ||||
Knosp | =22, +
31
| =36
| =29
| |||||
Supra-/parasellar extension | +
31
| +
37
| ||||||
Extension into the ACF | +
20
| +
20
| ||||||
Cavernous sinus invasion | =28
| =28,33
| ||||||
Pathology | ||||||||
Tumor type | =31
| =18, +
25
| =16
| |||||
Non-functioning adenoma | =26
| |||||||
Acromegaly | =26
| |||||||
Cushing’s disease | =24
| =26
| ||||||
Prolactinoma | =26
| |||||||
RCC | +
25
| +
26
| +
25,26
| |||||
Craniopharyngioma | +
34
| =26
| ||||||
Surgical factors | ||||||||
Previous radiation | +
20
| =20,33, +
34
| +
20
| |||||
Previous surgery | =24,33,34
| =26,26
| =25,26,26
| |||||
Learning curve | =19,35
| =19,23,32, +
18
| =32
| =32
| =19,23
| |||
Endocrine parameters | ||||||||
Preoperative prolactin/TSH/testosterone/cortisol | =16
| |||||||
Preoperative T4/IGF-1/FSH/LH | +
16
| |||||||
Urinary-free cortisol (nmol/24 h) | +
16
|
Risk factors for complications
Complications in general
Demographics
Tumor characteristics
Size and volume (3 studies)
Tumor extension (4 studies)
Tumor type (1 study)
CSF leak
Demographics
Age (6 studies)
Gender (5 studies)
Body mass index (BMI) (4 studies)
Tumor characteristics
Tumor size or volume (5 studies)
Tumor extension (7 studies)
Pathology (4 studies)
Surgical factors
Previous surgery (3 studies)
Radiation (3 studies)
Learning curve (4 studies)
Intracranial infections
Bleeding
Diabetes insipidus (DI)
Demographics
Tumor characteristics
Tumor size or volume (4 studies)
Tumor extension (1 study)
Surgical factors
Previous surgery (3 studies)
Adrenal insufficiency
Other complications of interest
Complications in general | CSF leak | Intracranial infections | Bleedings | Adrenal insufficiency | DI | |
---|---|---|---|---|---|---|
Amendable | ||||||
Learning curve | = | Decreased after >50 cases | = | |||
Non-amendable | ||||||
Age | Increased ≥50–70 years | Increased <65 years | = | = | = | = |
Gender | = | Increased in females | = | = | ||
BMI | Higher BMI or >30 kg/m2
| |||||
Diabetes mellitus | Increased risk | |||||
Race | = | = | ||||
Peptic ulcer disease | Increased risk | |||||
Large or giant tumors | Increased in larger tumors | Increased in larger tumors | = | = | Increased in larger tumors | Increased >1 cm |
Invasive tumors | Increased by increased extension | Increased by increased extension | Increased by increased extension | Increased by increased extension | = | = |
Tumor type | = | Increased in RCC/craniopharyngioma | = | Increased in RCC | ||
Previous radiation | Increased risk | Increased risk | Increased risk | |||
Previous surgery | = | = | ||||
Preoperative hypopituitarism/T4/IGF-1/FSH/LH/UFC | Increased risk |