Skip to main content
Erschienen in: Neurosurgical Review 1/2021

08.02.2020 | Original Article

Systematic review and network meta-analysis assess the comparative efficacy and safety of transsphenoidal surgery for pituitary tumor

verfasst von: Wei Dai, Zong Zhuang, Haiping Ling, Yongbo Yang, Chunhua Hang

Erschienen in: Neurosurgical Review | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

To quantitatively synthesize the comparative efficacy and safety of the most common surgical approaches including endonasal transsphenoidal endoscopic surgery (ETES), sublabial transsphenoidal microsurgery (STMS) and endonasal transsphenoidal microsurgery (ETMS) for all kinds of pituitary tumors. This systematic review and network meta-analysis was performed on randomized controlled trials (RCTs) and comparison studies from databases of Pubmed, EMBASE, and the Cochrane library. We selected the rate of gross complete resection as our primary outcome of efficacy. And the incidence of all complications, cerebrospinal fluid (CSF) leak, diabetes insipidus, nasal septal perforation, death, and bleeding were designed as our primary outcomes of safety. Twenty-seven studies with 2618 patients were included in this network meta-analysis. On efficacy, there was no statistical difference among the three methods including ETES, STMS, and ETMS. As for safety, results indicated that the incidence of total complications of STMS (OR = 4.74; 95% CI 1.03, 40.14) is significantly superior to ETES. And the incidence of diabetes insipidus of ETMS (OR = 2.21; 95% CI 1.31, 3.81) was significantly superior to that of ETES. Besides, there was no statistical difference in the other complications including CSF leak, nasal septal perforation, death, and bleeding. We clarified the overpraise of the efficacy of endoscopy especially the endonasal transsphenoidal approach, and verified that all the approaches owned similar efficacy. Moreover, we recommended the endoscopy to be the first choice for pituitary tumors, because it demonstrated the best safety.
Literatur
1.
2.
Zurück zum Zitat Atkinson JL, Young WF Jr, Meyer FB, Davis DH, Nippoldt TB, Erickson D, Vella A, Natt N, Abboud CF, Carpenter PC (2008) Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas. Mayo Clin Proc 83:550–553. https://doi.org/10.4065/83.5.550CrossRefPubMed Atkinson JL, Young WF Jr, Meyer FB, Davis DH, Nippoldt TB, Erickson D, Vella A, Natt N, Abboud CF, Carpenter PC (2008) Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas. Mayo Clin Proc 83:550–553. https://​doi.​org/​10.​4065/​83.​5.​550CrossRefPubMed
3.
5.
Zurück zum Zitat Caldwell DM, Ades AE, Higgins JPT (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ Br Med J 331:897–900CrossRef Caldwell DM, Ades AE, Higgins JPT (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ Br Med J 331:897–900CrossRef
6.
Zurück zum Zitat Cappabianca P, Alfieri A, Colao A, Ferone D, Lombardi G, De DE (1999) Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg 9:109–117CrossRefPubMedPubMedCentral Cappabianca P, Alfieri A, Colao A, Ferone D, Lombardi G, De DE (1999) Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg 9:109–117CrossRefPubMedPubMedCentral
7.
8.
Zurück zum Zitat Cheng RX, Tian HL, Gao WW, Li ZQ (2011) A comparison between endoscopic trans-sphenoidal surgery and traditional trans-sphenoidal microsurgery for functioning pituitary adenomas. J Int Med Res 39:1985CrossRefPubMed Cheng RX, Tian HL, Gao WW, Li ZQ (2011) A comparison between endoscopic trans-sphenoidal surgery and traditional trans-sphenoidal microsurgery for functioning pituitary adenomas. J Int Med Res 39:1985CrossRefPubMed
9.
Zurück zum Zitat Cho DY, Liau WR (2002) Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 58:371–375CrossRefPubMed Cho DY, Liau WR (2002) Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 58:371–375CrossRefPubMed
11.
Zurück zum Zitat Cornell JE (2015) The PRISMA extension for network meta-analysis: bringing clarity and guidance to the reporting of systematic reviews incorporating network meta-analyses. Ann Intern Med 162:797–798CrossRefPubMed Cornell JE (2015) The PRISMA extension for network meta-analysis: bringing clarity and guidance to the reporting of systematic reviews incorporating network meta-analyses. Ann Intern Med 162:797–798CrossRefPubMed
13.
Zurück zum Zitat Dallapiazza R, Bond AE, Grober Y, Louis RG, Payne SC, Oldfield EH, Jane JA Jr (2014) Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp grades 0-2 nonfunctioning pituitary macroadenomas at a single institution. J Neurosurg 121:511–517. https://doi.org/10.3171/2014.6.JNS131321CrossRefPubMed Dallapiazza R, Bond AE, Grober Y, Louis RG, Payne SC, Oldfield EH, Jane JA Jr (2014) Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp grades 0-2 nonfunctioning pituitary macroadenomas at a single institution. J Neurosurg 121:511–517. https://​doi.​org/​10.​3171/​2014.​6.​JNS131321CrossRefPubMed
19.
Zurück zum Zitat Gandhi CD, Christiano LD, Jean Anderson E, Prestigiacomo CJ, Post KD (2009) The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 27:E8CrossRefPubMed Gandhi CD, Christiano LD, Jean Anderson E, Prestigiacomo CJ, Post KD (2009) The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 27:E8CrossRefPubMed
20.
Zurück zum Zitat Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, Zheng Y, Wang Y, Luo Q, Jiang J (2014) Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World J Surg Oncol 12:1–12CrossRefPubMedPubMedCentral Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, Zheng Y, Wang Y, Luo Q, Jiang J (2014) Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World J Surg Oncol 12:1–12CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Georgia S, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171CrossRef Georgia S, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171CrossRef
22.
Zurück zum Zitat Graham SM, Iseli TA, Karnell LH, Clinger JD, Hitchon PW, Greenlee JD (2009) Endoscopic approach for pituitary surgery improves rhinologic outcomes. Ann Otol Rhinol Laryngol 118:630–635CrossRefPubMed Graham SM, Iseli TA, Karnell LH, Clinger JD, Hitchon PW, Greenlee JD (2009) Endoscopic approach for pituitary surgery improves rhinologic outcomes. Ann Otol Rhinol Laryngol 118:630–635CrossRefPubMed
25.
Zurück zum Zitat Horsley V (2010) Remarks on ten consecutive cases of operations upon the brain and cranial cavity to illustrate the details and safety of the method employed. Br Med J 1:863–865CrossRef Horsley V (2010) Remarks on ten consecutive cases of operations upon the brain and cranial cavity to illustrate the details and safety of the method employed. Br Med J 1:863–865CrossRef
27.
Zurück zum Zitat Jai-Ho C, Kun-Soo L, Sin-Soo J, Jin-Hee C, Yong-Kil H (2008) Endocrine outcome of endoscopic endonasal transsphenoidal surgery in functioning pituitary adenomas. J Korean Neurosurg Soc 44:151–155CrossRef Jai-Ho C, Kun-Soo L, Sin-Soo J, Jin-Hee C, Yong-Kil H (2008) Endocrine outcome of endoscopic endonasal transsphenoidal surgery in functioning pituitary adenomas. J Korean Neurosurg Soc 44:151–155CrossRef
31.
Zurück zum Zitat Koren I, Hadar T, Rappaport ZH, Yaniv E (2010) Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope 109:1838–1840CrossRef Koren I, Hadar T, Rappaport ZH, Yaniv E (2010) Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope 109:1838–1840CrossRef
32.
Zurück zum Zitat Levi V, Bertani GA, Guastella C, Pignataro L, Zavanone ML, Rampini PM, Caroli MA, Sala E, Malchiodi E, Mantovani G (2016) Microscopic versus endoscopic transsphenoidal surgery for pituitary adenoma: analysis of surgical safety in 221 consecutive patients. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 42:n/a-n/a Levi V, Bertani GA, Guastella C, Pignataro L, Zavanone ML, Rampini PM, Caroli MA, Sala E, Malchiodi E, Mantovani G (2016) Microscopic versus endoscopic transsphenoidal surgery for pituitary adenoma: analysis of surgical safety in 221 consecutive patients. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 42:n/a-n/a
33.
Zurück zum Zitat Li T, Puhan MA, Vedula SS, Singh S, Dickersin K (2011) Network meta-analysis-highly attractive but more methodological research is needed. BMC Med 9:79–79CrossRefPubMedPubMedCentral Li T, Puhan MA, Vedula SS, Singh S, Dickersin K (2011) Network meta-analysis-highly attractive but more methodological research is needed. BMC Med 9:79–79CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Lu G, Ades AE (2004) Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 23:3105–3124CrossRefPubMed Lu G, Ades AE (2004) Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 23:3105–3124CrossRefPubMed
36.
Zurück zum Zitat Mario A, Lai W, Ivan C (2013) Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 84:843–849CrossRef Mario A, Lai W, Ivan C (2013) Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 84:843–849CrossRef
41.
Zurück zum Zitat Neal J, Patel S, Js OJ, Schlosser R (2007) Comparison of techniques for transsphenoidal pituitary surgery. Am J Rhinol 21:203–206CrossRefPubMed Neal J, Patel S, Js OJ, Schlosser R (2007) Comparison of techniques for transsphenoidal pituitary surgery. Am J Rhinol 21:203–206CrossRefPubMed
48.
Zurück zum Zitat Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A (2000) Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches ☆. Otolaryngol Head Neck Surg 122:367–369CrossRefPubMed Spencer WR, Levine JM, Couldwell WT, Brown-Wagner M, Moscatello A (2000) Approaches to the sellar and parasellar region: a retrospective comparison of the endonasal-transsphenoidal and sublabial-transsphenoidal approaches ☆. Otolaryngol Head Neck Surg 122:367–369CrossRefPubMed
49.
Zurück zum Zitat Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed
50.
51.
Zurück zum Zitat Strychowsky J, Nayan S, Reddy K, Farrokhyar F, Sommer D (2011) Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J Otolaryngol Head Neck Surg 40:175–185PubMed Strychowsky J, Nayan S, Reddy K, Farrokhyar F, Sommer D (2011) Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J Otolaryngol Head Neck Surg 40:175–185PubMed
52.
Zurück zum Zitat Takakazu K, Hiroshi I, Ritsuko I, Tomokatsu H (2002) Minimally invasive endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors: experience with 215 cases comparing with sublabial trans-sphenoidal approach. Neurol Res 24:259–265CrossRef Takakazu K, Hiroshi I, Ritsuko I, Tomokatsu H (2002) Minimally invasive endoscope-assisted endonasal trans-sphenoidal microsurgery for pituitary tumors: experience with 215 cases comparing with sublabial trans-sphenoidal approach. Neurol Res 24:259–265CrossRef
54.
Zurück zum Zitat Villwock JA, Villwock MR, Parul G, Deshaies EM (2015) Current trends in surgical approach and outcomes following pituitary tumor resection. Laryngoscope 125:1307–1312CrossRefPubMed Villwock JA, Villwock MR, Parul G, Deshaies EM (2015) Current trends in surgical approach and outcomes following pituitary tumor resection. Laryngoscope 125:1307–1312CrossRefPubMed
56.
Zurück zum Zitat Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H, White WL, Little AS (2016) Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 124:596–604. https://doi.org/10.3171/2015.4.JNS15102CrossRefPubMed Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H, White WL, Little AS (2016) Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 124:596–604. https://​doi.​org/​10.​3171/​2015.​4.​JNS15102CrossRefPubMed
Metadaten
Titel
Systematic review and network meta-analysis assess the comparative efficacy and safety of transsphenoidal surgery for pituitary tumor
verfasst von
Wei Dai
Zong Zhuang
Haiping Ling
Yongbo Yang
Chunhua Hang
Publikationsdatum
08.02.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Neurosurgical Review / Ausgabe 1/2021
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-020-01240-3

Weitere Artikel der Ausgabe 1/2021

Neurosurgical Review 1/2021 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.