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10.11.2017 | Review Article - Brain Tumors | Ausgabe 1/2018 Open Access

Acta Neurochirurgica 1/2018

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis

Zeitschrift:
Acta Neurochirurgica > Ausgabe 1/2018
Autoren:
Ivo S. Muskens, Vanessa Briceno, Tom L. Ouwehand, Joseph P. Castlen, William B. Gormley, Linda S. Aglio, Amir H. Zamanipoor Najafabadi, Wouter R. van Furth, Timothy R. Smith, Rania A. Mekary, Marike L. D. Broekman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-017-3390-y) contains supplementary material, which is available to authorized users.
Rania A. Mekary and Marike L. D. Broekman 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, 2027.

Abstract

Object

In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes.

Methods

A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values.

Results

Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results.

Conclusion

In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.

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Zusatzmaterial
Supplementary Table 1 Search syntax (DOCX 12 kb)
701_2017_3390_MOESM1_ESM.docx
Literatur
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