Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Growth Hormone–Secreting Pituitary Adenomas—Systematic Review and Meta-Analysis

Phan, Kevin; Xu, Joshua; Reddy, Rajesh; Kalakoti, Piyush; Nanda, Anil; Fairhall, Jacob

doi:10.1016/j.wneu.2016.10.029

Cited by 63 publications

(41 citation statements)

References 44 publications

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“…The merits and disadvantages of endoscopic and microscopic transsphenoidal pituitary adenoma resection have been evaluated in several previous studies [4][5][6]. However, the comparison of endoscopic and microscopic transsphenoidal resection specifically on NFPA has never been systematically performed before.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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Both microscopic and endoscopic transsphenoidal surgery are effective approaches for nonfunctioning pituitary adenomas. The issue on the comparison of their efficacy and safety remains inconsistent. A thorough search of the literatures (PubMed, EMBASE, MEDLINE) were performed up to March 2017. Studies reporting outcomes of microscopic or endoscopic transsphenoidal surgery on nonfunctioning pituitary adenomas were included. A meta‐analysis was performed focusing on the early stage and long term outcomes. The final search yielded 19 eligible studies enrolling 3847 patients, 389 of them underwent microscopic approach and 3458 of them with endoscopic approach. As to the early stage outcomes, the rate of gross tumor resection was significantly higher in the endoscopic group than that in microscopic group (73% versus 60%, P < 0.001). Meanwhile, endoscopic approach showed priority over microscopy on postoperative hypopituitarism (63% versus 65%, P < 0.001) and CSF leakage (3% versus 7%, P < 0.001). For the long term outcomes, the rate of visual improvement was significant higher in the endoscopic group than that in microscopic group (77% versus 50%, P < 0.001). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus and meningitis. The endoscopic approach may be associated with higher rate of gross tumor movement and lower risk of postoperatively complications for treating nonfunctioning pituitary adenoma, when compared with microscopic approach. However, the confidence was shorted due to limited high quality evidence (largely randomized and controlled studies).

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Section: Discussionmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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“…However, recent meta-analyses showed that the endoscopic technique is associated with higher gross tumor removal ( 57 ) and modest increases of resection rates in residual or recurrent cases ( 58 ). In patients with functional pituitary adenomas (growth hormone-secreting adenoma), Phan and coworkers ( 59 ) concluded that clinical use of the endoscopic approach conferred potential benefits, including increased remission rates with non-invasive macroadenomas, but that overall endocrine remission is comparable. Chen and coworkers ( 60 ) also concluded that both approaches yielded similar rates of remission.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding postoperative complications, previous studies include thorough descriptions and analyses, most of which demonstrate that patients who underwent endoscopic surgery had comparable proportions of complications, including diabetes insipidus, CSF leakage, hypocortisolemia, hypothyroidism, hypogonadism and visual defects, compared to patients who underwent microscopic surgery ( 57 , 58 , 59 , 60 ). In this meta-analysis, we did not include any of these complications.…”

Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Qiao

2018

Endocrine Connections

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IntroductionIt is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS.MethodsWe conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD.ResultsA total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651).ConclusionsWe found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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“…One systematic review on endoscopic and microscopic transsphenoidal surgery for acromegaly exists (Table ) …”

Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Growth Hormone–Secreting Pituitary Adenomas—Systematic Review and Meta-Analysis

Cited by 63 publications

References 44 publications

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

ICAR: endoscopic skull‐base surgery

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