Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

Chen, Ching-Jen; Ironside, Natasha; Pomeraniec, I. Jonathan; Chivukula, Srinivas; Buell, Thomas J.; Ding, Dale; Taylor, Davis G.; Dallapiazza, Robert F.; Lee, Cheng‐Chia; Bergsneider, Marvin

doi:10.1007/s00701-017-3318-6

Cited by 86 publications

(72 citation statements)

References 106 publications

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“…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. However, a meta-analysis comparing outcomes from endoscopic TS and microscopic TS was lacking.…”

Section: Discussionmentioning

confidence: 92%

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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Section: Discussionmentioning

confidence: 92%

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

Qiao

2018

Endocrine Connections

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“…Therefore, the rate of CSF leak after expanded methods is significantly higher than the rate during endoscopic approaches in which the arachnoid space is not intentionally violated. [4][5][6] A major risk factor for developing meningitis following EETS is the presence of a postoperative CSF leak. 4,7,8 The consequences from meningitis can be life-threatening 9 and carries risks of both long-term physiological and cognitive impairements [10][11][12] ; therefore, it is crucial to identify clinical features that may predispose patients to postoperative infections.…”

Section: Introductionmentioning

confidence: 99%

Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases

Lee

Cohen

Chan

et al. 2019

J Neurol Surg B Skull Base

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Objective To identify perioperative factors that may predict postoperative cerebrospinal fluid (CSF) leak and meningitis following expanded endoscopic transsphenoidal surgery (EETS). Study Design This is a retrospective study. This study was set at the Cedars-Sinai Medical Center, Los Angeles. A total of 78 patients who underwent EETS between January 2007 and November 2018 were participated. The main outcome measures were CSF leak and meningitis. Results A total of 78 patients underwent a total of 100 EETS procedures; 17.9 and 10.3% of patients developed postoperative CSF leaks and meningitis, respectively. Out of eight, three patients with meningitis did not develop an observable CSF leak. The risk of developing meningitis in patients with a CSF leak was significantly higher than those without a leak, with an odds ratio (OR) of 11.48 (95% confidence interval, 2.33–56.47; p = 0.004). Pituicytomas were significantly associated with meningitis compared with other pathologies. No other patient-specific factors were identified as risks for leak or meningitis, including method of skull base repair, sex, tumor volume, or body mass index, although there was a strong trend toward reduced CSF leak rates in patient with nasoseptal flaps used for skull base repair, compared with those without (9.5 vs. 25%). CSF protein was consistently elevated on the first CSF values obtained when meningitis was suspected. Conclusion CSF leak and meningitis are common complications of expanded endonasal surgery No statistically significant risk factors for developing a postoperative leak other than the pathology of pituicytoma were identified, including method of skull base repair, although the use of a vascularized nasoseptal flap did trend toward a reduced CSF leak rate. CSF protein is the most sensitive marker for the presumptive diagnosis and timely treatment of meningitis.

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“…Treatment of patients with acromegaly is aimed at normalizing GH and/or IGF1 levels to ameliorate signs and symptoms of the disease 2,4,5 and reduce excess mortality [6][7][8] . Long-term biochemical control is achieved in fewer than 65% of patients following surgical resection of the tumour despite the use of novel surgical approaches [9][10][11][12][13][14][15] , and only approximately half of patients treated with medical therapy achieve control of IGF1 levels [16][17][18][19] . Radiation therapy remains an option in patients with persistently active disease, but rates of control and safety have only marginally improved with the use of stereotactic radiosurgery instead of conventional fractionated radiotherapy 20 .…”

mentioning

confidence: 99%

A Consensus Statement on acromegaly therapeutic outcomes

et al. 2018

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Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

Abstract: Both endoscopic and microsurgical approaches for TSR of growth hormone-secreting adenomas are viable treatment options for patients with acromegaly, and yield similarly high rates of remission under the most current consensus criteria.

Cited by 86 publications

References 106 publications

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

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

Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases

A Consensus Statement on acromegaly therapeutic outcomes

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