Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis
Mario Ammirati, Lai Wei, Ivan Ciric J Neurol Neurosurg Psychiatry 2013;84:843–849. doi:10.1136/jnnp-2012-303194
Context: Since the 1960s the transphenoidal route for the resection of pituitary adenomas has been most commonly used. Initially this route was used solely with the aid of an operating microscope. The last decade however has seen the rapid expansion of endoscopic techniques and approaches to the skull base. It has been suggested that the greater visualisation from endoscopes may result in less damage to surrounding tissue and fewer complications but no formal randomised controlled trials have been undertaken to validate this. As such the authors have performed a meta-analysis of all English language studies with greater than 10 patients from 1990 to August 2011 in which the outcomes from endoscopic and/or microscopic transphenoidal pituitary resections were published.
Methods: In total 16 manuscripts were found that dealt with the endoscopic approach alone, a further 14 on the microscopic approach and eight papers included both techniques comprising of 5643 patients. From the published series there was no statistical significance in the size of the tumour or the gender of the patients undergoing endoscopic or microscopic resections.
Context: Since the 1960s the transphenoidal route for the resection of pituitary adenomas has been most commonly used. Initially this route was used solely with the aid of an operating microscope. The last decade however has seen the rapid expansion of endoscopic techniques and approaches to the skull base. It has been suggested that the greater visualisation from endoscopes may result in less damage to surrounding tissue and fewer complications but no formal randomised controlled trials have been undertaken to validate this. As such the authors have performed a meta-analysis of all English language studies with greater than 10 patients from 1990 to August 2011 in which the outcomes from endoscopic and/or microscopic transphenoidal pituitary resections were published.
Methods: In total 16 manuscripts were found that dealt with the endoscopic approach alone, a further 14 on the microscopic approach and eight papers included both techniques comprising of 5643 patients. From the published series there was no statistical significance in the size of the tumour or the gender of the patients undergoing endoscopic or microscopic resections.
The results show there are no immediate benefits of endoscopic over microscopic resections but there may be a slightly increased rate of vascular complications associated with it. The documented vascular complications include intracerebral haemorrhages, midbrain stroke / haemorrhages, posterior cerebral artery laceration and internal carotid artery injury. The authors hypothesise this may be due to a greater exposure of the optico-carotid recess or the lack of 3-dimensional depth perception with endoscopic techniques.
Conclusion: In this meta-analysis the results of 38 publications with a total of 5643 patients (2125 endoscopic and 3518 microscopic) were analysed. The results show no significant difference between transphenoidal endoscopic and microscopic pituitary resection with the exception of a slightly raised incidence of vascular injuries in the endoscopic group. A randomised control trial comparing the two operative techniques is required to confirm these findings.
Vejay N. Vakharia MB BChir MA(Cantab) MRCS
Conclusion: In this meta-analysis the results of 38 publications with a total of 5643 patients (2125 endoscopic and 3518 microscopic) were analysed. The results show no significant difference between transphenoidal endoscopic and microscopic pituitary resection with the exception of a slightly raised incidence of vascular injuries in the endoscopic group. A randomised control trial comparing the two operative techniques is required to confirm these findings.
Vejay N. Vakharia MB BChir MA(Cantab) MRCS
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