OBJECT: Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. METHODS: The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. RESULTS: Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67-89%). Hormone resolution was achieved in 81% (95% CI 71-91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76-92%) of growth hormone secreting tumors, and 82% (95% CI 70-94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0-4%) for CSF leak and 1% (95% CI 0-2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. CONCLUSIONS: The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.
OBJECT: Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. METHODS: The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. RESULTS: Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67-89%). Hormone resolution was achieved in 81% (95% CI 71-91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76-92%) of growth hormone secreting tumors, and 82% (95% CI 70-94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0-4%) for CSF leak and 1% (95% CI 0-2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. CONCLUSIONS: The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.
Authors: Jackson A Gondim; Joao Paulo C Almeida; Lucas Alverne F Albuquerque; Michele Schops; Erika Gomes; Tania Ferraz; Wladia Sobreira; Meissa T Kretzmann Journal: Pituitary Date: 2011-06 Impact factor: 4.107
Authors: Hussein Fathalla; Michael D Cusimano; Antonio Di Ieva; John Lee; Omar Alsharif; Jeannette Goguen; Stanley Zhang; Harley Smyth Journal: Neurosurg Rev Date: 2015-02-10 Impact factor: 3.042
Authors: Nyssa Fox Farrell; Todd T Kingdom; Anne E Getz; Kevin O Lillehei; A Samy Youssef; Vijay R Ramakrishnan Journal: World Neurosurg Date: 2018-12-19 Impact factor: 2.104
Authors: Adam S Deconde; Darshni Vira; Christopher F Thompson; Marilene B Wang; Marvin Bergsneider; Jeffrey D Suh Journal: J Neurol Surg B Skull Base Date: 2013-06-10