Endoscopic transsphenoidal surgery versus microsurgery for the resection of pituitary adenomas: a systematic review

Abstract

To evaluate the efficacy and safety between endoscopic and microscopic surgery for transsphenoidal pituitary adenoma. Randomized or semi-random controlled trials comparing endoscopic with microscopic surgery for transsphenoidal pituitary adenoma and published between January 2000 and July 2013 were recruited. This meta-analysis (RevMan 5.1 software) was conducted to estimate short-term and long-term complications. Fixed random effect model or semi-random effect model was established to analyse the data. Twelve randomized or semi-random controlled trials were included in this study. Among 848 patients studied, 380 of them were treated with endoscopic and 468 were treated with microscopic. The analysis of the basic characteristics of these patients included in these studies showed that: compared with microscopic, the follow-up of patients in endoscopic group was shorter [OR = -2.29, 95%CI (-4.18, -0.39), P = 0.02], while there were no significant difference in gender proportion and the age of patients between the two groups (P > 0.05) . Also, compared with endoscopic, there was a significant addition in the incidence of diabetes insipidus [OR = 0.45, 95%CI(0.30,0.66), P < 0.0001] and other complications [OR = 0.26, 95%CI ( 0.12, 0.57), P = 0.0008] in the microscopic group, the blood loss during surgery was more [OR = -0.62, 95%CI(-1.19, 0.05), P = 0.03], the rate of complete tumor resection lower [OR = 0.61, 95%CI(0.39, 0.96), P = 0.03], and the hospitalization [OR = -1.53, 95%CI(-2.18, -0.88), P < 0.00001] was also significantly longer, there was no significant difference in the incidence of cerebrospinal fluid leakage, operation time and vision improvement rate (P > 0.05). For patients with pituitary tumors, endoscopic surgery may be more suitable compared with microscopic.