Meta‐analysis of Endoscopic vs Sublabial Pituitary Surgery

Abstract

Objective: Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates. Method: A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach. Results: A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P < .01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay ( P = .01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery. Conclusion: The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta-analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.