Abstract
Both microscopic and endoscopic transsphenoidal surgery are effective approaches for nonfunctioning pituitary adenomas. The issue on the comparison of their efficacy and safety remains inconsistent. A thorough search of the literatures (PubMed, EMBASE, MEDLINE) were performed up to March 2017. Studies reporting outcomes of microscopic or endoscopic transsphenoidal surgery on nonfunctioning pituitary adenomas were included. A meta‐analysis was performed focusing on the early stage and long term outcomes. The final search yielded 19 eligible studies enrolling 3847 patients, 389 of them underwent microscopic approach and 3458 of them with endoscopic approach. As to the early stage outcomes, the rate of gross tumor resection was significantly higher in the endoscopic group than that in microscopic group (73% versus 60%, P < 0.001). Meanwhile, endoscopic approach showed priority over microscopy on postoperative hypopituitarism (63% versus 65%, P < 0.001) and CSF leakage (3% versus 7%, P < 0.001). For the long term outcomes, the rate of visual improvement was significant higher in the endoscopic group than that in microscopic group (77% versus 50%, P < 0.001). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus and meningitis. The endoscopic approach may be associated with higher rate of gross tumor movement and lower risk of postoperatively complications for treating nonfunctioning pituitary adenoma, when compared with microscopic approach. However, the confidence was shorted due to limited high quality evidence (largely randomized and controlled studies).
Highlights
Non-functioning pituitary adenoma (NFPA) is the most common phenotype of pituitary adenomas with considerable morbidity because of hypopituitarism and mass effect [1]
In contrast to the prolactin and growth hormone-secreting pituitary adenomas, none of effective drugs are available for NFPA, and transsphenoidal surgical resection remains the first-line treatment [1]
Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine
Summary
Non-functioning pituitary adenoma (NFPA) is the most common phenotype of pituitary adenomas with considerable morbidity because of hypopituitarism and mass effect [1]. Endoscopic approach provides a wider and superior picture of the parasellar and suprasellar compartments, which may gain access to improve the rate of GTR, protection of normal pituitary tissue, and reduce post-operative complications [3]. Previous studies have systemically reviewed the outcome of endoscopic and microscopic approach among either all the subtypes of pituitary adenomas [4, 5] or growth hormone-secreting pituitary adenomas [6].
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