Transcranial Approach versus Endoscopic Transsphenoidal Approach during Midline Suprasellar Meningioma Resection—A Complication and Outcome-Based Study: A Meta-Analysis

Abstract

Background and Purpose The choice of surgical approach for the removal of midline suprasellar meningiomas (MSM) has long remained inconclusive among neurosurgeons. While some neurosurgeons prefer transcranial approach (TCA), others favor the use of endoscopic transsphenoidal approach (ETSA). Retrospectively, we assessed the effectiveness of TCA and ETSA on the basis of postoperative outcome and complications to inform future clinical decision making on MSMs. Materials and Methods A retrospective systematic review and meta-analysis was performed on published case series in PubMed from the year 2000 to 2014. Demographic data, clinical variables, and outcome measures of patients who had their MSMs surgically removed via TCA or ETSA were subjected to rigorous statistical analysis. Results There were 48 studies with 1,466 patients who underwent TCA (32 studies) and ETSA (16 studies). TCA had a statistically significant rate of tumor recurrence (p = 0.02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1–6.39) while ETSA had a high rate of CSF leakage (p = 0.04; OR, 25; 95% CI, 1.78–11.56). Both TCA and ETSA did not improve visual recovery and gross total resection, but only minimally influenced total clinical outcome. Conclusion Put together, ETSA and TCA did not improve CSF leakage rate and tumor recurrence respectively, but in the absence of a surgical approach that could maximize the advantages of both TCA and ETSA, it is advisable that neurosurgeons take an informed clinical decision reflective of patient peculiar clinical presentations as well as risk/benefit profile of surgical technique.