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Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis

  • Review Article - Brain Tumors
  • Published:
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Abstract

Background

Microscopic transsphenoidal surgery (mTSS) is a well-established method to address adenomas of the pituitary gland. Endoscopic transsphenoidal surgery (eTSS) has become a viable alternative, however. Advocates suggest that the greater illumination, panoramic visualization, and angled endoscopic views afforded by eTSS may allow for higher rates of gross total tumor resection (GTR). The aim of this meta-analysis was to determine the rate of GTR using mTSS and eTSS.

Methods

A meta-analysis of the literature was conducted using PubMed, EMBASE, and Cochrane databases through July 2017 in accordance with PRISMA guidelines.

Results

Seventy case series that reported GTR rate in 8257 pituitary adenoma patients were identified. For all pituitary adenomas, eTSS (GTR=74.0%; I2 = 92.1%) was associated with higher GTR as compared to mTSS (GTR=66.4%; I2 = 84.0%) in a fixed-effect model (P-interaction < 0.01). For functioning pituitary adenomas (FPAs) (n = 1170 patients), there was no significant difference in GTR rate between eTSS (GTR=75.8%; I2 = 63.9%) and mTSS (GTR=75.5%; I2 = 79.0%); (P-interaction = 0.92). For nonfunctioning pituitary adenomas (NFPAs) (n = 2655 patients), eTSS (GTR=71.0%; I2 = 86.4%) was associated with higher GTR as compared to mTSS (GTR=60.7%; I2 = 87.5%) in a fixed-effect model (P-interaction < 0.01). None of the associations were significant in a random-effect model (all P-interaction > 0.05). No significant publication bias was identified for any of the outcomes.

Conclusion

Among patients who were not randomly allocated to either approach, eTSS resulted in a higher rate of GTR as compared to mTSS for all patients and for NFPA patients alone, but only in a fixed-effect model. For FPA, however, eTSS did not seem to offer a significantly higher rate of GTR. These conclusions should be interpreted with caution because of the nature of the included non-comparative studies.

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Authors and Affiliations

  1. Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA

    Reem D. Almutairi, Kholoud Ghazawi & Rania A. Mekary

  2. School of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

    Reem D. Almutairi

  3. Brain Center Rudolf Magnus, Utrecht University Medical Center, Utrecht, The Netherlands

    Ivo S. Muskens, Mark D. Dijkman & Marike L. D. Broekman

  4. Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Ivo S. Muskens, David J. Cote, Vasileios K. Kavouridis, Erin Crocker, Marike L. D. Broekman, Timothy R. Smith, Rania A. Mekary & Hasan A. Zaidi

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  1. Reem D. Almutairi
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Correspondence to David J. Cote.

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Reem D. Almutairi and Ivo S. Muskens are shared first author

Rania A. Mekary and Hasan A. Zaidi are shared last author

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Studies excluded in the Analysis of Gross Tumor Resection (GTR). CS, Case series; RT, Randomized Trail; ETSS, Endoscopic Transsphenoidal surgery; MTSS, Microscopic Transsphenoidal Surgery; EATSS, Endoscope-Assisted Endonasal Trans-sphenoidal microsurgery; PA, Pituitary Adenomas; GTR, Gross Tumor Resection; NS, Not specified; NA, Not Available; (DOCX 30 kb)

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Analysis of Gross Tumor Resection (GTR) In Pituitary Adenoma Patients according to Tumor Characteristic in the selected studies. ETSS, Endoscopic Transsphenoidal surgery; MTSS, Microscopic Transsphenoidal Surgery; PA, Pituitary Adenomas; GTR, Gross Tumor Resection; NA, No Available; FPA, Functional Pituitary Adenoma; NFPA, Non- Functional Pituitary Adenoma ACTH, Cushing Disease; PRL, Prolactinoma; GH, Growth Hormone Hypersecretion (DOCX 41 kb)

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Funnel plot for publication bias for overall pituitary adenoma (PNG 55 kb)

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Funnel plot for publication bias for functional pituitary adenoma (PNG 39 kb)

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Funnel plot for publication bias for non-functional pituitary adenoma (PNG 51 kb)

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Almutairi, R.D., Muskens, I.S., Cote, D.J. et al. Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis. Acta Neurochir 160, 1005–1021 (2018). https://doi.org/10.1007/s00701-017-3438-z

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  • DOI: https://doi.org/10.1007/s00701-017-3438-z

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