Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery

a meta-analysis

Reem D. Almutairi, Ivo S. Muskens, David J. Cote, Mark D. Dijkman, Vasileios K. Kavouridis, Erin Crocker, Kholoud Ghazawi, Marike L.D. Broekman, Timothy R. Smith, Rania A. Mekary, Hasan A. Zaidi

Research output: Contribution to journalReview articleResearchpeer-review

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1005-1021
Number of pages17
JournalActa Neurochirurgica
Volume160
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Fingerprint

Pituitary Neoplasms
Meta-Analysis
Neoplasms
Publication Bias
Pituitary Gland
Lighting
PubMed
Adenoma
Databases
Guidelines

Keywords

  • Endoscopic transsphenoidal surgery
  • Gross total resection
  • Meta-analysis
  • Microscopic transsphenoidal surgery
  • Pituitary adenoma
  • Transsphenoidal surgery

Cite this

Almutairi, Reem D. ; Muskens, Ivo S. ; Cote, David J. ; Dijkman, Mark D. ; Kavouridis, Vasileios K. ; Crocker, Erin ; Ghazawi, Kholoud ; Broekman, Marike L.D. ; Smith, Timothy R. ; Mekary, Rania A. ; Zaidi, Hasan A. / Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery : a meta-analysis. In: Acta Neurochirurgica. 2018 ; Vol. 160, No. 5. pp. 1005-1021.
@article{b30f8d36e85a4986acbc3e3158adf96d,
title = "Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis",
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.",
keywords = "Endoscopic transsphenoidal surgery, Gross total resection, Meta-analysis, Microscopic transsphenoidal surgery, Pituitary adenoma, Transsphenoidal surgery",
author = "Almutairi, {Reem D.} and Muskens, {Ivo S.} and Cote, {David J.} and Dijkman, {Mark D.} and Kavouridis, {Vasileios K.} and Erin Crocker and Kholoud Ghazawi and Broekman, {Marike L.D.} and Smith, {Timothy R.} and Mekary, {Rania A.} and Zaidi, {Hasan A.}",
year = "2018",
month = "5",
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doi = "10.1007/s00701-017-3438-z",
language = "English",
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pages = "1005--1021",
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Almutairi, RD, Muskens, IS, Cote, DJ, Dijkman, MD, Kavouridis, VK, Crocker, E, Ghazawi, K, Broekman, MLD, Smith, TR, Mekary, RA & Zaidi, HA 2018, 'Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis', Acta Neurochirurgica, vol. 160, no. 5, pp. 1005-1021. https://doi.org/10.1007/s00701-017-3438-z

Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery : a meta-analysis. / Almutairi, Reem D.; Muskens, Ivo S.; Cote, David J.; Dijkman, Mark D.; Kavouridis, Vasileios K.; Crocker, Erin; Ghazawi, Kholoud; Broekman, Marike L.D.; Smith, Timothy R.; Mekary, Rania A.; Zaidi, Hasan A.

In: Acta Neurochirurgica, Vol. 160, No. 5, 01.05.2018, p. 1005-1021.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery

T2 - a meta-analysis

AU - Almutairi, Reem D.

AU - Muskens, Ivo S.

AU - Cote, David J.

AU - Dijkman, Mark D.

AU - Kavouridis, Vasileios K.

AU - Crocker, Erin

AU - Ghazawi, Kholoud

AU - Broekman, Marike L.D.

AU - Smith, Timothy R.

AU - Mekary, Rania A.

AU - Zaidi, Hasan A.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

KW - Endoscopic transsphenoidal surgery

KW - Gross total resection

KW - Meta-analysis

KW - Microscopic transsphenoidal surgery

KW - Pituitary adenoma

KW - Transsphenoidal surgery

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U2 - 10.1007/s00701-017-3438-z

DO - 10.1007/s00701-017-3438-z

M3 - Review article

VL - 160

SP - 1005

EP - 1021

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

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