Endoscopic pituitary surgery: a systematic review and meta-analysis

Clinical article

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Object

Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes.

Methods

The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes.

Results

Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67–89%). Hormone resolution was achieved in 81% (95% CI 71–91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76–92%) of growth hormone secreting tumors, and 82% (95% CI 70–94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0–4%) for CSF leak and 1% (95% CI 0–2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%.

Conclusions

The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.

Abbreviations used in this paper: ACTH = adrenocorticotropic hormone; GH = growth hormone; LOS = length of stay; PRL = prolactin.

Article Information

Address correspondence to: Abtin Tabaee, M.D., 10 Union Square East, Suite 4J, New York, New York 10003. email: atabaee@hotmail.com.

Please include this information when citing this paper: published online January 23, 2009; DOI: 10.3171/2007.12.17635.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graphic representation showing pooled rates of gross tumor removal.

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    Graphic representation showing pooled hormone resolution rates for ACTH-secreting tumors.

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    Graphic representation showing pooled hormone resolution rates for GH-secreting tumors.

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    Graphic representation showing pooled hormone resolution rates for PRL-secreting tumors.

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    Graphic representation showing pooled hormone resolution rates for all hormone-secreting tumors.

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    Graphic representation showing pooled complication rates for CSF leak.

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    Graphic representation showing pooled complication rates for both any diabetes insipidus events.

  • View in gallery

    Graphic representation showing pooled complication rates for permanent diabetes insipidus.

  • View in gallery

    Graphic representation showing pooled complication rates for epistaxis.

  • View in gallery

    Graphic representation showing pooled complication rates for anterior pituitary dysfunction.

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