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J Neurosurg. 2009 Sep;111(3):545-54. doi: 10.3171/2007.12.17635.

Endoscopic pituitary surgery: a systematic review and meta-analysis.

Author information

1
Department of Otolaryngology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10003, USA. atabaee@hotmail.com

Abstract

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.

Comment in

PMID:
19199461
DOI:
10.3171/2007.12.17635
[Indexed for MEDLINE]
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