Endoscopic pituitary surgery: a systematic review and meta-analysis.
OBJECTIVE
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.
Tabaee
Abtin
A
Department of Otolaryngology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10003, USA. atabaee@hotmail.com
Anand
Vijay K
VK
Barrón
Yolanda
Y
Hiltzik
David H
DH
Brown
Seth M
SM
Kacker
Ashutosh
A
Mazumdar
Madhu
M
Schwartz
Theodore H
TH
D006801:Humans; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome