title: Microscopic versus endoscopic pituitary surgery: a systematic review.
abstract: OBJECTIVE
  To critically review current literature comparing microscopic versus endoscopic surgery in the treatment of pituitary adenomas.
  
  
  METHODS
  Systematic review of the literature.
  
  
  METHODS
  All English language literature published between January 1989 and June 2009 on PubMed were eligible for inclusion. Inclusion criteria were: direct comparison between microscopic and fully endoscopic approaches and surgery performed with the intent to treat a pituitary adenoma. Endoscopic-assisted comparisons and studies comparing outcomes with previous literature were excluded. Technical notes, case reports, letters, and comments were also excluded. Included studies were categorized according to level of evidence and evaluated for quality using a modified Downs and Black scale. Data was extracted and compared between studies.
  
  
  RESULTS
  Of the 3,586 studies retrieved from the search strategy, 11 studies met the inclusion and exclusion criteria. Various outcomes measures were used including: operating time, extent of tumor resection, postoperative normalization of hormone levels, incidence of complications, length of hospital stay, and patient pain and discomfort. The endoscopic approach decreased operating time, lumbar drains, immediate postoperative diabetes insipidus, some rhinologic complications, length of hospital stay, and patient pain and discomfort. Other outcome measures were comparable between the two approaches.
  
  
  CONCLUSIONS
  The literature comparing endoscopic and microscopic pituitary surgery favors the endoscopic approach for pituitary surgery. Major outcome measures (extent of tumor resection, changes in hormone levels) do not differ between the two approaches. Complications, time in the operating room and hospital, and patient discomfort are significantly less with the endoscopic approach.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. brian.rotenberg@sjhc.london.on.ca
authors.forename: Brian
authors.initials: B
authors.lastname: Rotenberg
authors.forename: Samantha
authors.initials: S
authors.lastname: Tam
authors.forename: Won Hyung A
authors.initials: WH
authors.lastname: Ryu
authors.forename: Neil
authors.initials: N
authors.lastname: Duggal
mesh_terms: D006801:Humans; D007016:Hypophysectomy / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*