title: Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review.
abstract: OBJECTIVE
  To determine, in a systematic review, whether purely endoscopic transsphenoidal resection of pituitary adenomas offers improved outcomes and decreased complications compared to the traditional microscopic approach.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  The literature was searched using Medline, EMBASE, and the Cochrane Library (inception to October 2009) by two independent review authors.
  
  
  METHODS
  Studies were included if they compared the two surgical approaches for the management of pituitary adenomas and at least one main outcome measure.
  
  
  METHODS
  Gross tumour resection (GTR), recurrence, visual field improvement, hormone resolution, mean blood loss, mean operative time, mean hospital length of stay, cerebrospinal fluid (CSF) leak, hormone deterioration, vision deterioration, nasal complications, meningitis, and death.
  
  
  RESULTS
  Ten studies met the inclusion criteria (one prospective and nine retrospective) and involved 687 patients. The purely endoscopic approach was associated with less mean blood loss, shorter hospital stays and operative times, and fewer nasal complications. There was also a trend toward better GTR and decreased incidence of postoperative diabetes insipidus. However, a higher incidence of postoperative CSF leak was also noted with the endoscopic approach. Other outcomes and complication rates appeared to be similar between the two groups.
  
  
  CONCLUSIONS
  Purely endoscopic transsphenoidal resection of pituitary adenomas seems to be safe and efficacious when compared to the traditional microscopic approach and may offer some benefit.
authors: Otolaryngology-Head and Neck Surgery, McMaster University, 1200 Main St W, Hamilton, ON L8N 3Z5. juliestrychowsky@medportae.ca
authors: Julie
authors: J
authors: Strychowsky
authors: Smriti
authors: S
authors: Nayan
authors: Kesava
authors: K
authors: Reddy
authors: Forough
authors: F
authors: Farrokhyar
authors: Doron
authors: D
authors: Sommer
mesh_terms: D000236:Adenoma / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D006801:Humans; D008866:Microsurgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications