title: Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis.
abstract: OBJECTIVE
  Tuberculum sellae meningiomas (TSMs) are challenging tumors for surgical resection. Endoscopic endonasal (EE) approaches to these lesions have not been directly compared to open craniotomy in a controlled trial.
  
  
  METHODS
  We searched Medline and Embase online databases for English-language articles containing key words related to TSMs. Data were pooled, including 5 of our own patients reported here for the first time. Metaregression was used and a decision-analytical model was constructed to compare outcomes between open microsurgery and EE approaches.
  
  
  RESULTS
  The overall quality of life (QOL) was not significantly different between the approaches (p = 0.410); however, there were large differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 and in endoscopic patients of 0.952. Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, p < 0.001) but a lower rate of injury to the optic apparatus (1.4 vs. 9.2%, p < 0.001) compared with craniotomy. The 3-year recurrence rates were not statistically different (p = 0.529).
  
  
  CONCLUSIONS
  EE resection of TSMs appears to be a comparable alternative to traditional open microsurgical resection with respect to overall QOL based on available publications. A meaningful comparison of recurrence rates will require a longer follow-up.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
authors.forename: Leif-Erik
authors.initials: LE
authors.lastname: Bohman
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
authors.forename: Aamir
authors.initials: A
authors.lastname: Khan
authors.forename: T T
authors.initials: TT
authors.lastname: Sitterley
authors.forename: Diana
authors.initials: D
authors.lastname: Chang
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000009:adverse effects; D003661:Decision Support Techniques; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012658:Sella Turcica; D016896:Treatment Outcome