title: Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Growth Hormone-Secreting Pituitary Adenomas-Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The pituitary adenoma causing acromegaly is typically resected through a transsphenoidal approach and visualized with an operating microscope or endoscope. We undertook a systematic review and meta-analysis examining the clinical efficacy of endoscopic and microsurgical approaches.
  
  
  METHODS
  Relevant studies using either endoscopic or microscopic transsphenoidal approaches for growth hormone pituitary adenomas were identified until February 2016. Data were extracted and analyzed according to predefined clinical end points.
  
  
  RESULTS
  We identified 31 studies, in which 950 patients underwent endoscopic transsphenoidal resection and 2137 patients underwent microsurgical transsphenoidal resection. Patients undergoing microsurgery were less likely to present with hypothyroidism (10.7% vs. 19.1%, P = 0.033, 462 vs. 156 patients) and less likely to have macroadenomas (66.9% vs. 83.8%, P ≤ 0.001, 1484 vs. 884 patients); adenomas with cavernous sinus invasion (21.3% vs. 44.4%, P = 0.036, 592 vs. 558 patients); and a lower mean tumor volume (17.84 vs. 20.54 mm3, P = 0.012, 158 vs. 248 patients). Patients treated via the endoscopic approach were more likely to achieve remission for noninvasive macroadenomas (83.8% vs. 66.9%, P ≤ 0.001, 115 vs. 365 patients). Sinusitis (15.6% vs. 2.6%, P < 0.001, 241 vs. 295 patients) and intraoperative cerebrospinal fluid leak (21.6% vs. 1.0%, P = 0.022, 697 vs. 127 patients) were more common in patients treated endoscopically, and meningitis (0.7% vs. 1.7%, P = 0.027, 511 vs. 1513 patients) was more common in patients undergoing a microsurgical approach.
  
  
  CONCLUSIONS
  Our study shows the clinical utility of the endoscopic approach and demonstrates potential benefits including increased remission rates with noninvasive macroadenomas and a lower rate of meningitis.
authors.affiliation: NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia. Electronic address: kphan.vc@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Xu
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Reddy
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors.forename: Piyush
authors.initials: P
authors.lastname: Kalakoti
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Jacob
authors.initials: J
authors.lastname: Fairhall
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D013100:Sphenoid Bone / Q000601:surgery; D000067369:Transanal Endoscopic Microsurgery / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Acromegaly; Adenoma; Endoscopic; Meta-analysis; Microsurgical; Pituitary