title: Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Inconsistent findings have been reported regarding the efficacy and safety of endoscopic and microscopic transsphenoidal surgery for pituitary adenoma. This study aimed to assess the benefits and shortcomings of these surgical methods in patients with pituitary adenoma.
  
  
  METHODS
  The electronic databases PubMed, Embase, and the Cochrane Library were systematically searched, as well as proceedings of major meetings. Eligible studies with a retrospective or prospective design that evaluated endoscopic versus microscopic methods in patients with pituitary adenoma were included. Primary outcomes included gross tumor removal, cerebrospinal fluid leak, diabetes insipidus, and other complications.
  
  
  RESULTS
  Overall, 23 studies (4 prospective and 19 retrospective) assessing 2272 patients with pituitary adenoma were included in the final analysis. Endoscopic transsphenoidal surgery was associated with a higher incidence of gross tumor removal (odds ratio, 1.52; 95% confidence interval, 1.11-2.08; P = 0.009) than those with microscopic transsphenoidal surgery. In addition, endoscopic transsphenoidal surgery had no significant effect on the risk of cerebrospinal fluid leak, compared with microscopic transsphenoidal surgery. Furthermore, endoscopic transsphenoidal surgery was associated with a 22% reduction in risk of diabetes insipidus compared with microscopic transsphenoidal surgery, but the difference was not statistically significant. Endoscopic transsphenoidal surgery significantly reduced the risk of septal perforation (odds ratio, 0.29; 95% confidence interval, 0.11-0.78; P = 0.014) and was not associated with the risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, and recurrence.
  
  
  CONCLUSIONS
  Endoscopic transsphenoidal surgery is associated with higher gross tumor removal and lower incidence of septal perforation in patients with pituitary adenoma. Future large-scale prospective randomized controlled trials are needed to verify these findings.
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China.
authors.forename: Aijun
authors.initials: A
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China.
authors.forename: Weisheng
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China.
authors.forename: Peicheng
authors.initials: P
authors.lastname: Cao
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China. Electronic address: yuehuazheng16@163.com.
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China.
authors.forename: Zhenfu
authors.initials: Z
authors.lastname: Bu
authors.affiliation: Department of Neurosurgery, Weifang People's Hospital, Shandong, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods / Q000592:standards*; D044583:Neuroendoscopy / Q000379:methods / Q000592:standards*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic; Meta-analysis; Microscopic; Pituitary adenoma