title: Endoscopic Endonasal Versus Microscopic Transsphenoidal Surgery for Recurrent and/or Residual Pituitary Adenomas.
abstract: OBJECTIVE
  Surgery for recurrent/residual pituitary adenomas is increasingly being performed through endoscopic surgery. Whether this new technology has altered the indications and outcomes of surgery is unknown. We conducted a systematic review and meta-analysis of published studies to compare the indications and outcomes between microscopic and endoscopic approaches.
  
  
  METHODS
  A PubMed search was conducted (1985-2015) to identify surgical series of endoscopic endonasal and microscopic transsphenoidal resection of residual or recurrent pituitary adenomas. Data were extracted regarding tumor characteristics, surgical treatment, extent of resection, endocrine remission, visual outcome, and complications.
  
  
  RESULTS
  Twenty-one studies met inclusion criteria. A total of 292 patients were in the endoscopic group, and 648 patients were in the microscopic group. Endoscopic cases were more likely nonfunctional (P < 0.001) macroadenomas (P < 0.001) with higher rates of cavernous sinus invasion (P = 0.012). The pooled rate of gross total tumor resection was 53.5% for the endoscopic group and 46.6% for the microscopic group. Endocrine remission was achieved in 53.0% and 46.7% of patients, and visual improvement occurred in 73.2% and 49.6% for the endoscopic and microscopic groups. Cerebrospinal fluid leak and pituitary insufficiency were higher in the endoscopic group.
  
  
  CONCLUSIONS
  This meta-analysis indicates that the use of the endoscope to reoperate on residual or recurrent adenomas has only led to modest increases in resection rates. However, larger more complex cases are being tackled, so direct comparisons are misleading. The most dramatic change has been in visual improvement along with modest increases in risk. Reoperation for recurrent or residual adenomas is a safe and effective treatment option.
authors.affiliation: Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA. Electronic address: Yoshua.EsquenaziLevy@uth.tmc.edu.
authors.forename: Yoshua
authors.initials: Y
authors.lastname: Esquenazi
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Walid I
authors.initials: WI
authors.lastname: Essayed
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA; Department of Neurological Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.affiliation: Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mauer
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Mudassir
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Neurological Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA; Department of Neuroscience, Weill Cornell Medical College, Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods / Q000592:standards*; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods / Q000592:standards*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Endonasal endoscopic; Microscopic; Pituitary adenoma; Pituitary surgery; Recurrent; Skull base; Transsphenoidal