Journal Article: Endoscopic Versus Microscopic Transsphe… A Systematic Review and Meta-Analysis

This systematic review and meta-analysis published in World Neurosurgery in 2017 attempted to compare and contrast the endoscopic vs. microscopic approach to transsphenoidal surgery for pituitary adenomas. Transsphenoidal surgery has become a well-established option for treating patients with these benign tumors. Microscopy has been the initial gold standard, however in recent years endoscopic approach has been increasingly used. How exactly these two surgical methods compare has been controversial, thereby warranting this study.

Data was collected to assess both the safety and efficacy of the two contrasting approaches. Ultimately out of the 410 articles, 23 (4 prospective and 19 retrospective) met the inclusion criteria and were selected for final analysis. The results indicated a higher incidence of gross tumor removal in the endoscopic approach vs. the microscopic. Additionally, endoscopic transsphenoidal surgery had no significant effect on risk of CSF leak, was associated with a 22% reduction in risk of diabetes insipidus, reduced risk of septal perforation, and was not associated with risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocorticolism, total mortality or recurrence.

Limitations of this study include some studies not lasting long enough to properly determine the efficacy/safety of the contrasting approaches, sample size may not have been large enough, and individualized patient data is not available for meta-analyses. Overall, this study displayed the benefit of endoscopic surgery over microscopic approach. It should be noted though that the main findings are based on retrospective evaluations, and therefore future large-scale prospective randomized controlled trials should be performed to confirm these results.