Purely Endoscopic Transsphenoidal Surgery versus Traditional Microsurgery for Resection of Pituitary Adenomas: Systematic Review

Objective: To determine, in a systematic review, whether purely endoscopic transsphenoidal resection of pituitary adenomas offers improved outcomes and decreased complications compared to the traditional microscopic approach. Design: Systematic review. Setting: The literature was searched using Medline, EMBASE, and the Cochrane Library (inception to October 2009) by two independent review authors. Methods: Studies were included if they compared the two surgical approaches for the management of pituitary adenomas and at least one main outcome measure. Main Outcome Measures: Gross tumour resection (GTR), recurrence, visual field improvement, hormone resolution, mean blood loss, mean operative time, mean hospital length of stay, cerebrospinal fluid (CSF) leak, hormone deterioration, vision deterioration, nasal complications, meningitis, and death. Results: Ten studies met the inclusion criteria (one prospective and nine retrospective) and involved 687 patients. The purely endoscopic approach was associated with less mean blood loss, shorter hospital stays and operative times, and fewer nasal complications. There was also a trend toward better GTR and decreased incidence of postoperative diabetes insipidus. However, a higher incidence of postoperative CSF leak was also noted with the endoscopic approach. Other outcomes and complication rates appeared to be similar between the two groups. Conclusions: Purely endoscopic transsphenoidal resection of pituitary adenomas seems to be safe and efficacious when compared to the traditional microscopic approach and may offer some benefit.