Transnaso-sphenoidal Microsurgery And Neuroendoscopic Resection Of Pituitary Adenoma: A Meta-analysis Of Clinical Efficacy

Objective:Evaluate the clinical efficacy of transnaso-sphenoidal microsurgery and neuroendoscopic resection of pituitary adenoma quantitatively by meta-analysis to provide the latest evidence for clinical application.Methods:The literatures about transnaso-sphenoidal resection of pituitary adenoma under microsurgery and neuroendoscopic were collected by researching the database,including Pub Med,Embase,Cochrane Library,CNKI,Wanfang,VIP,and China Biology Medicine disc between January 2010 and March 2021.The literatures were screened according to the inclusion and exclusion criteria.Data processing was performed adopting STATA15.1 and then a meta-analysis was performed.Results:731 articles were retrieved and 19 were eventually included,including1466 patients in the neuroendoscopic group and 2228 patients in the microscope group.Results of meta-analysis can be seen as follows: The total removal rate of tumors of neuroendoscopy was higher than microscopy(OR=2.49,95%CI:1.62-3.84,P=0.000);The postoperative recovery rate of hormone levels of neuroendoscopic group was significantly higher than microscope group(OR=1.54,95%CI:1.13-2.11,P=0.007);There was no statistical significance in the duration of operation between the two groups(WMD=12.36,95%CI:-13.57-38.30,P=0.350);The intraoperative blood loss of neuroendoscopic group was significantly lower than microscope group(WMD=-20.53,95%CI:-28.51 ～-12.54,P=0.000);In terms of incidence of postoperative complications,the incidence of diabetes insipidus of neuroendoscopic group was significantly lower than microscope group(OR=0.64,95%CI: 0.45-0.92,P=0.015;I~2=0.0%,P=0.605),while there was no statistically significant difference in cerebrospinal fluid leakage(OR=0.99,95%CI: 0.72-1.36,P=0.939;I2=22.7%,P=0.202),epistaxis(OR=1.11,95%CI:0.51-2.44,P=0.791;I2=21.1%,P=0.268),meningitis(OR=1.55,95%CI:0.74-3.23,P= 0.242;I~2=0.0%,P =0.698),hypothyroidism(OR=1.08,95%CI:0.54-2.14,P =0.833;I~2=0.0%,P =0.592)and visual impairment(OR=0.71,95%CI: 0.40-1.25,P =0.233;I~2=0.0%,P =0.673).Conclusions:For patients with pituitary adenoma,both minimally invasive transnasal surgery methods are effective in removing the tumor.The resection of pituitary adenoma under neuroendoscopy is better than microscope in improving the total removal rate of tumors and postoperative recovery rate of hormone levels and reducing the intraoperative blood loss and the postoperative diabetes insipidus incidence.However,there was no significant difference in the duration of the operation and the incidence of most common postoperative complications.There are not enough published literature related to randomized controls,so more clinical studies on the efficacy of minimally invasive surgery for pituitary adenomas are needed to improve relevant surgical protocols.