Department of Neurological Surgery, University of California, San Francisco 505 Parnassus Ave. Rm. M779, San Francisco, CA 94143-0112, USA.
Neurosurg Rev. 2013 Jul;36(3):349-59. doi: 10.1007/s10143-013-0458-x. Epub 2013 Apr 9.
Recent reports of surgical resection of tuberculum sellae meningiomas through an endoscopic endonasal approach (EEA) have provided an alternative to transcranial approaches in selected cases. However, these published reports have been limited by small sample size from single institutions. We performed a systematic review and meta-analysis to gain insight into potential limitations and benefits of EEA for tuberculum sellae meningiomas. We performed a systematic review of the literature and analyzed pooled data for descriptive statistics on short-term morbidity and outcomes. We compared EEA to transcranial approaches reported during the same time-frame. Six studies (49 patients) met inclusion criteria for EEA. A pooled analysis of transcranial results reported during a similar time period yielded 11 studies (412 patients). There were no differences in rate of gross total resection or peri-operative complications between the two groups. Although the EEA group was associated with higher rates of CSF leak (p < 0.05; OR 3.9; 95 % CI 1.15, 15.75), EEA were also associated with significantly higher rates of post-operative visual improvement compared to transcranial approaches (p < 0.05; OR 1.5; 95 % CI 1.18, 1.82). A systematic review of the small series of EEA for tuberculum sellae meningiomas published to date revealed similar extent of resection and morbidity, but increased post-operative visual improvement compared to transcranial approaches during a similar time period. Long-term follow-up will be needed to define recurrence rates of EEA as compared to transcranial approaches. Cautious use of EEA for the removal of smaller tuberculum sellae meningiomas after formal endoscopic training may be warranted.
最近有报道称，通过内镜经鼻入路（EEA）对鞍结节脑膜瘤进行手术切除，为某些病例提供了一种替代开颅入路的方法。然而，这些已发表的报道受到了来自单一机构的小样本量的限制。我们进行了一项系统评价和荟萃分析，以深入了解 EEA 治疗鞍结节脑膜瘤的潜在局限性和益处。我们对文献进行了系统评价，并对短期发病率和结果的汇总数据进行了描述性统计分析。我们将 EEA 与同期报告的开颅入路进行了比较。符合 EEA 纳入标准的研究有 6 项（49 例患者）。在类似时期报告的开颅入路结果的汇总分析得出了 11 项研究（412 例患者）。两组之间的大体全切除率或围手术期并发症发生率无差异。虽然 EEA 组的 CSF 漏发生率较高（p<0.05；OR 3.9；95%CI 1.15,15.75），但与开颅入路相比，EEA 术后视力改善的发生率也明显更高（p<0.05；OR 1.5；95%CI 1.18,1.82）。对迄今为止发表的关于 EEA 治疗鞍结节脑膜瘤的小系列研究进行系统评价显示，其切除范围和发病率相似，但与同期的开颅入路相比，术后视力改善的发生率更高。需要进行长期随访，以确定 EEA 与开颅入路相比的复发率。在经过正式的内镜培训后，对于较小的鞍结节脑膜瘤，谨慎地使用 EEA 切除可能是必要的。
