Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
, Cambridge, USA.
Acta Neurochir (Wien). 2019 Aug;161(8):1683-1698. doi: 10.1007/s00701-019-03955-9. Epub 2019 May 28.
Intraoperative magnetic resonance imaging (iMRI) is a technology that may improve rates of gross total resection (GTR) for pituitary adenomas. The endoscope is another less expensive technology, which also may maximize resection rates. A direct comparison of these approaches and their additive benefit has never been performed.
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard. PubMed and Embase databases were searched for studies that examined GTR for pituitary adenoma resection with either endoscopic transsphenoidal surgery (eTSS), microscopic transsphenoidal surgery with iMRI (mTSS + iMRI), or endoscopic transsphenoidal surgery with iMRI (eTSS + iMRI).
Eighty-five studies that reported GTR rates in 7124 pituitary adenoma patients were identified. For all pituitary adenomas, eTSS had a pooled proportion of GTR of 68.9% (95% CI 64.7-73.0%) which was similar to that of mTSS + iMRI (GTR 68.3%; 95% CI = 59.4-76.5%) and eTSS + iMRI (GTR 70.7%; 95% CI = 56.9-89.6%). For the subgroup of pituitary macroadenomas, pooled proportions for GTR were similar between eTSS and mTSS + iMRI (eTSS: GTR 59.4%; 95% CI = 49.6-68.7% vs mTSS + iMRI: GTR 68.8%; 95% CI = 57.3-79.3%), and higher for eTSS + iMRI (81.1%; 95% CI = 75.5-86.2%). The post-operative CSF leak proportion for eTSS (4.7%; 95% CI = 3.6-5.9%) was similar to that for eTSS + iMRI (3.7%; 95% CI = 1.6-6.5%) and mTSS + iMRI (4.6%; 95% CI = 2.0-8.3%). No direct statistical comparisons could be performed.
Final GTR proportions are similar whether the surgeon uses a microscope supplemented with iMRI or endoscope with or without iMRI. The benefit of the two technologies may be complementary for macroadenomas. These findings are important to consider when comparing the efficacy of different technical strategies in the management of pituitary adenomas.
术中磁共振成像（iMRI）是一种可能提高垂体腺瘤全切除率（GTR）的技术。内窥镜是另一种成本较低的技术，也可能最大限度地提高切除率。这两种方法及其附加益处的直接比较从未进行过。
根据系统评价和荟萃分析的首选报告项目（PRISMA）标准进行了系统评价。检索了 PubMed 和 Embase 数据库，以检查经蝶窦内窥镜手术（eTSS）、显微镜下经蝶窦手术联合 iMRI（mTSS + iMRI）或经蝶窦内窥镜手术联合 iMRI（eTSS + iMRI）治疗垂体腺瘤切除的 GTR 率。
共确定了 85 项报告了 7124 例垂体腺瘤患者 GTR 率的研究。对于所有垂体腺瘤，eTSS 的 GTR 总体比例为 68.9%（95%CI 64.7-73.0%），与 mTSS + iMRI（GTR 68.3%；95%CI=59.4-76.5%）和 eTSS + iMRI（GTR 70.7%；95%CI=56.9-89.6%）相似。对于垂体大腺瘤亚组，eTSS 与 mTSS + iMRI 的 GTR 总体比例相似（eTSS：GTR 59.4%；95%CI=49.6-68.7% vs mTSS + iMRI：GTR 68.8%；95%CI=57.3-79.3%），而 eTSS + iMRI 的 GTR 比例更高（81.1%；95%CI=75.5-86.2%）。eTSS 的术后脑脊液漏比例（4.7%；95%CI=3.6-5.9%）与 eTSS + iMRI（3.7%；95%CI=1.6-6.5%）和 mTSS + iMRI（4.6%；95%CI=2.0-8.3%）相似。无法进行直接的统计学比较。
无论外科医生使用显微镜加 iMRI 还是内窥镜加或不加 iMRI，最终的 GTR 比例都是相似的。这两种技术的益处可能对大腺瘤具有互补性。在比较不同技术策略治疗垂体腺瘤的疗效时，这些发现非常重要。
