Al-Dardery Nada Mostafa, Khaity Abdulrhman, Soliman Youssef, Ali Mohamed Osama Mohamed, Zedan Esraa Mohamed, Muyasarah Kamila, Elfakhrany Mohamed Diaa
Faculty of Medicine, Fayoum University, Fayoum, Egypt.
Faculty of Medicine, Elrazi University, Khartoum, Sudan.
Neurosurg Rev. 2025 Jun 1;48(1):471. doi: 10.1007/s10143-025-03600-3.
Pituitary adenomas (PAs) represent a prevalent category of intracranial tumors, frequently resulting in endocrine dysfunction and neurological impairments. Transsphenoidal surgery (TSS) serves as the primary treatment modality, with the endoscopic transsphenoidal approach (ETSA) and microscopic transsphenoidal approach (MTSA) representing the two principal techniques. This systematic review and meta-analysis aimed to assess and compare the outcomes of ETSA and MTSA in treating PAs. A literature search was performed across PubMed, Scopus, Web of Science, and Cochrane Library. A total of 31 studies comprising 38,301 patients were included. The primary outcomes assessed were gross total resection (GTR) and cerebrospinal fluid (CSF) leak rates. Secondary outcomes encompass endocrine and surgical complications and mortality rates. Statistical analyses utilized R software, employing random-effects models. The analysis indicated insignificant differences in GTR rates between ETSA and MTSA (RR: 1.05, 95% CI [0.97, 1.15]) or in CSF leak rates (RR: 1.03, 95% CI [0.82, 1.31]). Meta-regression analysis revealed that nonfunctional tumors correlated with increased GTR rates, regardless of the surgical technique employed. No notable differences were detected in endocrine or surgical complications between the two methods. Notably, meta-regression analysis indicated that nonfunctional tumors and higher Knosp grade tumors are more likely to be completely resected. Moreover, larger preoperative tumor volume was significantly correlated with an increased risk of postoperative hypopituitarism. Nevertheless, a narrative review of total mortality demonstrated a higher rate in the MTSA group compared to the ETSA group (198 vs. 149 deaths), even with a larger patient cohort in the ETSA group. No publication bias was observed for GTR or CSF leak outcomes. ETSA and MTSA exhibit similar efficacy and safety profiles in treating PAs, with no significant differences in resection rates or complications. The findings highlight the necessity of personalized surgical planning, considering tumor characteristics and institutional expertise. Future research should prioritize long-term outcomes, patient-reported metrics, and the incorporation of emerging technologies to enhance surgical strategies for PAs.
垂体腺瘤（PAs）是一类常见的颅内肿瘤，常导致内分泌功能障碍和神经功能损害。经蝶窦手术（TSS）是主要的治疗方式，内镜经蝶窦入路（ETSA）和显微镜经蝶窦入路（MTSA）是两种主要技术。本系统评价和荟萃分析旨在评估和比较ETSA和MTSA治疗PAs的疗效。通过检索PubMed、Scopus、Web of Science和Cochrane图书馆进行文献检索。共纳入31项研究，涉及38301例患者。评估的主要结局为全切除率（GTR）和脑脊液（CSF）漏率。次要结局包括内分泌和手术并发症以及死亡率。统计分析使用R软件，采用随机效应模型。分析表明，ETSA和MTSA的GTR率（RR：1.05，95%CI[0.97，1.15]）或CSF漏率（RR：1.03，95%CI[0.82，1.31]）无显著差异。荟萃回归分析显示，无论采用何种手术技术，无功能肿瘤与GTR率增加相关。两种方法在内分泌或手术并发症方面未发现显著差异。值得注意的是，荟萃回归分析表明，无功能肿瘤和较高Knosp分级的肿瘤更有可能被完全切除。此外，术前肿瘤体积较大与术后垂体功能减退风险增加显著相关。然而，对总死亡率的叙述性综述显示，MTSA组的死亡率高于ETSA组（198例死亡 vs. 149例死亡），尽管ETSA组的患者队列更大。在GTR或CSF漏结局方面未观察到发表偏倚。ETSA和MTSA在治疗PAs方面表现出相似的疗效和安全性，切除率或并发症无显著差异。研究结果强调了根据肿瘤特征和机构专业知识进行个性化手术规划的必要性。未来的研究应优先关注长期结局、患者报告指标以及纳入新兴技术以改进PAs的手术策略。
