Open AccessMeta‐analysis of Endoscopic vs Sublabial Pituitary Surgery
Author(s) -
DeKlotz Timothy,
Aulisi Edward,
Makambi Kepher,
Lu Wenxin,
Chia Stanley,
Deeb Ziad
Publication year - 2011
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599811415823a415
Subject(s) - medicine , perforation , meta analysis , surgery , meningitis , gold standard (test) , transsphenoidal surgery , diabetes insipidus , complication , endoscopy , pituitary adenoma , radiology , adenoma , materials science , punching , metallurgy
Objective Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates. Method A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta‐analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach. Results A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P <. 0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P <. 01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P <. 0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay ( P =. 01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery. Conclusion The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta‐analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.