Comparison of Complication Rate between Endoscopic Transsphenoidal Surgery and Microscopic Transsphenoidal Surgery for Patients with Pituitary Adenomas: A Meta-analysis

Aim: The aim of this meta-analysis was to determine the rate of operative and postoperative complications of PA surgery using mTSS and eTSS based on the type of complication, number of cases, and type of PA.

Methods: A meta-analysis of the literature was conducted using PubMed, EMBASE, and Cochrane databases through September 2018 to determine the rate of operative complication (internal carotid artery injury, intraoperative CSF leaks, hemorrhage) and postoperative complication (death, meningitis) of mTSS and eTSS in PA.

Results: Case series were identified as the following: 22 that reported ICAI rate, 17 for IOCSF leaks without rhinorrhea, and 52 for death.

ICAI: For all PA (n = 7447), eTSS (rate = 0.8%; I ² = 0%) was associated with higher ICAI rate as compared with mTSS (rate = 0.3%; I ² = 74.4) in a FEM (p = 0.024). For FPAs (n = 279 patients), there was no SD in ICAI rate between eTSS (rate = 1.9%; I ² = 0%) and mTSS (rate = 0.2%; I ² = 0%); in FEM (p = 0.158).For (mixed FPA + NFPAs) (n = 6037patients), eTSS (rate = 0.8%; I ² = 5.51%) was associated with nonsignificant higher ICAI rate as compared with mTSS (rate = 0.3%; I ² = 58.8%) in a FEM (p = 0.069). IOCSF leaks without rhinorrhea: For all PA (n = 3716), eTSS (rate = 16.8%; I ² = 93.6%) was associated with S higher IOCSF leaks rate as compared with mTSS (rate = 7.1%; I ² = 96.3%) in a FEM (p = 0.000). For FPAs (n = 272 patients), there was no SD in IOCSF leaks rate between eTSS (rate = 37.7%; I ² = 90.69%) and mTSS (rate = 28.8%; I ² = 87.08%); in FEM (p = 0.184). For mixed FPA + NFPAs (n = 2935 patients), eTSS (rate = 12.5%; I ² = 86.1%) was associated S with higher IOCSF leaks rate as compared with mTSS (rate = 1.7%; I ² = 0%) in FEM (p = 0.000).None of the associations of IOCSF leaks rate was S in a REM (all p > 0.05). except for mixed FPA + NFPAs (p = 0.001). Death: For all PA (n = 15076 Patients), eTSS (rate = 0.9%; I ² = 0%) was associated with higher death rate as compared with mTSS (rate = 0.5%; I ² = 0) in a FEM (p = 0.005). For (FPAs) (n = 1680 patients), there was no SD in death rate between eTSS (rate = 1.2%; I ² = 0%) and mTSS (rate = 0.9%, I ² = 0%); (p = 0.636). For (mixed FPA + NFPAs) (n = 11,903 patients), eTSS (rate = 0.8%; I ² = 0%) was associated with higher death rate as compared with mTSS (rate = 0.3%; I ² = 0%) in a FEM (p = 0.002). None of the associations were S in a REM (all p > 0.05).except for mixed NFPA and FPA.

Conclusion: The rate of complication is higher with eTSS as compared with mTSS for all PA, FPA, Mixed FPA + NFPA.