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Intra-operative MRI vs endoscopy in achieving gross total resection of pituitary adenomas: a systematic review.

TitleIntra-operative MRI vs endoscopy in achieving gross total resection of pituitary adenomas: a systematic review.
Publication TypeJournal Article
Year of Publication2019
AuthorsSoneru CP, Riley CA, Hoffman K, Tabaee A, Schwartz TH
JournalActa Neurochir (Wien)
Volume161
Issue8
Pagination1683-1698
Date Published2019 08
ISSN0942-0940
KeywordsAdenoma, Endoscopy, Humans, Magnetic Resonance Imaging, Monitoring, Intraoperative, Pituitary Neoplasms, Postoperative Complications
Abstract

BACKGROUND: 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.

METHODS: 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).

RESULTS: 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.

CONCLUSION: 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.

DOI10.1007/s00701-019-03955-9
Alternate JournalActa Neurochir (Wien)
PubMed ID31139934
Grant List1-UL1-TR002384-01 / / Clinical and Translational Science Center at Weill Cornell Medical College / International