Cargando…

The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis

OBJECT: In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered...

Descripción completa

Detalles Bibliográficos
Autores principales: Muskens, Ivo S., Briceno, Vanessa, Ouwehand, Tom L., Castlen, Joseph P., Gormley, William B., Aglio, Linda S., Zamanipoor Najafabadi, Amir H., van Furth, Wouter R., Smith, Timothy R., Mekary, Rania A., Broekman, Marike L. D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735207/
https://www.ncbi.nlm.nih.gov/pubmed/29127655
http://dx.doi.org/10.1007/s00701-017-3390-y
_version_ 1783287159924457472
author Muskens, Ivo S.
Briceno, Vanessa
Ouwehand, Tom L.
Castlen, Joseph P.
Gormley, William B.
Aglio, Linda S.
Zamanipoor Najafabadi, Amir H.
van Furth, Wouter R.
Smith, Timothy R.
Mekary, Rania A.
Broekman, Marike L. D.
author_facet Muskens, Ivo S.
Briceno, Vanessa
Ouwehand, Tom L.
Castlen, Joseph P.
Gormley, William B.
Aglio, Linda S.
Zamanipoor Najafabadi, Amir H.
van Furth, Wouter R.
Smith, Timothy R.
Mekary, Rania A.
Broekman, Marike L. D.
author_sort Muskens, Ivo S.
collection PubMed
description OBJECT: In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. METHODS: A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. RESULTS: Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. CONCLUSION: In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-017-3390-y) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5735207
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Springer Vienna
record_format MEDLINE/PubMed
spelling pubmed-57352072017-12-26 The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis Muskens, Ivo S. Briceno, Vanessa Ouwehand, Tom L. Castlen, Joseph P. Gormley, William B. Aglio, Linda S. Zamanipoor Najafabadi, Amir H. van Furth, Wouter R. Smith, Timothy R. Mekary, Rania A. Broekman, Marike L. D. Acta Neurochir (Wien) Review Article - Brain Tumors OBJECT: In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. METHODS: A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. RESULTS: Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. CONCLUSION: In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-017-3390-y) contains supplementary material, which is available to authorized users. Springer Vienna 2017-11-10 2018 /pmc/articles/PMC5735207/ /pubmed/29127655 http://dx.doi.org/10.1007/s00701-017-3390-y Text en © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review Article - Brain Tumors
Muskens, Ivo S.
Briceno, Vanessa
Ouwehand, Tom L.
Castlen, Joseph P.
Gormley, William B.
Aglio, Linda S.
Zamanipoor Najafabadi, Amir H.
van Furth, Wouter R.
Smith, Timothy R.
Mekary, Rania A.
Broekman, Marike L. D.
The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title_full The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title_fullStr The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title_full_unstemmed The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title_short The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
title_sort endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis
topic Review Article - Brain Tumors
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735207/
https://www.ncbi.nlm.nih.gov/pubmed/29127655
http://dx.doi.org/10.1007/s00701-017-3390-y
work_keys_str_mv AT muskensivos theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT bricenovanessa theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT ouwehandtoml theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT castlenjosephp theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT gormleywilliamb theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT agliolindas theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT zamanipoornajafabadiamirh theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT vanfurthwouterr theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT smithtimothyr theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT mekaryraniaa theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT broekmanmarikeld theendoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT muskensivos endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT bricenovanessa endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT ouwehandtoml endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT castlenjosephp endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT gormleywilliamb endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT agliolindas endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT zamanipoornajafabadiamirh endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT vanfurthwouterr endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT smithtimothyr endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT mekaryraniaa endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis
AT broekmanmarikeld endoscopicendonasalapproachisnotsuperiortothemicroscopictranscranialapproachforanteriorskullbasemeningiomasametaanalysis