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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2017
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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 |
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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 |
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