Mononostril versus Binostril Endoscopic Transsphenoidal Approach for Pituitary Adenomas: A Systematic Review and Meta-Analysis

被引:20
作者
Wen, Guodao [1 ]
Tang, Chao [1 ]
Zhong, Chunyu [2 ]
Li, Xiang [1 ]
Li, Junyang [1 ]
Li, Liwen [1 ]
Yang, Youqing [3 ]
Ma, Chiyuan [1 ]
机构
[1] Nanjing Univ, Sch Med, Jinling Hosp, Dept Neurosurg, 305 East Zhongshan Rd, Nanjing 210002, Jiangsu, Peoples R China
[2] Nanjing Med Univ, Sch Med, 104 Hanzhong Rd, Nanjing 210002, Jiangsu, Peoples R China
[3] Southern Med Univ, Sch Med, 1813 North Guangzhou Big Rd, Guangzhou 510000, Guangdong, Peoples R China
来源
PLOS ONE | 2016年 / 11卷 / 04期
关键词
MODERN CRITERIA; LEARNING-CURVE; SELLAR LESIONS; SURGERY; EXPERIENCE; COMPLICATIONS; MICROSURGERY; REMISSION; OUTCOMES; SERIES;
D O I
10.1371/journal.pone.0153397
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Over the past several decades, the endoscopic endonasal transsphenoidal approach (EETA) has gradually become a preferred option of pituitary adenomas surgery because of its minimal invasiveness and high efficiency. However, some EETA operations were performed through one nostril (mononostril), while other EETA operations were performed through both nostrils (binostril). Therefore, we conducted this study to compare the pros and cons of these two methods in an attempted to confirm which method is more effective. Methods We executed a systematic literature search of PubMed, the Cochrane Library, and the Web of Science and Medline (1992-2015). The language is limited to English and all studies should meet the inclusion criteria. Comparisons were made for postoperative outcomes, complications, and other relevant parameters between the mononostril and the binostril group. Statistical analyses of categorical variables were undertaken by the use of Stata 12.0 and SPASS 19.0. Results Thirty studies, involving 4805 patients, were included. The two groups had similar results in GTR rate (included GTR rate of macroadenomas), hormonal remission rate, improvement in visual function, postoperative CSF leak, permanent diabetes insipidus, meningitis, and sinusitis. The binostril group had less temporary diabetes insipidus (2.9% vs. 5.3%, p = 0.022), less anterior pituitary insufficiency (2.3% vs. 6.4%, p = 0.000) and few hospitalization days (3.2 days vs. 4.4 days, p<0.05) than the mononostril group. However, the mononostril group had less rate of epistaxis (0.4% vs. 1.5%, p = 0.008) than the binostril group. For invasive macroadenomas, the binostril group seem to demonstrate a tendency towards better outcomes though there was no subgroup analysis between the two groups. Conclusion The binostril approach had less temporary diabetes insipidus, anterior pituitary insufficiency, and a shorter length of hospital stay, although they demonstrated a higher rate of epistaxis than the mononstril group. Additionally, the binostril group seemed to suggest a tendency towards better outcomes for invasive macroadenomas.
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页数:11
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