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Outcome of Purely Endoscopic Surgery for Pituitary Adenoma

Outcome of Purely Endoscopic Surgery for Pituitary Adenoma. A Systematic Literature Review. Orphee Makiese MD, Promod Pillai MD Venko Filipce MD, Mario Ammirati MD,MBA Dept. of Neurological Surgery Ohio State University Medical Center Columbus , OH. NASBS-2008.

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Outcome of Purely Endoscopic Surgery for Pituitary Adenoma

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  1. Outcome of Purely Endoscopic Surgery for Pituitary Adenoma A Systematic Literature Review Orphee Makiese MD, PromodPillai MD Venko Filipce MD, Mario Ammirati MD,MBA Dept. of Neurological Surgery Ohio State University Medical Center Columbus , OH NASBS-2008

  2. A Systematic Literature Review I. INTRODUCTION • Applying new technology: a challenging change to surgical routines • After feasibility study, using technology to treat patients requires strict follow-ups and comparisons with reference (s) technique (s) • In order to fully and safely benefit patients NASBS-2008

  3. A Systematic Literature Review I. INTRODUCTION (Cont’d) • Over last decade, endoscopic used to assist trans-sphenoidal approaches • Review of the literature outcome of pure endoscopic assisted pituitary surgery NASBS-2008

  4. A Systematic Literature Review II. MATERIALS & METHODS • Medline Pubmed (PM) data base (English) • Publications ranging from early 1990’s to 2007 • Eligible studies all included outcome measurements A. Materials NASBS-2008

  5. A Systematic Literature Review B. Methods Objectives • Outcomes measurement of • Major and • Minor complications • Remission and recurrence rates evaluation • Comparison to microscopic survey and systematic literature review NASBS-2008

  6. A Systematic Literature Review C. Inclusion Criteria • Purely endoscopic studies for pituitary adenoma (+10 patients) • Adult pituitary surgery • Trans-sphenoidal surgery (sub labial or nostril) NASBS-2008

  7. A Systematic Literature Review C. Inclusion Criteria (Cont’d) • Diagnosis confirmed by MRI and endocrinology screening • Histopathology-definitediagnosis of pituitaryadenoma • Studiesincludingoutcomemeasurements • Follow-up more than 6 months • First surgery NASBS-2008

  8. A Systematic Literature Review D. Exclusion Criteria • Following cases weredisregarded… • Recurrentpituitarytumors • Subjects to previousendoscopicapproach • Submitted to prior radiation NASBS-2008

  9. A Systematic Literature Review III. RESULTS • 16 Articles: • 2 Class II • 2 Class III • 12 Class IV • From 105 articles “Pituitary and Endoscope Surgery’’,  PM terms • Selection from a pool of 26617 articles on “Pituitary surgery” PM terms NASBS-2008

  10. A Systematic Literature Review III. RESULTS (Cont’d) • 37.5% NA, 25% EU, 25% Asia, 12.5% ME • 974 patients: • 444 non functioning • 480 functioning • 709 macro adenoma • 265 micro adenoma • Mean age=46 yrs; 51% female NASBS-2008

  11. A Systematic Literature Review III. RESULTS (Cont’d) • Identical methodology for microscopic group • Statistical comparison of groups based on homogeneity and known epidemiologic pathology • Assuming different surgeons and distinct population • 16 articles for endoscopic group 974 • 16 articles for microscopic group 1971 NASBS-2008

  12. A Systematic Literature Review A. Comparability: Sex, Age and Adenoma Size NASBS-2008

  13. A Systematic Literature Review B. Major Complications and Comparisons NASBS-2008

  14. A Systematic Literature Review C. Minor Complications and Comparisons NASBS-2008

  15. A Systematic Literature Review D. Length of Stay in Hospital NASBS-2008

  16. E. Death, Follow-up and Remission A Systematic Literature Review NASBS-2008

  17. A Systematic Literature Review CONCLUSIONS Two accurate observations that: • Statistics seem SIGNIFICANT for microscope performed on major complications but… • NON SIGNIFICANT on minor complications A. Preliminary Remarks NASBS-2008

  18. A Systematic Literature Review B. Research recommendations • Study accuracy would require more … • Report data about length of stay in hospital for microscopic group • Report data about recurrence and follow-up for endoscopic group • Comparative studies to further meta-analysis study NASBS-2008

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