Pterional versus Endoscopic Endonasal Transsphenoidal Surgery for Resection of Tuberculum Sellae ‎Meningioma: Comparative Assessment of Opthalmological and Surgical Outcomes

Objective A Comparatively study of effectiveness and safety of traditional pterional surgery (TPS) and endoscopic endonasal trans-sphenoidal suirgery (EETS) for resection of Tuberculum sellae meningioma using visual and gross total resection as outcome measures. Methods A PUBMED and MEDLINE (2002-2014) search were performed to identify the series for tuberculum sellae meningioma (TSM) resected by TPS and EETS. Visual outcome, extent of resection and surgical complication were analyzed to evaluate efficacy the both procedures. Statistical analyses for categorical and continuous variables were performed using chi-square, t-test and Fisher exact test as appropriate. Results The literature review included 21 studies, involving 507 patients. Among, 334 patients were under TPS and 173 patients were under EETS. EETS achieved higher rate of visual improvement (p = 0.0106) and lower rate of visual worse (p < 0.0001) as well as lower rate of gross total resection (GTR) (p = 0.0080) . Even if CSF leak was higher rate in EETS, there were no significant differences with TPS (25% vs. 6%, p =0.6038). Surgical complications reported more frequently in TPS, even though there were no significant differences, except mortality rate (6 % vs. 2 %, p = 0.0486). Conclusions Based on these current literature review EETS for resection of TSM result in higher rate of visual improvement, lower rate of visual worse and lower rate of gross total resection as well as higher rate of CSF leak despite no significant differences compared to TPS. We believe that EETS is safe and effective for TSM resection as compared to pterional surgery