背景/目的:鞍区脑膜瘤(TSM)占颅内脑膜瘤的5-10%,经常导致视力障碍。传统的显微外科经颅手术(MTA)是有效的,但是创新手术轨迹的出现,例如鼻内镜入路(EEA),引发了辩论。虽然EEA提供了减少大脑收缩的优势,它们与更高的脑脊液漏(CSF漏)风险有关。这项荟萃分析旨在全面比较EEA和MTA切除TSM的疗效和安全性,提供对各自结果和并发症的见解。方法:对PubMed数据库进行全面的文献综述,OvidMEDLINE,和OvidEMBASE在2024年之前在接受EEA或MTA治疗的TSM上发表的文章进行了研究。根据系统评价的首选报告项目和荟萃分析指南进行系统评价。进行荟萃分析以估计合并事件发生率并评估异质性。固定和随机效应用于评估出现症状的95%保密间隔(CI),结果,和并发症。结果:初步确定论文291篇,其中2000年至2024年的18项研究符合纳入标准。排除180篇文章是由于不相关等原因,未报告选定的结果,系统文献综述或荟萃分析,缺乏方法/结果的细节。18项研究共包括1093例患者:444例接受EEA的患者和649例接受MTA的TSM。总切除率(GTR)从EEA的80.9%到MTA的79.8%不等。EEA组为86.6%,MTA组为65.4%。EEA组的复发率为6.9%,而MTA组为5.1%。术后并发症分析为脑脊液漏,感染,功能障碍,颅内出血(ICH),和内分泌失调。EEA组的CSF泄漏率为9.8%,MTA组为2.1%。EEA组感染率为5.7%,而MTA组为3.7%。运动障碍的发生率从MTA的10.3%到EEA的12.9%不等。EEA组ICH发生率为0.9%,而MTA组为3.8%。EEA组内分泌紊乱率为10.8%,而MTA组为10.2%。EEA组和MTA组之间的GTR率无显着差异(OR1.15,95%CI0.7-0.95;p=0.53),而EEA显示了视觉结局的显着益处(OR3.54,95%CI2.2-5.72;p<0.01)。EEA组和MTA组之间的复发率没有显着差异(OR0.92,95%CI0.19-4.46;p=0.89)。虽然显示EEA的CSF泄漏机会大大增加(OR4.47,95%CI2.52-7.92;p<0.01),EEA和MTA组的感染率没有显着差异(OR1.92,95%CI0.73-5.06;p=0.15),功能障碍率(OR1.25,95%CI0.31-4.99;p=0.71),脑出血率(OR0.61,95%CI0.20-1.87;p=0.33),和内分泌失调的发生率(OR1.16,95%CI0.69-1.95;p=0.53)。结论:这项荟萃分析表明,EEA和MTA都是TSM切除术的可行选择,具有明显的优点和缺点。EEA在选定病例中表现出优异的视力结果,而GTR和复发率支持MTA和EEA的整体有效性。内镜经鼻入路脑脊液漏的机率较高,但是其他并发症没有明显的变化。这些结果提供了有关TSM复杂临床环境中患者结果的其他见解。
Background/Objectives: Tuberculum sellae meningiomas (TSMs) constitute 5-10% of intracranial meningiomas, often causing visual impairment. Traditional microsurgical transcranial approaches (MTAs) have been effective, but the emergence of innovative surgical trajectories, such as endoscopic endonasal approaches (EEAs), has sparked debate. While EEAs offer advantages like reduced brain retraction, they are linked to higher cerebrospinal fluid leak (CSF leak) risk. This meta-analysis aims to comprehensively compare the efficacy and safety of EEAs and MTAs for the resection of TSMs, offering insights into their respective outcomes and complications. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on TSMs treated with either EEA or MTA until 2024. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 291 papers were initially identified, of which 18 studies spanning from 2000 to 2024 met the inclusion criteria. The exclusion of 180 articles was due to reasons such as irrelevance, non-reporting of selected results, systematic literature review or meta-analysis, and a lack of details on method/results. The 18 studies comprised a total sample of 1093 patients: 444 patients who underwent EEAs and 649 patients who underwent MTAs for TSMs. Gross total resection (GTR) rates ranged from 80.9% for EEAs to 79.8% for MTAs. The rate of visual improvement was 86.6% in the EEA group and 65.4% in the MTA group. The recurrence rate in the EEA group was 6.9%, while it was 5.1% in MTA group. The postoperative complications analyzed were CSF leak, infections, dysosmia, intracranial hemorrhage (ICH), and endocrine disorders. The rate of CSF leak was 9.8% in the EEA group and 2.1% in MTA group. The rate of infections in the EEA group was 5.7%, while it was 3.7% in the MTA group. The rate of dysosmia ranged from 10.3% for MTAs to 12.9% for EEAs. The rate of ICH in the EEA group was 0.9%, while that in the MTA group was 3.8%. The rate of endocrine disorders in the EEA group was 10.8%, while that in the MTA group was 10.2%. No significant difference was detected in the rate of GTR between the EEA and MTA groups (OR 1.15, 95% CI 0.7-0.95; p = 0.53), while a significant benefit in visual outcomes was shown in EEAs (OR 3.54, 95% CI 2.2-5.72; p < 0.01). There was no significant variation in the recurrence rate between EEA and MTA groups (OR 0.92, 95% CI 0.19-4.46; p = 0.89). While a considerably increased chance of CSF leak from EEAs was shown (OR 4.47, 95% CI 2.52-7.92; p < 0.01), no significant difference between EEA and MTA groups was detected in the rate of infections (OR 1.92, 95% CI 0.73-5.06; p = 0.15), the rate of dysosmia (OR 1.25, 95% CI 0.31-4.99; p = 0.71), the rate of ICH (OR 0.61, 95% CI 0.20-1.87; p = 0.33), and the rate of endocrine disorders (OR 1.16, 95% CI 0.69-1.95; p = 0.53). Conclusions: This meta-analysis suggests that both EEAs and MTAs are viable options for TSM resection, with distinct advantages and drawbacks. The EEAs demonstrate superior visual outcomes in selected cases while GTR and recurrence rates support the overall effectiveness of MTAs and EEAs. Endoscopic endonasal approaches had a higher chance of CSF leaks, but there are no appreciable variations in other complications. These results provide additional insights regarding patient outcomes in the intricate clinical setting of TSMs.