Pterional Surgery vs. Endoscopic Endonasal Transsphenoidal Surgery for the Resection of Tuberculum Sellae Meningioma: A Systematic Review of Ophthalmological and Surgical Outcomes

Background and Aim: A comparative study of the effectiveness and safety of Traditional Pterional Surgery (TPS) and Endoscopic Endonasal Transsphenoidal Surgery (EETS) for the resection of Tuberculum Sellae Meningioma (TSM) using visual resection and Gross Total Resection (GTR) as the outcome measures. Methods and Materials/Patients: A PUBMED and MEDLINE (2002-2014) search was performed to identify case series for TSM resected by TPS and EETS. The visual outcome, extent of resection and surgical complications were analyzed to evaluate the efficacy of the procedures. Statistical analyses were performed for the categorical and continuous variables using the Chi-square test, t-test and Fisher’s exact test, as befitting. Results: The literature review revealed 21 studies, which had examined 507 patients overall. A total of 334 patients had undergone TPS and 173 EETS. EETS had achieved a higher rate of visual improvement (P=0.0106) and lower rate of visual worsening (P<0.0001) and a lower rate of GTR (P=0.0080). Even if Cerebrospinal Fluid (CSF) leak was higher in EETS, there were no significant differences with TPS (25% vs. 6%, P=0.6038). Surgical complications were reported more frequently in TPS, even though there were no significant differences between the two procedures, except in terms of the mortality rate (6% vs. 2%, P=0.0486). Conclusion: The literature review showed that EETS for the resection of TSM results in a higher rate of visual improvement, lower rate of visual worsening and lower rate of GTR as well as a higher rate of CSF leak despite the lack of significant differences compared to TPS. EETS appears to be safe and effective for TSM resection compared to pterional surgery.