SynthesisPituitary2018
Endoscopic vs. microscopic transsphenoidal surgery for Cushing's disease: a systematic review and meta-analysis.
Synthesis in Pituitary, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
55 citing papers in PubMed, 9 syntheses or guidelines pooled it, 98 citations in OpenAlex.
- Predictors of long-term remission following trans-sphenoidal surgery in cushing's disease: a systematic review and meta-analysis based on different remission criteria.Neurosurgical review · 2026Pooled it
- Radiosurgery in recurrent and persistent Cushing's Disease: a Systematic Review and Meta-Analysis.Neurosurgical review · 2026Pooled it
- Safety and efficacy of endoscopic vs. microscopic approaches in pituitary adenoma surgery: A systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- The incidence of postoperative cerebrospinal fluid leakage after elective cranial surgery: a systematic review.Neurosurgical review · 2022Pooled it
- Pediatric pituitary adenomas are more aggressive, more likely to be hormone producing and are more difficult to cure than adult pituitary adenomas: case series and systematic literature review.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2022Pooled it
- Systematic review and network meta-analysis assess the comparative efficacy and safety of transsphenoidal surgery for pituitary tumor.Neurosurgical review · 2021Pooled it
- Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma: A Meta-Analysis.Frontiers in surgery · 2021Pooled it
- Effect of cabergoline monotherapy in Cushing's disease: an individual participant data meta-analysis.Journal of endocrinological investigation · 2018Pooled it
- Effectiveness of medical treatment for Cushing's syndrome: a systematic review and meta-analysis.Pituitary · 2018Pooled it
- A randomized prospective comparative study on sinonasal morbidity and quality of life of transsphenoidal endoscopic surgery for pituitary adenomas: endonasal versus trans-septal approach.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2024Trial
- Comparative effectiveness of endoscopic and microscopic adenoma removal in acromegaly.Frontiers in endocrinology · 2023Trial
- Systemic and cardiac pathology induced by a clinically relevant USP8 activating mutation.Disease models & mechanisms · 2026Article
- Management of persistent and recurrent Cushing's disease: Efficacy of repeat transsphenoidal surgery.Endocrine · 2026Article
- Frontiers of Innovation and Clinical Application in Endoscopic Endonasal Transsphenoidal Surgery.Journal of clinical medicine · 2026Review
- Outcomes of endoscopic transsphenoidal pituitary surgery in patients with Cushing's disease: A retrospective review.Surgical neurology international · 2026Article
- Cushing's disease in children: a single-centre experience.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025Article
- The CuPeR model: A dynamic online tool for predicting Cushing's disease persistence and recurrence after pituitary surgery.Journal of clinical & translational endocrinology · 2025Article
- Long-term surgical outcomes in TSH-secreting pituitary adenomas: the hidden burden of asymptomatic hyperthyroidism.Endocrine · 2025Article
- Innovative Approaches to Improve the Success of Pituitary Surgery in Cushing's Disease: A Cost-Effectiveness Perspective.Clinical endocrinology · 2025Article
- Surgical Treatment of Cushing's Disease: The Lessons Learned.Advances and technical standards in neurosurgery · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSystematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size.
methodsNine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible. Pooled proportions were reported including 95% confidence intervals.
resultsWe included 97 articles with 6695 patients in total (5711 microscopically and 984 endoscopically operated). Overall, remission was achieved in 5177 patients (80%), with no clear difference between both techniques. Recurrence was around 10% and short term mortality < 0.5% for both techniques. Cerebrospinal fluid leak occurred more often in endoscopic surgery (12.9 vs. 4.0%), whereas transient diabetes insipidus occurred less often (11.3 vs. 21.7%). For microadenomas, results were comparable between both techniques. For macroadenomas, the percentage of patients in remission was higher after endoscopic surgery (76.3 vs. 59.9%), and the percentage recurrence lower after endoscopic surgery (1.5 vs. 17.0%).
conclusionsEndoscopic surgery for patients with Cushing's disease reaches comparable results for microadenomas, and probably better results for macroadenomas than microscopic surgery. This is present despite the presumed learning curve of the newer endoscopic technique, although confounding cannot be excluded. Based on this study, endoscopic surgery may thus be considered the current standard of care. Microscopic surgery can be used based on neurosurgeon's preference. Endocrinologists and neurosurgeons in pituitary centers performing the microscopic technique should at least consider referring Cushing's disease patients with a macroadenoma.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.