Endonasal Endoscopic Surgery for Pediatric Sellar and Suprasellar Lesions: A Systematic Review and Meta-analysis

2020 ◽  
Vol 163 (2) ◽  
pp. 284-292
Author(s):  
Joshua A. Lee ◽  
Rebecca L. Cooper ◽  
Shaun A. Nguyen ◽  
Rodney J. Schlosser ◽  
David A. Gudis
Keyword(s):  
Systematic Review ◽  
Pituitary Adenomas ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Csf Leak ◽  
Cochrane Library ◽  
Management Approach ◽  
Tumor Type ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Objectives The advent of endonasal endoscopic skull base surgery (ESBS) has redefined the management of pediatric sellar and suprasellar lesions. To date, the outcomes of these procedures have not been systematically reviewed. This study performed a systematic review with meta-analysis of surgical outcomes for pediatric patients undergoing ESBS for sellar and suprasellar lesions. Data Sources PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane Library (Wiley). Review Methods Articles reporting on pediatric patients undergoing ESBS for craniopharyngiomas, pituitary adenomas, and Rathke’s cleft cysts were reviewed. The primary outcome was postoperative cerebrospinal fluid (CSF) leak. Secondary outcomes included endocrine, visual, and other complications. Results Twenty-five articles reporting on 554 patients were included. Overall postoperative CSF leak rate was 8.6%, with tumor-specific rates of 10.6% in craniopharyngiomas, 6.5% in pituitary adenomas, and 7.2% in Rathke’s cleft cysts ( P > .05). Older studies demonstrate higher postoperative CSF leak rates as compared with more recent studies (12.5% vs 6.1%, P = .0082). Younger children (8.9-12.6 years old) experienced a higher rate of postoperative CSF leaks as compared with older children (13.0-16.6 years old; 12.9% vs 4.9%, P = .0016). Additional postoperative complications included diabetes insipidus (26.7%), hypopituitarism (46.6%), visual deficits (2.6%), meningitis (3.4%), and weight gain (3.4%). Conclusion ESBS for pediatric sellar and suprasellar lesions is overall an effective management approach with an increasingly favorable risk-benefit profile. Younger children may be more susceptible to postoperative CSF leak as compared with older pediatric patients. Tumor type does not appear to be an independent risk factor for postoperative CSF leak in this population.

Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations

2014 ◽  
Vol 121 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Arman Jahangiri ◽  
Jeffrey Wagner ◽  
Sung Won Han ◽  
Corinna C. Zygourakis ◽  
Seunggu J. Han ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Lesion Size ◽  
Csf Leak ◽  
Separate Analysis ◽  
Initial Surgery ◽  
Second Surgery ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Postoperative Hyponatremia

Object While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations. Methods The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities. Results The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3–0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02–0.04) but did not continue to increase for subsequent reoperations (p = 0.3–0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001–0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]). Conclusions Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

scholarly journals Stapled versus hand-sewn intestinal anastomosis in pediatric patients: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takayuki Fujii ◽  
Aya Tanaka ◽  
Hiroto Katami ◽  
Ryuichi Shimono
Keyword(s):  
Systematic Review ◽  
Anastomotic Leakage ◽  
Pediatric Patients ◽  
Operative Time ◽  
Anastomotic Stricture ◽  
Meta Analysis ◽  
Intestinal Anastomosis ◽  
Cochrane Library ◽  
Continuous Variables ◽  
Retrospective Cohort Studies

Abstract Background The safety and feasibility of stapled intestinal anastomosis have been widely reported in adults. However, the efficacy of stapled anastomosis (SA) in children is unclear. The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and effectiveness of SA compared with hand-sewn anastomosis (HA) in pediatric patients. Methods A systematic literature search was performed using PubMed, the Cochrane Library, and Scopus databases. Studies comparing outcomes of children aged < 7 years and subgroups of children aged < 1 year who underwent SA or HA were included. Primary outcomes were anastomotic leakage and anastomotic stricture. Mean differences (MDs) with 95 % confidence intervals (CIs) were calculated for continuous variables. Odds ratios (ORs) with 95 % CIs were calculated for dichotomous variables. Interstudy heterogeneity was assessed using the chi-squared test and was quantified using the I² statistic. Results One randomized control trial and five retrospective cohort studies, comprising 633 cases (229 SA cases and 404 HA cases), were included. No significant differences were observed in anastomotic leakage (6.5 % vs. 7.4 %; OR, 0.93; 95 % CI, 0.37–2.34; p = 0.88), anastomotic stricture (4.1 % vs. 9.3 %; OR, 0.54; 95 % CI, 0.19–1.51; p = 0.24), ileus (7.1 % vs. 9.3 %, OR, 2.35; 95 % CI, 0.15–37.51; p = 0.54), anastomosis-related complications (9.5 % vs. 10.9 %, OR, 0.98; 95 % CI, 0.52–1.86; p = 0.96; I2 = 39 %), and time until full-feeding (MD = -3.57 days; 95 % CI, -11.36 to 4.23; p = 0.37) between SA and HA. Operative time was significantly shorter in SA than in HA in children aged < 1 year (MD = -20.36 min; 95 % CI, -26.13 to -14.59). Conclusions SA required shorter operative time and was comparable to HA in the overall complication rate. Although the evidence was insufficient, SA could be an option for intestinal anastomosis in children.

Heterogeneity in Outcome Reporting in Endoscopic Endonasal Skull Base Reconstruction: A Systematic Review

2020 ◽  
Author(s):  
Christina Dorismond ◽  
Griffin D. Santarelli ◽  
Brian D. Thorp ◽  
Adam J. Kimple ◽  
Charles S. Ebert ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Meta Analysis ◽  
Reporting Guidelines ◽  
Csf Leak ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
History Of

Abstract Objectives Presently, there are no standards for reporting outcomes of endoscopic endonasal skull base reconstruction (ESBR). This is problematic as a lack of consistent reporting makes synthesizing findings in systematic reviews and meta-analysis challenging. Thus, the aim of this study was to systematically review and describe the patterns of reporting outcomes in ESBR as a foundation for developing reporting guidelines. Study Design Present study is a systematic review. Methods Embase, PubMed, CINAHL, Cochrane Library, and Web of Science were searched for all publications with ≥25 patients and a focus on ESBR. The reporting patterns of each study's variables and outcomes were assessed. Results A total of 112 studies were included in the review. The most commonly reported demographic variables were the number of included patients (n = 112, 100%) and types of pathologies treated (n = 104, 92.9%). Meanwhile, the most routinely described preoperative variable was history of prior treatment (n = 48, 42.9%). Type of reconstruction was a commonly reported intraoperative variable (n = 110, 98.2%), though the rate of intraoperative cerebrospinal fluid (CSF) leak was noted in only 76 studies (67.9%). With regard to postoperative outcomes, postoperative CSF leak rate was routinely provided (n = 101, 90.2%), but reporting of other surgical complications was more inconsistent. Ultimately, of the 43 variables and outcomes reviewed, a median of 12 (range: 4–22) was reported in each study. Conclusions There is significant heterogeneity in the outcomes reported in studies relating to ESBR. This highlights the need for the development of standard reporting guidelines to minimize bias and improve interstudy comparability.

Surgical Treatment for Olfactory Groove Meningiomas: A Meta-Analysis of the Literature

2021 ◽  
Author(s):  
Wei Wang ◽  
Cong Chen ◽  
Siqi Chen
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Csf Leak ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Olfactory Groove ◽  
Csf Leakage

Abstract Background Surgical resection of olfactory groove meningiomas (OGMs) is challenging and lots of surgical approaches can be chosen. We conducted a systematic review and meta-analysis of the studies investigating surgical resection of OGMs to better understand the surgical treatment of OGMs.Methods PubMed, Embase and Cochrane Library were used to search the studies reporting treatment outcomes of surgery for patients with OGMs. The final eligible studies were assessed using the Oxford Center for Evidence Based Medicine for level of evidence. Relevant parameters were extracted to perform descriptive and/or quantitative analyses.Results A total of 42 studies including 1673 patients were included in this systematic review (8 level 3 studies and 34 level 4 studies). Surgeries through transcranial approaches (TCAs) and endoscopic endonasal approach (EEA) were done on 1596 and 77 patients, respectively. Based on a random effects model, rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak were determined to be 92.4% (CI: 88.6-95.5%) and 5.9% (95% CI: 3.4-9%), respectively. The mortality following surgery was 1.6% (95% CI: 0.9-2.5%) under a fixed effects model. Through subgroup analyses, TCAs were found to be more favorable in GTR and CSF leakage compared to EEA. Besides, anterolateral TCA was associated with better control of CSF leakage than anterior TCA. Conclusion Surgical treatment is capable of achieving GTR in the vast majority of patients with OGMs and postoperative mortality is under well control. Transcranial approach allows a better chance of GTR and better control of CSF leak in comparison to EEA. In comparison to anterior TCA, anterolateral TCA is associated less mortality. However, low evidence level and significant heterogeneity of the included studies prevent the formation of more solid conclusions.

Cerebrospinal Fluid Leak after Transsphenoidal Surgery: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Emma M.H. Slot ◽  
Rengin Sabaoglu ◽  
Eduard H.J. Voormolen ◽  
Eelco W. Hoving ◽  
Tristan P.C. van Doormaal
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Meta Analysis ◽  
Adult Population ◽  
Csf Leak ◽  
Cochrane Library ◽  
Cavernous Sinus Invasion ◽  
Increased Risk

Abstract Background Cerebrospinal fluid (CSF) leak is widely recognized as a challenging and commonly occurring postoperative complication of transsphenoidal surgery (TSS).The primary objective of this study is to benchmark the current prevalence of CSF leak after TSS in the adult population. Methods The authors followed the PRISMA guidelines. The PubMed, Embase, and Cochrane Library databases were searched for articles reporting CSF leak after TSS in the adult population. Meta-analysis was performed using the Untransformed Proportion metric in OpenMetaAnalyst. For two between-group comparisons a generalized linear mixed model was applied. Results We identified 2,408 articles through the database search, of which 70, published since 2015, were included in this systematic review. These studies yielded 24,979 patients who underwent a total of 25,034 transsphenoidal surgeries. The overall prevalence of postoperative CSF leak was 3.4% (95% confidence interval or CI 2.8–4.0%). The prevalence of CSF leak found in patients undergoing pituitary adenoma resection was 3.2% (95% CI 2.5–4.2%), whereas patients who underwent TSS for another indication had a CSF leak prevalence rate of 7.1% (95% CI 3.0–15.7%) (odds ratio [OR] 2.3, 95% CI 0.9–5.7). Patients with cavernous sinus invasion (OR 3.0, 95% CI 1.1–8.7) and intraoperative CSF leak (OR 5.9, 95% CI 3.8–9.0) have increased risk of postoperative CSF leak. Previous TSS and microscopic surgery are not significantly associated with postoperative CSF leak. Conclusion The overall recent prevalence of CSF leak after TSS in adults is 3.4%. Intraoperative CSF leak and cavernous sinus invasion appear to be significant risk factors for postoperative CSF leak.

Comparative accuracy of 1,3 beta-D glucan and galactomannan for diagnosis of invasive fungal infections in pediatric patients: a systematic review with meta-analysis

2020 ◽  
Author(s):  
Shreya Singh ◽  
Manvi Singh ◽  
Nipun Verma ◽  
Minakshi Sharma ◽  
Pranita Pradhan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pediatric Patients ◽  
Fungal Infections ◽  
Meta Analysis ◽  
Invasive Fungal Infections ◽  
Cochrane Library ◽  
Operating Characteristics ◽  
Oncology Patients ◽  
Specificity And Sensitivity ◽  
Sensitivity Specificity

Abstract Invasive fungal infections (IFI) cause considerable morbidity and mortality in pediatric patients. Serum biomarkers such as 1,3-beta-D glucan (BDG) and galactomannan (GM) have been evaluated for the IFI diagnosis. However, most evidence regarding their utility is derived from studies in adult oncology patients. This systematic review aimed to compare the diagnostic accuracy of BDG and GM individually or in combination for diagnosing IFI in pediatric patients. PubMed, CINAHL, Embase, and Cochrane Library were searched until March 2019 for diagnostic studies evaluating both serum GM and BDG for diagnosing pediatric IFI. The pooled diagnostic odds ratio (DOR), specificity and sensitivity were computed. Receiver operating characteristics (ROC) curve and area under the curve (AUC) were used for summarizing overall assay performance. Six studies were included in the meta-analysis. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the GM assay for proven or probable IFI were 0.74, 0.76, 13.25, and 0.845. The summary estimates of sensitivity, specificity, pooled DOR, AUC of the BDG assay were 0.70, 0.69, 4.3, and 0.722. The combined predictive ability of both tests was reported in two studies (sensitivity: 0.67, specificity: 0.877). Four studies were performed in hematology-oncology patients, while two were retrospective studies from pediatric intensive care units (ICUs). In the subgroup of hematology-oncology patients, DOR of BDG remained similar at 4.25 but increased to 40.28 for GM. We conclude that GM and BDG have a modest performance for identifying IFI in pediatric patients. GM has a better accuracy over BDG. Combining both improves the specificity at the cost of sensitivity.

scholarly journals Efficacy of duodenal bulb biopsy for diagnosis of celiac disease: a systematic review and meta-analysis

2018 ◽  
Vol 06 (11) ◽  
pp. E1369-E1378 ◽  
Author(s):  
Thomas R. McCarty ◽  
Corey R. O’Brien ◽  
Anas Gremida ◽  
Christina Ling ◽  
Tarun Rustagi
Keyword(s):  
Systematic Review ◽  
Celiac Disease ◽  
Pediatric Patients ◽  
Web Of Science ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Duodenal Bulb ◽  
Cochrane Library ◽  
Data Abstraction ◽  
Pediatric Populations

Abstract Background and study aims Although duodenal biopsy is considered the “gold standard” for diagnosis of celiac disease, the optimal location of biopsy within the small bowel for diagnosis remains unclear. The primary aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic utility of endoscopic duodenal bulb biopsy for celiac disease. Patients and methods Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2000 through December 2017. Review of titles/abstracts, full review of potentially relevant studies, and data abstraction was performed. Measured outcomes of adult and pediatric patients included location of biopsy, mean number of biopsies performed, and diagnosis of celiac disease as defined by the modified Marsh-Oberhuber classification. Results A total of 17 studies (n = 4050) were included. Seven studies evaluated adults and 11 studies assessed pediatric populations. Mean age of adults and pediatric patients was 46.70 ± 2.69 and 6.33 ± 1.26 years, respectively. Overall, sampling from the duodenal bulb demonstrated a 5 % (95 % CI 3 – 9; P < 0.001) increase in the diagnostic yield of celiac disease. When stratified by pediatric and adult populations, duodenal bulb biopsy demonstrated a 4 % (95 % CI: 1 to 9; P < 0.001) and 8 % (95 % CI: 6 to 10; P < 0.001) increase in the diagnostic yield of celiac disease. Non-celiac histologic diagnoses including Brunner gland hyperplasia and peptic duodenitis were reported more commonly in the duodenal bulb as compared to the distal duodenum with an increase in diagnostic yield of 4 % (95 % CI 3 – 5; P < 0.001) and 1 % (95 % CI 1 – 2; P < 0.001), respectively. Conclusions Based upon our results, biopsy and histologic examination of duodenal bulb during routine upper endoscopy increases the diagnostic yield of celiac disease.

scholarly journals Urinary Exosomes Diagnosis of Urological Tumors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Yipeng Xu ◽  
Jianmin Lou ◽  
Mingke Yu ◽  
Yingjun Jiang ◽  
Han Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
False Negative ◽  
Cochrane Library ◽  
Tumor Type ◽  
Non Invasive ◽  
Specificity And Sensitivity ◽  
Urinary Exosomes ◽  
Urinary Exosome ◽  
Urological Tumors

PurposeExosomes could be released directly into the urine by the urological tumoral cells, so testing urinary exosomes has great potential for non-invasive diagnosis and monitor of urological tumors. The objective of this study is to systematically review and meta-analysis of urinary exosome for urological tumors diagnosis.Materials and MethodsA systematic review of the recent English-language literature was conducted according to the PRISMA statement recommendations (CRD42021250613) using PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases up to April 30, 2021. Risk-of-bias assessment was performed according to the QUADAS 2 tool. The true diagnostic value of urinary exosomes by calculating the number of true positive, false positive, true negative, and false negative, diagnoses by extracting specificity and sensitivity data from the selected literature.ResultsSixteen eligible studies enrolling 3224 patients were identified. The pooled sensitivity and specificity of urinary exosomes as a diagnostic tool in urological tumors were 83% and 88%, respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% CI: 0.89–0.94). Further subgroup analyses showed that our results were stable irrespective of the urinary exosome content type and tumor type.ConclusionUrinary exosomes may serve as novel non-invasive biomarkers for urological cancer detection. Future clinical trial designs must validate and explore their utility in treatment decision-making.Systematic Review Registration[ https://www.crd.york.ac.uk/prospero/], identifier [CRD42021250613].

Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

2020 ◽  
Author(s):  
Victor Lu ◽  
Avital Perry ◽  
Christopher Graffeo ◽  
Krishnan Ravindran ◽  
Jamie Van Gompel
Keyword(s):  
Cyst Wall ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Total Resection ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Does non-institutionalized elders have a better oral health status compared to institutionalized ones? A systematic review and meta-analysis

2020 ◽  
Vol 25 (6) ◽  
pp. 2177-2192 ◽  
Author(s):  
Ilky Pollansky Silva e Farias ◽  
Simone Alves de Sousa ◽  
Leopoldina de Fátima Dantas de Almeida ◽  
Bianca Marques Santiago ◽  
Antonio Carlos Pereira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Status ◽  
Oral Health ◽  
Dental Caries ◽  
Meta Analysis ◽  
Oral Health Status ◽  
Cochrane Library ◽  
Caries Experience ◽  
Institutionalized Elderly ◽  
Periodontal Status

Abstract This systematic review compared the oral health status between institutionalized and non-institutionalized elders. The following electronic databases were searched: PubMed (Medline), Scopus, Web of Science, Lilacs and Cochrane Library, in a comprehensive and unrestricted manner. Electronic searches retrieved 1687 articles, which were analyzed with regards to respective eligibility criteria. After reading titles and abstracts, five studies were included and analyzed with respect their methodological quality. Oral status of institutionalized and non-institutionalized elderly was compared through meta-analysis. Included articles involved a cross-sectional design, which investigated 1936 individuals aged 60 years and over, being 999 Institutionalized and 937 non-institutionalized elders. Studies have investigated the prevalence of edentulous individuals, the dental caries experience and the periodontal status. Meta-analysis revealed that institutionalized elderly have greater prevalence of edentulous (OR = 2.28, 95%CI = 1.68-3.07) and higher number of decayed teeth (MD = 0.88, 95%CI = 0.71-1.05) and missed teeth (MD = 4.58, 95%CI = 1.89-7.27). Poor periodontal status did not differ significantly between groups. Compared to non-institutionalized, institutionalized elders have worse dental caries experience.

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