The key point of transsphenoidal surgery for infradiaphragmatic craniopharyngioma：Better sellar diaphragm resection.

Background: Craniopharyngiomas have a high recurrence rate and a poor prognosis, and the key methods for reducing recurrences are unknown. The aim of this study was to explore the key points of microscopic or endoscopic transsphenoidal surgery used to treat infradiaphragmatic craniopharyngiomas. Methods: We reviewed the medical records of patients with infradiaphragmatic craniopharyngiomas who were admitted to Peking Union Medical College Hospital between 2011 and 2018. Results: When considering tumor location, all 34 patients had intrasellar tumors, with 19 of them exhibiting suprasellar extensions. Of the 34 patients, 24 patients underwent resection under the microscope and the remaining 10 patients underwent transsphenoidal endoscopic surgery. Gross total tumor resection was achieved in 16 patients. Twelve patients underwent invaded sellar diaphragm resection, while the remaining 22 patients were not. Cerebrospinal fluid leaks occurred during surgery in 18 patients. Visual acuity improved in two patients. After an average follow-up of 31.1 months, 13 patients experienced tumor recurrence. The short term recurrence rate in the sellar diaphragm resection group was significantly lower compared to the non-resected group (P < 0.001). Moreover, based on distinct surgical methods, the endoscope group displayed a reduced short term recurrence rate compared to the microscope group (P = 0.0048). Conclusion: Invaded sellar diaphragm resection emerges as a pivotal maneuver in craniopharyngioma surgery, substantively influencing tumor recurrence. Capitalizing on the advantageous angled lens of endoscopes, surgeons can achieve heightened visualization. Significantly, the endoscopic approach exhibits a superior capacity to curtail recurrence, while effectively managing potential complications, when contrasted with the microscope group.

Using Engineering Methods (Kaizen and Micromovements Science) to Improve and Provide Evidence Regarding Microsurgical Hand Skills.

OBJECTIVE: Microsurgical interventions involve the interaction of numerous variables, making objective analysis of skill proficiency challenging. This difficulty is even more pronounced in low-resource contexts. Continuous improvement methodologies such as Kaizen-planning, doing, checking, acting (PDCA) and micromovements science (MMS) can address this issue. This study aimed to demonstrate the advantages of designing and implementing microsurgical training programs using these methodologies. METHODS: Following an extensive literature review of Kaizen-PDCA and MMS, and under the guidance of experienced neurosurgeons and engineers, a microvascular bypass training program was developed using the human placenta. Subsequently, the training program was used to analyze and describe the process of a trainee neurosurgeon in Argentina with no prior experience in microvascular anastomosis, as the operator gained proficiency. RESULTS: The trainee required 12 attempts to achieve the program goals. The longest procedural time was during the first attempt (1 hour 49 minutes 05 seconds with 2 mistakes), while the shortest time was during the fourth attempt (53 minutes 29 seconds with 3 mistakes). After 12 attempts, the trainee made no mistakes, and the procedural time was reduced to 57 minutes 37 seconds. The final learning curve demonstrated a regular pattern and reached a plateau after 7 attempts. CONCLUSIONS: The training program and methodology effectively assessed, facilitated, and demonstrated the acquisition of microsurgical skills. Kaizen-PDCA and MMS enabled the effective use of expert experience, detailed evaluation of microsurgical procedures, and integration into a continuous improvement cycle. The program structure could also be valuable for teaching, evaluating, and enhancing similar surgical procedures.

Combined microscope-endoscopy resection of petrous bone cholesteatoma with temporary facial nerve transposition versus nontransposition.

PURPOSE: The narrow supralabyrinthine space affects surgical procedures. To study the effect of temporary transposition of geniculate ganglion of facial nerve versus nontransposition on lesion recurrence and facial nerve function in patients with petrous bone cholesteatoma. METHODS: A total of 18 patients with petrous bone cholesteatoma involving the facial nerve were treated in our hospital from November 2016 to March 2023. The main surgical method is the extended supralabyrinthine approach assisted by a microscope and an endoscope. We collected and retrospectively analyzed their medical records. RESULTS: Temporary facial nerve transposition was performed in five patients, and nontransposition was performed in 13 patients. Cholesteatoma recurred in three patients with facial nerve nontransposition, whereas none in patients with facial nerve transposition. In this study, except for one case with a second operation, postoperative facial paralysis in other cases was improved to varying degrees, and there was no significant difference between the two groups. CONCLUSION: Temporary transposition of geniculate ganglion of facial nerve will not affect the postoperative nerve function of patients and can reduce the possibility of cholesteatoma recurrence of the petrous bone.

The Role of Augmented Reality Neuronavigation in Transsphenoidal Surgery: A Systematic Review.

In the field of minimally invasive neurosurgery, microscopic transsphenoidal surgery (MTS) and endoscopic transsphenoidal surgery (ETS) have been widely accepted as a safe approach for pituitary lesions and, more recently, their indications have been extended to lesions at various skull base regions. It is mandatory during transsphenoidal surgery (TS) to identify key anatomical landmarks in the sphenoid sinus and distinguish them from the lesion. Over the years, many intraoperative tools have been introduced to improve the neuronavigation systems aiming to achieve safer and more accurate neurosurgical interventions. However, traditional neuronavigation systems may lose the accuracy of real-time location due to the discrepancy between the actual surgical field and the preoperative 2D images. To deal with this, augmented reality (AR)-a new sophisticated 3D technology that superimposes computer-generated virtual objects onto the user's view of the real world-has been considered a promising tool. Particularly, in the field of TS, AR can minimize the anatomic challenges of traditional endoscopic or microscopic surgery, aiding in surgical training, preoperative planning and intra-operative orientation. The aim of this systematic review is to analyze the potential future role of augmented reality, both in endoscopic and microscopic transsphenoidal surgeries.

Perioperative hormone level changes and their clinical implications in patients with pituitary adenoma: a retrospective study of 428 cases at a single center.

Objective: This study employs case data analysis to elucidate alterations in hormone levels pre and post-surgery among patients with pituitary adenoma. Moreover, it investigates the influence of various associated factors on endocrine function. Methods: A retrospective analysis was conducted on clinical data from 428 patients who underwent surgical treatment within a short period at a single center. Statistical methods were employed to examine detailed hormone level fluctuations before and after surgery in patients with pituitary adenoma, along with their interrelations with different factors. Results: Between January 2016 and October 2022, a total of 428 consecutive patients with pituitary adenoma underwent surgical treatment. Of these, 232 were males and 196 were females, with an average age of 45.91 years (range: 16-84, standard deviation: 12.18). Univariate analysis indicated that females exhibited a higher susceptibility to preoperative endocrine dysfunction (p < 0.05). Conversely, males, patients with larger tumor volumes, and older patients were more prone to preoperative pituitary insufficiency. Postoperatively, the most substantial remission rate occurred in prolactin (77.4%), followed by growth hormone (GH) (71.8%) and cortisol (4/6). The highest recovery rate in functions was observed in growth hormone secretion function (80%), followed by pituitary-adrenal axis hormone secretion function (56.3%) and pituitary-thyroid axis hormone secretion function (47.5%). The most noteworthy incidence of newly developed postoperative endocrine deficiencies was found in the pituitary-adrenal axis (31.8%), while the occurrence rates of deficiencies in other axes were relatively low. The elevated postoperative remission rate of growth hormone correlated with a higher surgical resection rate and lower preoperative growth hormone levels. Additionally, lower preoperative prolactin levels corresponded to a higher remission rate of prolactin postoperatively. Furthermore, the restoration of postoperative thyroid hormone secretion function was associated with higher preoperative free thyroxine levels. Reduced postoperative cortisol secretion function was linked to multiple surgeries and an extended interval between hormone retesting and surgery. Conclusion: Surgical intervention effectively ameliorates endocrine disorders in pituitary adenoma patients, thereby mitigating symptoms and enhancing their quality of life. Preoperative management of growth hormone and prolactin levels facilitates an increased remission rate of these hormones post pituitary adenoma surgery. Patients displaying preoperative thyroid hormone secretion dysfunction should be considered for active supplementation therapy. Whenever feasible, complete tumor resection is recommended. For patients undergoing reoperation or multiple surgeries, vigilant postoperative cortisol monitoring and supplementation should be thoughtfully administered.

Remodeling of Lumbar Spinal Osteoid Osteoma Resected With Microscopic Surgery in a 15-Year-Old Basketball Player: A Case Report.

This case report focuses on a 15-year-old competitive-level high school basketball player who experienced chronic low back pain. Diagnostic imaging revealed osteoid osteoma in the L5 posterior element, causing osteosclerotic deformity of the left lamina and more inferior facet. To return him to the condition of sports activity, less invasive surgery of microscopic tumor resection with autologous bone grafting was planned instead of CT-guided ablation, which can cause thermal injury to nearby tissues. This procedure could preserve spinal structures, including the facet, pedicle, and paravertebral muscles. The day after surgery, the patient experienced a complete resolution of lower back pain. He gradually resumed light exercise two months postoperatively. Three-month follow-up CT imaging revealed bone remodeling at the resection site, to return to complete basketball activities. Over five years, no tumor recurrence or symptoms were observed, and he maintained his competitive activity level.

Recording the direct surgeon's view with an operating microscopic view improves microscopic ophthalmic surgery training.

AIM: To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope, which lacks information on the movement and position of the surgeon's hands, and to facilitate the reproduction of a skilled surgeon's technique by a surgeon in training. METHODS: A small camera was attached to the operating microscope with a custom adapter. Microscopic surgeon's view and direct surgeon's view through this new camera were recorded in the surgical recording system. Both movies were synchronized and analyzed how do surgeons handle the instruments. RESULTS: A small camera attached to the operating microscope allowed the surgeon's hands motion to be recorded without interfering with the surgeon's movements. Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device. Even in the simple paracentesis procedure, different surgeons used different methods. Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view. CONCLUSION: Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.

Comparison of clinical effects between microscopic surgery and conventional surgery in children with penile hypospadias and difference analysis of postoperative urodynamics.

Objective: To compare and analyze the clinical effects of microscopic surgery and conventional surgery in children with penile hypospadias and the differences in postoperative urodynamic indexes. Methods: It was a clinical comparative study. A total of 80 children with penile hypospadias admitted to Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital from July 2018 to September 2022 were selected and randomly divided into two group. The experimental group were treated with microscopic urethroplasty, while the control group were treated with traditional urethroplasty. The operative effect, operation time, total intraoperative blood loss, postoperative hospital stay and incidence of surgical complications were compared and analyzed between the two groups. All the children were followed up for two years, and the changes in urodynamic parameters including maximum urine flow rate (Qmax), average urine flow rate (Qavc), urine flow time (FT), peak time (TQmax) and residual urine (PVR) were compared before, two weeks after, six months after and two years after surgery. Results: The efficacy of the experimental group was significantly higher than that of the control group (p=0.013). The intraoperative blood loss and postoperative hospital stay in the experimental group were significantly better than those in the control group (p=0.000). The incidences of urinary leakage and urethral stricture in the experimental group were lower than those in the control group (p<0.05). The Qmax level in the experimental group was higher than that in the control group at six months and two years after surgery, while the FT level was lower than that of the control group (p<0.05). Conclusion: Microscopic surgery is a method with significant clinical value in the treatment of penile hypospadias.

Automatic detection and segmentation of chorda tympani under microscopic vision in otosclerosis patients via convolutional neural networks.

BACKGROUND: Artificial intelligence (AI) techniques, especially deep learning (DL) techniques, have shown promising results for various computer vision tasks in the field of surgery. However, AI-guided navigation during microscopic surgery for real-time surgical guidance and decision support is much more complex, and its efficacy has yet to be demonstrated. We propose a model dedicated to the evaluation of DL-based semantic segmentation of chorda tympani (CT) during microscopic surgery. METHODS: Various convolutional neural networks were constructed, trained, and validated for semantic segmentation of CT. Our dataset has 5817 images annotated from 36 patients, which were further randomly split into the training set (90%, 5236 images) and validation set (10%, 581 images). In addition, 1500 raw images from 3 patients (500 images randomly selected per patient) were used to evaluate the network performance. RESULTS: When evaluated on a validation set (581 images), our proposed CT detection networks achieved great performance, and the modified U-net performed best (mIOU = 0.892, mPA = 0.9427). Moreover, when applying U-net to predict the test set (1500 raw images from 3 patients), our methods also showed great overall performance (Accuracy = 0.976, Precision = 0.996, Sensitivity = 0.979, Specificity = 0.902). CONCLUSIONS: This study suggests that DL can be used for the automated detection and segmentation of CT in patients with otosclerosis during microscopic surgery with a high degree of performance. Our research validated the potential feasibility for future vision-based navigation surgical assistance and autonomous surgery using AI.

Rare Case of Managing and Evaluating Viability after Replantation of a Serial Self-Amputated Bilateral Testis by a Patient with Schizophrenia: A Case Report.

Amputation of the testis is very rare in clinical situations; therefore, most surgeons have no experience with an amputated testis. In this case, a 31-year-old male with schizophrenia amputated both testes due to self-mutilation. We performed replantation surgery via microscopy. On postoperative day 1, he removed his right testis by using his hand, even though his hands were restrained. The second attack disrupted the viability of the right testis. However, after proper management, we checked the normal sex hormone level by preserving the replanted left testis. We evaluated the viability of the replanted testis by performing five examinations, namely, intraoperative indocyanine green injection, testicular scan with technetium pertechnetate, contrast-enhanced computerized tomography, Doppler ultrasonography, and serum testosterone level. In this report, we aimed to describe our rare experience about management with replantation of the amputated testes and evaluation of their viability.

[Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report].

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

Female Surgical Ergonomics in Otolaryngology: A Qualitative Study.

OBJECTIVE: To explore the surgical ergonomic challenges experienced by women in otolaryngology, identify specific equipment that is ergonomically challenging, and assess the impact of suboptimal ergonomics on female otolaryngologists. METHODS: We performed a qualitative study using an interpretive framework rooted in grounded theory. We performed semi-structured qualitative interviews of 14 female otolaryngologists from nine institutions at various stages in training and across subspecialties. Interviews were independently analyzed by thematic content analysis by two researchers and inter-rater reliability was assessed via Cohen's kappa. Differing opinions were reconciled via discussion. RESULTS: Participants noted difficulties with equipment including microscopes, chairs, step stools, and tables as well as difficulty using larger surgical instruments, preference for smaller instruments, frustration with lack of smaller instruments, and a desire for a larger spectrum of instrument sizes. Participants reported neck, hand, and back pain associated with operating. Participants suggested modifications to the operative environment, including a wider variety of instrument sizes, adjustable instruments, and more focus and attention on ergonomic issues and the range of surgeon physiques. Participants felt that optimizing their operating room set-up was an additional burden on them, and that lack of inclusive instrumentation affected their sense of belonging. Participants emphasized positive stories of mentorship and empowerment from peers and superiors of all genders. CONCLUSION: Female otolaryngologists face unique ergonomic challenges. As the otolaryngology workforce becomes increasingly diverse, it is important to address the needs of a diverse set of physiques to avoid inadvertently disadvantaging certain individuals. LEVEL OF EVIDENCE: N/A Laryngoscope, 133:3034-3041, 2023.

Outcomes of invasive melanoma of the head and neck treated with Mohs micrographic surgery - A multicenter study.

BACKGROUND: There are no randomized controlled trials to guide surgical margins for invasive head and neck (H&N) melanoma using conventional excision. Mohs micrographic surgery (MMS) has shown improved local recurrence rates and survival for invasive H&N melanomas. OBJECTIVE: Determine local recurrence (LR), nodal recurrence, and distant recurrence rates, and disease specific survival for invasive melanoma of the H&N treated with MMS. METHODS: A retrospective multicenter study of 785 cases of invasive H&N melanoma treated with MMS using frozen sections with melanoma antigen recognized by T-cells 1 immunohistochemical staining was performed to evaluate long-term outcomes over 12-years. RESULTS: 785 melanomas (thickness: 0.3 mm-8.5 mm) were treated with MMS. LR, nodal recurrence, and distant recurrence rates were 0.51% (4/785), 1.0% (8/785), and 1.1% (9/785) respectively. For T1, T2, T3, and T4 tumors LR was 0.16% (1/636), 1.18% (1/85), 2.22% (1/45), and 5.26% (1/19), respectively. Five and 10-year disease specific survival were 96.8% (95% CI 95.0% to 98.5%) and 93.4% (95% CI 88.5% to 98.3%). LIMITATIONS: A nonrandomized retrospective study. CONCLUSION: MMS achieves significant improvements in LR compared to a meta-analysis of historical cohorts of patients treated with conventional excision. MMS should be considered an important surgical option for invasive H&N melanoma.

Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report / 临床耳鼻咽喉头颈外科杂志

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis.

Osbjective: Several studies have shown that both microscopic unilateral laminotomy bilateral decompression (ULBD) and unilateral biportal endoscopic (UBE) ULBD are effective for treating lumbar canal stenosis (LCS). However, there are different viewpoints as to which surgical technique is superior. Therefore, this meta-analysis investigated the clinical efficacy and side effects of microscopic ULBD and UBE ULBD for treating LCS. Methods: To identify relevant studies describing the clinical outcomes and complication rates of microscopic ULBD and UBE ULBD for LCS, several databases were systematically searched in the Internet. The visual analog scale score for back and leg pain and the Oswestry Disability Index were used to assess clinical outcomes. Furthermore, data about perioperative outcomes and complications were documented. Results: In total, six studies with 450 participants were included in this meta-analysis. The UBE ULBD was found to be superior to microscopic ULBD in terms of efficacy against early postoperative back and leg pain. However, there was no significant difference between the two procedures in terms of final clinical outcomes and complications. In addition, compared with microscopic ULBD, UBE ULBD was associated with a significant reduction in the length of hospital stay and C-reactive protein levels 2 days after surgery. Conclusion: UBE ULBD and microscopic ULBD for the treatment of LCS were similar in terms of final clinical outcomes and complications. However, UBE ULBD has several advantages over microscopic ULBE, including a shorter hospital stay and faster alleviation of postoperative back and leg pain.

Case Report: Extensive Temporal Bone Invasion in a Giant Vestibular Schwannoma.

Background: Rare giant vestibular schwannomas (GVSs) invade the temporal bone extensively, which carries unique risks for surgery owing to their complicated relationship with adjacent structures, difficult dissection of the temporal bone, and high risk of complications. The underlying mechanism of this invasive behavior remains unknown. Case description: We report on a 28-year-old woman who presented with typical hearing loss and facial paralysis (House-Brackmann II). Magnetic resonance imaging exhibited a giant mass (∼5.0 cm) in the right cerebellopontine angle (CPA), petrous apex, and middle cranial fossa. Her primary diagnosis was GVS with petrous apex invasion. With the aid of presurgical imaging reconstruction and intraoperative facial nerve monitoring, we adopted a sequential therapeutic strategy, which included microsurgery for the CPA lesion followed by gamma knife radiosurgery (GKRS) for the petrous mass. During follow-up, stable tumor control was achieved with functional preservation of the facial nerve and no other complications. The postoperative immunohistochemical examination demonstrated dramatic intratumoral inflammation, which suggested its potential role in bony erosion. We reviewed the literature of large vestibular schwannoma with a petrous invasion and further discussed its treatment. Conclusion: Microsurgery remains the top therapeutic strategy for GVS. However, gross total resection with functional preservation of cranial nerves is challenging to achieve once the temporal bone is involved. In this case, we applied a planned and sequential approach of microsurgery and GKRS with a promising outcome, which highlighted this combinational strategy in this rare situation. In addition, pathological examination suggested that intratumoral inflammation might play a role in the bony erosion of GVS. Longer observation and more cases are needed to further investigate its molecular mechanism and treatment plan.

Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy? A systematic review and meta-analysis.

BACKGROUND: For prolactinoma patients, dopamine agonists (DAs) are indicated as the first-line treatment and surgery is an adjunctive choice. However, with the development of surgical technique and equipment, the effect of surgery has improved. The aim of this study was to assess the efficacy and safety of surgery versus DAs in patients with different types of prolactinomas. METHODS: A systematic search of literature using Web of Science, PubMed, Cochrane Library, and Clinical Trial databases was conducted until July 12, 2019. Prolactinoma patients treated with DAs (bromocriptine or cabergoline) or surgery (microscopic or endoscopic surgery) were included. Outcomes included the biochemical cure rate, recurrence rate, prolactin level, improvement rates of symptoms, and incidence rates of complications. A random-effects model was used to pool the extracted data. Qualitative comparisons were conducted instead of quantitative comparison. RESULTS: DAs were better than surgery in terms of the biochemical cure rate (0.78 versus 0.66), but surgery had a much lower recurrence rate (0.19 versus 0.57). Full advantages were not demonstrated in improvement rates of symptoms and incidence rates of complications with both treatment options. In microprolactinoma patients, the biochemical cure rate of endoscopic surgery was equal to the average cure rate of DAs (0.86 versus 0.86) and it surpassed the biochemical cure rate of bromocriptine (0.86 versus 0.76). In macroprolactinoma patients, endoscopic surgery was slightly higher than bromocriptine (0.66 versus 0.64) in terms of the biochemical cure rate. CONCLUSION: For patients with clear indications or contraindications for surgery, choosing surgery or DAs accordingly is unequivocal. However, for patients with clinical equipoise, such as surgery, especially endoscopic surgery, in microprolactinoma and macroprolactinoma patients, we suggest that neurosurgeons and endocrinologists conduct high-quality clinical trials to address the clinical equipoise quantitatively.

Pretemporal Transcavernous Approach for Resection of Non-meningeal Tumors of the Cavernous Sinus: Single Center Experience.

OBJECTIVES: To study the outcomes of the pretemporal transcavernous approach in the treatment of non-meningeal tumors involving cavernous sinus and to investigate the surgical strategy for these lesions. METHODS: We conducted a retrospective study of 45 patients with non-meningeal tumors involving cavernous sinus. All 45 patients received microsurgical resection via the pretemporal transcavernous approach from April 2012 to January 2019 by the same neurosurgeon. We analyzed clinical manifestations, image data, perioperative complications, surgical outcomes, functional outcomes, and follow-up data of these patients. RESULTS: Gross total resection was achieved in 38 cases (84.4%) of the 45 patients. Preoperatively, a total of 64 individual cranial nerves were affected. Postoperatively, 92.2% of 64 impaired cranial nerves completely or partially restored function, 7.8% had worsened function compared with their preoperative statuses, and 5 new cranial nerve deficits (CNV) were observed in five patients during the last follow-up. Seven patients presented transient new cranial nerve deficits (5 CNIII and 2 CNVI), three cases suffered transient worsen cranial nerve deficits (3 CNIII and 1 CNVII). There were no cases of intracranial hematoma, intracranial infection, cerebrospinal fluid leaks, and death. The progression of residual tumor was observed in two patients (1 chordoma and 1 pituitary adenoma). CONCLUSIONS: Non-meningeal tumors involving cavernous sinus can be safely and radically removed with less morbidity and mortality. Pretemporal transcavernous approach is an ideal approach to the cavernous sinus and can be tailored individually.

Comparison of microscopic and endoscopic resection of third-ventricular colloid cysts: A systematic review and meta-analysis.

BACKGROUND AND AIM: Colloid cysts are uncommon benign lesions. There is a lack of consensus regarding the preferred surgical strategy for colloid cyst resection; the technique with the optimal rates of remission, recurrence, mortality, and complications is debatable. MATERIALS AND METHODS: To determine surgical outcomes, we performed a systematic review of the published literature on Colloid cysts. Eligible studies (n = 63) with a prospective or retrospective evaluation of endoscopic or microscopic resection of third ventricle colloid cysts were included, which contained data describing extents of resection, seizures, meningitis, and tumor recurrence. A total of 3143 patients (1741 microscopically and 1402 endoscopically operated) were included in the final analysis. RESULTS: According to the results of the meta-analysis, there was a higher rate of gross total resection (GTR) (98.15% versus 91.29%, p = 0.00), need for shunting (4.75% versus 1.46%, p = 0.04), postoperative complications (20.68% versus 10.42%, P = 0.03), mean operating time (194.18 versus 113.04 min), and duration of hospitalization (7.85 versus 4.69 days) for microscopic resection compared with endoscopic resection. While endoscopic resection is associated with a higher rate of cyst recurrence (1.78% versus 0.00%, P = 0.00), there was no difference in reoperation rate (0.49% for endoscopic versus 0.09% for microscopic resection). CONCLUSION: Microsurgical resection of third ventricle colloid cysts was associated with a higher rate of GTR and a lower rate of recurrence, while there was a lower rate of postoperative complications, duration of surgery, and shorter hospitalization period in the endoscopic group.