Comparison Of The Effect Of Different Microsurgical Approaches To Tuberculum Sellae Meningiomas:A Network Meta-analysis

Objective:To assess the safety and the effectiveness of three common microsurgical approaches to tuberculum sellae meningioma,run a network Meta-analysis to get reference from the evidence-based medicine.Methods:Full text advanced searches was performed on websites such as Pubmed,CNKI online database,Wanfang Data and Weipu Information.The keywords were"Tuberculum sellae meningioma","sellae meningioma","sellar meningioma" and "鞍结节脑膜瘤","鞍区脑膜瘤",selected all published articles from January 2010 to December 2019 that involved a controlled study on the surgical methods of tuberculum sellae meningioma,were screened strictly in accordance with the inclusion and exclusion criteria and were evaluated for quality via the modified Newcastle-Ottawa scale.Extract the relevant data,use Revman 5.3 to analyze the risk of bias,use StataMP 15 to draw the network evidence map,and use WinBUGS-based ADDIS v1.16.8 to run the network Meta analysis;Results:A total of 14 articles were included,including 13 in Chinese and 1 in English.All 14 studies have reported the Simpson Ⅰ grade Ⅱ resection rate,there is no significant difference in the effect of different surgical approaches on the total resection rate.Among the possible rankings of rates,the pterion approach is better than the longitudinal fissure approach than the subfrontal approach;13 studies have reported the postoperative complications including diabetes insipidus,brain tissue damage,incision infection,gastrointestinal bleeding,secondary epilepsy,etc.,and there is a significant difference in the impact of the complication rate.11 studies reported postoperative diabetes insipidus rate.There are significant differences in the advantages of the longitudinal fissure approach over the pterion approach and the subfrontal approach,and the advantage of the pterion approach over the subfrontal approach is not significant,but it has reference value.10 studies reported postoperative brain tissue damage rate.There are significant differences in the advantages of the longitudinal fissure approach over the pterion approach and the subfrontal approach,and the advantage of the subfrontal approach over the pterion approach is not significant,but it has reference value.6 studies have reported postoperative incision infection rate,and there is no significant difference in the effect of different surgical approaches on the it.Among the possible rankings of rates,the longitudinal fissure approach is better than the pterion approach than the subfrontal approach;All 14 studies reported postoperative mortality.There is no significant difference in the impact of different surgical approaches on postoperative mortality.In the possible ranking that is beneficial to reduce postoperative mortality,subfrontal approach is better than pterion approach than longitudinal fissure approach.In addition,limited by the number of studies,4 articles reported the postoperative vision improvement of the pterion and subfrontal approaches,thus only the traditional meta-analysis can be done,and the result is that there is no significant difference between these 2 methods(OR=1.39,95%[0.72,2.66],P=0.32).2 articles reported the quality of life improvement after the pterion and longitudinal fissure approach approaches,thus only the traditional meta analysis can be done,and the result is that there is no significant difference between these 2 methods(OR=0.69,95%[0.14,3.35],P=0.32).3 studies reported the secondary epilepsy after the pterion and subfrontal approach approaches,according to the traditional meta-analysis,there is no significant difference between these 2 methods(OR=1.24,95%[0.28,5.55],P=0.36).2 studies reported the postoperative recurrence while they cannot be compared,and according to the primary data,there is no significant difference between these methods.Conclusion:The three microsurgical methods of longitudinal fissure,pterion and subfrontal approach have no significant difference in the resection rate of Simpson Ⅰ andⅡ and the postoperative mortality when treating tuberculum sellae meningioma.Meanwhile,the pterion approach may be better for the resection rate of Simpson Ⅰ andⅡ,and for the postoperative mortality rate,subfrontal approach may be the best.There is a significant difference in the incidence of postoperative total complications,longitudinal fissure approach is superior to pterion and subfrontal approach.As for the postoperative visual acuity improvement rate,postoperative quality of life improvement rate,and postoperative secondary epilepsy incidence rate can only be compared by pairwise comparison using traditional Meta analysis,and the results have no significant difference.The results of this study have some reference significance,but we still need more large samples,multi-center randomized controlled experiments to verify.