PURPOSE The transsphenoidal approach presents unique challenges in young, with scanty literature. This study compares the outcome of pituitary tumors among young in our center between endoscopic(EES) and microscopic(MTS) transsphenoidal surgery, with a meta-analysis. METHODS Patients within 20 years were studied for their surgical approach to a favorable outcome of endocrine remission (ER) (functioning) or Gross/Near-Total resection (nonfunctioning), besides the need for retreatment. Relevant studies were pooled and analyzed according to PRISMA guidelines. RESULTS Out of 64 young patients with pituitary tumors, 48 underwent transsphenoidal surgery using MTS(33) or EES(15). Of these, 21, 14, 5, and 8 had Cushing's, somatotropinomas, prolactinomas, and non-secreting tumors, respectively. Mean symptom duration was 28months, with weight gain(50 %) and visual complaints(29 %) most prevalent. Hypogonadism(21 %) was the most frequent endocrinopathy. The mean tumor volume was 3.8 cm3. Over mean follow-up of 4.4years, favorable outcome was significantly higher after EES than MTS(78.6 % vs. 46.7 %)(odds ratio 4.18, p = 0.05). EES's better outcome was homogeneous across subgroups of age and tumor type, with no significant subgroup difference. Symptom duration was significantly higher among those who required retreatment(p = 0.05), while ER had a non-significant association with tumor volume(p = 0.07). Overall, 40 %, 27 %, 17 %, and 8% were on hydrocortisone, thyroxine, sex hormone, and desmopressin, respectively, at follow-up with no significant difference between EES and MTS. In pooled analysis of literature, both favorable outcome(74 % vs. 48 %,p = 0.02) and retreatment rate(8% vs. 37 %,p = 0.004) were significantly better with EES than MTS. CONCLUSION Among young patients with pituitary tumors, the favorable outcome and retreatment rates are better with endonasal endoscopy and associated with symptom duration and tumor volume.

中文翻译：

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年轻人垂体瘤的鼻内镜与显微经蝶窦手术：比较研究和汇总数据荟萃分析

目的 经蝶入路在缺乏文献的年轻人中提出了独特的挑战。本研究通过荟萃分析比较了内窥镜（EES）和显微（MTS）经蝶手术在我们中心的年轻人中垂体瘤的结果。方法 研究了 20 年内患者的手术方法，除了需要再治疗外，内分泌缓解 (ER)（功能性）或大体/近全切除（非功能性）的有利结果。根据 PRISMA 指南汇总和分析相关研究。结果 在 64 名患有垂体瘤的年轻患者中，48 名接受了使用 MTS(33) 或 EES(15) 的经蝶窦手术。其中，21、14、5 和 8 名分别患有库欣氏病、生长激素瘤、催乳素瘤和非分泌性肿瘤。平均症状持续时间为 28 个月，体重增加 (50%) 和视觉投诉 (29%) 最为普遍。性腺机能减退（21%）是最常见的内分泌疾病。平均肿瘤体积为 3.8 cm3。在平均 4.4 年的随访中，EES 后的有利结果显着高于 MTS（78.6 % 对 46.7 %）（优势比 4.18，p = 0.05）。EES 更好的结果在年龄和肿瘤类型的亚组中是均匀的，没有显着的亚组差异。需要再治疗的患者的症状持续时间明显更长（p = 0.05），而ER与肿瘤体积无显着相关性（p = 0.07）。总体而言，随访时分别有 40%、27%、17% 和 8% 使用氢化可的松、甲状腺素、性激素和去氨加压素，EES 和 MTS 之间没有显着差异。在文献汇总分析中，两种结果都有利（74 % vs. 48 %，p = 0。02) 和再治疗率 (8% vs. 37%, p = 0.004) 使用 EES 显着优于 MTS。结论在年轻垂体瘤患者中，鼻内窥镜检查的良好预后和再治疗率更好，并且与症状持续时间和肿瘤体积有关。