Table 2.
– Predictors assessed for worsening endocrine deficits following transsphenoidal surgery
| Predictor | Number of Studies | Key Findings | Statistical Finding | Meta-analysis Performed | GRADE (certainty of evidence) |
|---|---|---|---|---|---|
| Patient Factors | |||||
| Age | 7 (Chinezu 2017; Gondim 2015; Little 2020; Araujo-Castro 2022; Vivancos Sanchez 2021; Jahangiri 2016; Biamonte 2021) | Across all studies, age was not statistically associated with new pituitary deficits | MESE = 0.07; 95% CI − 0.34 to 0.48; p = 0.74; I² = 0% | Yes (2 studies only) | ⊕⊕⊝⊝ LOW |
| Sex | 4 (Little 2020; Araujo-Castro 2022; Jahangiri 2016; Biamonte 2021) | No significant relationship found in the meta-analysis and in individual studies | Pooled OR = 0.68; 95% CI 0.29–1.68; p = 0.38 | Yes (2 studies) | ⊕⊝⊝⊝ VERY LOW |
| BMI | 1 (Little 2020) | No significant relationship | p = 0.82 | No | |
| Preoperative visual impairment | 1 (Araujo-Castro 2022) | No significant relationship | Adjusted OR = 5.7; p = 0.065 | No | |
| Preoperative hyperprolactinaemia | 1 (Araujo-Castro 2022) | No significant relationship | p = 0.509 | No | |
| Comorbidities | 1 (Araujo-Castro 2022) | No significant relationship | p > 0.05 for all comorbidities | No | |
| Tumour Characteristics | |||||
| Size (diameter) | 3 (Jahangiri 2016; Biamonte 2021; Araujo-Castro 2022) | No significant difference | p > 0.05 | No | ⊕⊕⊝⊝ LOW |
| Volume | 2 (Little 2020; Vivancos Sanchez 2021) | Significant relationship - Larger tumours associated with new/worsened deficits | Mean difference = 4.3 mL; 95% CI 0.76–7.85; p = 0.02 | Yes | ⊕⊝⊝⊝ VERY LOW |
| Clinical apoplexy | 1 (Araujo-Castro) | No significant relationship | p = 0.42 | No | |
| Cavernous sinus invasion | 4 (Little; Araujo-Castro; Vivancos Sanchez; Biamonte 2021) | Mixed results – mostly non-significant relationship on Meta-analysis | pooled OR 1.99, 95% CI (0.67–5.86), p = 0.21 | Yes | ⊕⊝⊝⊝ VERY LOW |
| Tumour consistency | 1 (Araujo-Castro) | No significant relationship | p = 0.937 | No | |
| Pituitary stalk visibility | 1 (Vivancos Sanchez) | No significant relationship | All p > 0.05 | No | |
| Pituitary gland visibility | 1 (Vivancos Sanchez) | No significant relationship | Adjusted OR = 2.47; 95% CI 0.67–9.05; p = 0.173 | No | |
| Surgical/Technical Factors | |||||
| Surgeon experience | 4 (Seejore; Little; Araujo-Castro; Palpes Flores) | No significant relationship | Pooled OR 1.60, 95% CI 0.53–4.85, p = 0.40 | Yes | ⊕⊝⊝⊝ VERY LOW |
| Extent of resection | 4 (Seejore; Little; Vivancos Sanchez; Araujo-Castro 2022) | Significant relationship in favour of GTR showing reduced odds of new pituitary deficits. | GTR showed pooled OR = 0.49; 95% CI 0.24–0.98; p = 0.04; I² = 0% | Yes | ⊕⊕⊝⊝ LOW |
| Surgical goal | 1 (Little 2020) | No significant relationship | p = 0.32 | No | |
| Previous surgery | 1 (Araujo-Castro) | No significant relationship | p-0.651 | No | |
| CSF leak | 1 (Araujo-Castro) | Significantly association with CSF leak for increased odds of a new pituitary deficit | 2.8% in patients with preserved function versus 18.2% in those with new deficits, p = 0.028 | No | |
| Microscopic vs. Endoscopic approach | 1 (Song) | No significant relationship | P = 0.228 | No | |