Search

Background Pituitary adenoma, a benign tumor of the pituitary gland, represents 10-15% of intracranial tumors. Although non-cancerous, its size and location can cause significant health issues, including hormonal imbalances and compression of nearby structures like the optic chiasm, leading to conditions such as Cushing’s disease, acromegaly, and visual disturbances. The prevalence ranges from 46 to 95 per 100,000 individuals. This study evaluates the effectiveness and safety of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenomas. Methods A systematic review and meta-analysis following PRISMA guidelines included 10 RCTs with 633 patients. English-language RCTs were sourced from PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library. Risk of bias was assessed using the ROB2 tool, and statistical analyses were performed using RevMan 5.3. Results Dexmedetomidine significantly reduced heart rate after intubation (MD: -6.61 bpm, 95% CI: -8.98 to -4.24, p < 0.00001) and post-extubation (MD: -6.77 bpm, 95% CI: -8.59 to -4.96, p < 0.00001). Mean arterial pressure decreased after intubation (MD: -10.49 mmHg, 95% CI: -12.73 to -8.26, p < 0.00001) and post-extubation (MD: -12.97 mmHg, 95% CI: -14.37 to -11.57, p < 0.00001). Dexmedetomidine also reduced surgical duration (SMD: -0.23, 95% CI: -0.41 to -0.05, p = 0.01), blood loss (MD: -109.49 mL, 95% CI: -152.60 to -66.38, p < 0.00001), propofol dose (SMD: -1.04, 95% CI: -1.72 to -0.37, p = 0.002), extubation time (SMD: -0.70, 95% CI: -0.93 to -0.47, p < 0.00001), and postoperative nausea and vomiting (OR: 0.45, 95% CI: 0.25 to 0.80, p = 0.007). Conclusions Dexmedetomidine enhances perioperative outcomes in transsphenoidal resection of pituitary adenomas, supporting its use as an effective anesthetic adjunct.

Background Surgical procedures on the cervical spine are frequently performed to treat spinal diseases such as degenerative disc degeneration, trauma, tumors, and infections. However, postoperative complications are a cause for concern, and the surgical procedure with the lowest complication risk still unknown. Methods A comprehensive literature search was carried out in different databases from the beginning of the study to January 2024. Observational studies that reported the incidence of postoperative complications following anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy (PCF), laminoplasty, laminectomy with fusion, and corpectomy were included in the review. Outcomes like reoperation rates, infections, and nerve injuries were analyzed using random-effects models, with ORs (ORs) and 95% confidence intervals (CIs). Results 13 studies with 22,874 patients were included. ACDF was associated with higher complication rates versus PCF (OR 1.84, 95% CI 1.31 to 2.60) and laminoplasty (OR 2.85, 95% CI 1.84 to 4.41). Laminectomy with fusion showed greater pseudarthrosis (OR 2.57, 95% CI 1.35 to 4.90) and reoperation rates (OR 2.46, 95% CI 1.36 to 4.43) than ACDF. No differences were detected between other procedures. Conclusion Complications risk significantly differs based on surgical strategy and technique, with ACDF potentially having higher rates compared to less invasive methods.