Background: Acromegaly is a severe progressive neuroendocrine disease caused by chronic elevated concentrations of growth hormone and insulin-like growth factor 1 in individuals with completed physiological growth and leading to early disability and mortality. The Acromegaly Registry with its regular updates makes it possible to merge and systematize all the available information on the diseases, to assess the efficacy of treatment algorithms and to choose an optimal diagnostic and treatment strategy in a given territory.Aim: To evaluate the efficacy of various treatments for acromegaly based on the analysis of the regional Registry of patients with pituitary tumors in the Republic of Tatarstan.Materials and methods: The study was based on data from 217 patients with somatotropin producing pituitary adenomas entered in the Registry of patients with pituitary tumors in the Republic of Tatarstan as per January 2021. One hundred and eighty one (181 patients) with sufficient data to assess the remission rates and the disease course were included into the analysis.Results: Endonasal endoscopic adenomectomy as a first-line treatment has been performed in 93% (169/181) of the patients, with 34% of the cases (57/169) being in the full postoperative remission. The efficacy of surgical treatment depended on the tumor size, invasion grade and aggressiveness. A 1st generation long-acting somatostatin analog (octreotide) has been prescribed to 50% (91/181) of the patients (11 patients as first-line therapy and 80 patients after adenomectomy), with biochemical remission rate of 56% (51/91). Radiological treatment has been completed in 11,6% (21/181) of the patients. The complete remission rate after all treatment modalities (surgical, medical, and radiation therapy) was 60% (108/181).Conclusion: The effectiveness of treatment for acromegaly in the Republic of Tatarstan is comparable to that in the all-Russian and international registries. Nevertheless, 40% of the patients with acromegaly in the region do not have their disease biochemically controlled indicating the need to optimize drug treatment.
Introduction To determine safety and efficacy of the supraorbital eyebrow approach (SEA) in clipping of ruptured and unruptured aneurysms in comparison with the pterional approach (PA).Methods A total of 229 patients who underwent surgical clipping of aneurysm from 2013–2022 and met inclusion criteria were recruited in the study. Study group of 67 patients treated via the SEA and comparison group of 162 patients treated via the PA were formed. Then, study groups of 66 patients in each with equal incoming factors were analyzed using propensity score technique. Parameters of safety and efficacy were then retrospectively compared.Results Successful clipping was achieved in all cases of both groups. There were no patients in the SEA group who required conversion to the standard craniotomy. There were no procedure-related deaths in this series. No patient experienced early or late rebleeding in either group. Mean blood loss volume in the SEA group was lower than in the PA group by approximately 77.5ml (P < .001). There were favorable differences in the SEA group regarding postoperative neurological deficit (p = .016), postoperative epileptic seizures rate (p = .013) ischemic and hemorrhagic complications (p = .028 and .0009 respectively) and outcomes (p < .001). Patients’ satisfaction of cosmetic result measured by visual analogue scale were rated highly in both groups (p = .081).Conclusion For patients where SEA provides adequate exposure, the SEA provides safety and cosmetic outcomes that are not inferior to the PA.
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