Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels &lt; 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.</jats:p></jats:sec>

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

“…As shown in recent papers, the best results were achieved in microadenomas (56-100%) compared to macroadenomas (27-71.7%) 1,4,18,28 . The worst outcomes were related to suprasellar and parasellar lesions.…”

“…In this study, the patients were followed on average for 46.9 months, much longer than published in recent studies 1,3,4,5,27 . Only Wagenmakers et al 23 presented long term follow-ups with a mean time of 56 months.…”

“…With CSF (n = 5) values were achieved using old criteria to define a cure 1,3,23 . As shown in recent papers, the best results were achieved in microadenomas (56-100%) compared to macroadenomas (27-71.7%) 1,4,18,28 .…”

“…Supraphysiological levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are related to acromegaly 1,2 . This chronic disease is most commonly caused by pituitary tumors 3,4 .…”

“…The options for acromegaly treatment include medical therapy, surgery, and radiotherapy. The surgical treatment provides rapid control of GH and IGF-1 levels and it is the first line of treatment for GH-secreting adenomas 1,9,10 . In 1893, in England, the first pituitary surgery for acromegaly was performed by Caton and Paul, under the supervision of Sir Victor Horsley 11,12,13 , while the first transnasal resection of a pituitary tumor was performed by Schloffer in 1907 14 .…”