Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas.
OBJECTIVE
The aim of this study was to determine the preoperative predictors of the extent of resection and endocrinological remission following endonasal endoscopic removal of growth hormone (GH)-secreting pituitary adenomas.


METHODS
The authors analyzed a prospectively collected database of 24 consecutive acromegalic patients who underwent endoscopic endonasal transsphenoidal surgery. The extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined as normal insulin-like growth factor I (IGFI) serum levels and either a nadir GH level of < 0.4 ng/ml after an oral glucose load or a basal GH serum level < 1 ng/ml.


RESULTS
The majority of acromegalic patients (83%) had macroadenomas > 1 cm in maximum diameter. Gross-total resection was achieved in 17 (71%) of 24 patients. Notably, endoscopic transsphenoidal surgery allowed complete resection of all lesions without cavernous sinus invasion, regardless of the suprasellar extent. Biochemical remission was achieved in 11 (46%) of 24 patients. A smaller tumor volume and a postoperative reduction in GH serum levels were associated with a higher rate of biochemical cure (p < 0.05). During a 23-month follow-up period 5 patients (21%) underwent Gamma Knife treatment of any residual disease to further reduce excess GH production. Twenty patients (83%) reported significant relief of their symptoms, while 3 (13%) considered their symptoms stable. Two patients (8%) with large macroadenomas experienced postoperative panhypopituitarism, and 2 patients (8%) suffered from CSF leaks, which were treated with lumbar CSF diversion.


CONCLUSIONS
A purely endoscopic endonasal transsphenoidal adenoma resection leads to a high rate of gross-total tumor resection and endocrinological remission in acromegalic patients, even those harboring macroadenomas with wide suprasellar extension. Extended approaches and angled endoscopes are useful tools for increasing the extent of resection.
Hofstetter
Christoph P
CP
Department of Neurological Surgery, Weill Cornell Medical College, New York–Presbyterian Hospital, New York, New York 10021, USA.
Mannaa
Raaid H
RH
Mubita
Lynn
L
Anand
Vijay K
VK
Kennedy
John W
JW
Dehdashti
Amir R
AR
Schwartz
Theodore H
TH
D000172:Acromegaly / Q000601:surgery*; D000236:Adenoma / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000601:surgery*; D019382:Human Growth Hormone / Q000097:blood / Q000378:metabolism*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000378:metabolism / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D012074:Remission Induction; D013100:Sphenoid Bone; D016896:Treatment Outcome; D047368:Tumor Burden
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I