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Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas.
Neurosurg Focus 2010; 29(4):E6NF

Abstract

OBJECT

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.

Authors+Show Affiliations

Department of Neurological Surgery, Weill Cornell Medical College, New York–Presbyterian Hospital, New York, New York 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20887131

Citation

Hofstetter, Christoph P., et al. "Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone-secreting Pituitary Adenomas." Neurosurgical Focus, vol. 29, no. 4, 2010, pp. E6.
Hofstetter CP, Mannaa RH, Mubita L, et al. Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg Focus. 2010;29(4):E6.
Hofstetter, C. P., Mannaa, R. H., Mubita, L., Anand, V. K., Kennedy, J. W., Dehdashti, A. R., & Schwartz, T. H. (2010). Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurgical Focus, 29(4), pp. E6. doi:10.3171/2010.7.FOCUS10173.
Hofstetter CP, et al. Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone-secreting Pituitary Adenomas. Neurosurg Focus. 2010;29(4):E6. PubMed PMID: 20887131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. AU - Hofstetter,Christoph P, AU - Mannaa,Raaid H, AU - Mubita,Lynn, AU - Anand,Vijay K, AU - Kennedy,John W, AU - Dehdashti,Amir R, AU - Schwartz,Theodore H, PY - 2010/10/5/entrez PY - 2010/10/5/pubmed PY - 2010/12/22/medline SP - E6 EP - E6 JF - Neurosurgical focus JO - Neurosurg Focus VL - 29 IS - 4 N2 - OBJECT: 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. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/20887131/Endoscopic_endonasal_transsphenoidal_surgery_for_growth_hormone_secreting_pituitary_adenomas_ L2 - https://thejns.org/doi/10.3171/2010.7.FOCUS10173 DB - PRIME DP - Unbound Medicine ER -