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Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center.
Neurosurg Focus. 2010 Oct; 29(4):E7.NF

Abstract

OBJECT

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.

METHODS

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 < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex.

RESULTS

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%).

CONCLUSIONS

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Gondim JA
Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil.
Almeida JP
No affiliation info available
de Albuquerque LA
No affiliation info available
Gomes E
No affiliation info available
Schops M
No affiliation info available
Ferraz T
No affiliation info available

MeSH

AcromegalyAdenomaAdultAgedEndoscopyFemaleGrowth Hormone-Secreting Pituitary AdenomaHuman Growth HormoneHumansInsulin-Like Growth Factor IMaleMiddle AgedNeurosurgical ProceduresPituitary NeoplasmsRemission InductionRetrospective StudiesSphenoid BoneTreatment OutcomeTumor Burden

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20887132

Citation

Gondim, Jackson A., et al. "Pure Endoscopic Transsphenoidal Surgery for Treatment of Acromegaly: Results of 67 Cases Treated in a Pituitary Center." Neurosurgical Focus, vol. 29, no. 4, 2010, pp. E7.
Gondim JA, Almeida JP, de Albuquerque LA, et al. Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg Focus. 2010;29(4):E7.
Gondim, J. A., Almeida, J. P., de Albuquerque, L. A., Gomes, E., Schops, M., & Ferraz, T. (2010). Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurgical Focus, 29(4), E7. https://doi.org/10.3171/2010.7.FOCUS10167
Gondim JA, et al. Pure Endoscopic Transsphenoidal Surgery for Treatment of Acromegaly: Results of 67 Cases Treated in a Pituitary Center. Neurosurg Focus. 2010;29(4):E7. PubMed PMID: 20887132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. AU - Gondim,Jackson A, AU - Almeida,João Paulo, AU - de Albuquerque,Lucas Alverne F, AU - Gomes,Erika, AU - Schops,Michele, AU - Ferraz,Tania, PY - 2010/10/5/entrez PY - 2010/10/5/pubmed PY - 2010/12/22/medline SP - E7 EP - E7 JF - Neurosurgical focus JO - Neurosurg Focus VL - 29 IS - 4 N2 - OBJECT: 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. METHODS: 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 < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. RESULTS: 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%). CONCLUSIONS: 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. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/20887132/Pure_endoscopic_transsphenoidal_surgery_for_treatment_of_acromegaly:_results_of_67_cases_treated_in_a_pituitary_center_ DB - PRIME DP - Unbound Medicine ER -