A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission

Unal T. C., Aydoseli A., Ozgen U., Dolas I., Sabanci P. A., Aras Y., ...More

BRITISH JOURNAL OF NEUROSURGERY, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2021
  • Doi Number: 10.1080/02688697.2021.1947977
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, MEDLINE, Violence & Abuse Abstracts
  • Keywords: Acromegaly, growth hormone secreting adenoma, endoscopy, pituitary, trans-sphenoidal endoscopic surgery, GROWTH-HORMONE, PITUITARY-ADENOMAS, CONSENSUS, CRITERIA, MICROSURGERY, PROLACTIN, TUMORS, CURE, GUIDELINES, MORTALITY
  • Istanbul University Affiliated: Yes


Background Transsphenoidal endoscopic surgery is the first-line treatment for growth hormone-secreting adenomas. Objective To analyse the results of the transsphenoidal endoscopic approach for acromegaly and to determine the predictive factors of remission. Methods A single-centre retrospective review was performed in patients who underwent endoscopic transsphenoidal surgery for acromegaly between January 2009 and January 2019. Demographic features, clinical presentation, histopathology records, complications and pre- and postoperative radiologic and endocrinological assessments were evaluated. The factors that influenced the remission rates were investigated. Results A total of 73 patients underwent surgery via the transsphenoidal endoscopic approach. Cavernous sinus invasion was detected in 32 patients (43.8%); and macroadenoma, in 57 (78%). The pathology specimens of the 27 patients (36.9%) showed dual-staining adenomas with prolactin. A total of 51 patients (69.8%) attained biochemical remission 1 year after surgery. A second operation was performed in 10 patients (13.6%) with residual tumours without biochemical remission in the first year. Six (60%) of the patients attained remission at the last follow-up. Transient diabetes insipidus was observed in 18 patients (24.6%); and rhinorrhoea, which was resolved with conservative treatment, in 4 (5.4%). None of the patients developed panhypopituitarism. The presence of cavernous sinus invasion and preoperative IGF-1, immediate postoperative GH and third-month IGF-1 levels were predictive of remission. Conclusion Transsphenoidal endoscopic surgery is a safe and effective treatment for acromegaly. Reoperation should be considered in patients with residual tumours without remission.