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

Autor: Unal TC; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Aydoseli A; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Ozgen U; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Dolas I; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Sabanci PA; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Aras Y; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Ozturk M; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Ozata MS; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Gul N; Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Kubat Uzum A; Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Mutlu U; Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Bilgic B; Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Saka E; Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Yarman S; Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Sencer A; Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2024 Jun; Vol. 38 (3), pp. 648-653. Date of Electronic Publication: 2021 Jul 09.
DOI: 10.1080/02688697.2021.1947977
Abstrakt: 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.
Databáze: MEDLINE
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