Endoscopic endonasal transsphenoidal approach for growth hormone-producing pituitary adenomas. Preliminary results
Rangel Morales, C.Raul.; Santos-Franco, J.Arturo.; Sandoval-Balanzario, M.Antonio.; Saavedra-Andrade, R.; Velázquez-Chávez, F.; Dávila-Romero, J.César.
Gaceta Medica de Mexico 146(6): 367-375
2010
ISSN/ISBN: 0016-3813 PMID: 21384631 Document Number: 637990
An endoscopic endonasal transsphenoidal approach is reported as less invasive, allowing an earlier discharge. Published series have never focused on its use in acromegalic patients. To assess the effectiveness of an endoscopic endonasal transsphenoidal approach in the management of growth hormone-secreting adenomas. Nineteen consecutively operated patients were assessed with a prospective follow-up of one year. Sex ratio was 0.7/1 and gross total removal was obtained in 16 cases (84%), subtotal in three (16%). The only complication was a cerebrospinal fluid leak requiring spinal drainage. The median in-hospital stay was 2.5 days. Sixteen patients experienced clinical improvement (84%) and no changes were observed in three (16%). Residual tumor was seen in two cases (11%). Growth hormone levels < 2 ng/dl were seen in 17 cases (89%) and only two patients (11%) had a level >2 ng/dl. Insulin-like growth factor-1 levels were normalized in 16 cases (84%) and remained elevated in three patients (16%). One patient presented an isolated elevated level of insulin-like growth factor-1. Patients with residual tumor and elevated growth hormone and insulin-like growth factor-1 levels underwent complementary radiosurgery. The endoscopic endonasal transsphenoidal approach seems to be useful in acromegaly, with a high rate of clinical and biochemical cure among other benefits.