Endoscopic Transsphenoidal Approach for Acromegaly with Remission Rates in 401 Patients: 2010 Consensus Criteria.

Abstract

Transsphenoidal surgery is the first-choice treatment for acromegaly. Postoperative remission is an important predictor of outcome. Various factors have been described as markers of remission: preoperative mean growth hormone (GH) and insulin-like growth factor-1 levels, cavernous sinus invasion, tumor size, extrapseudocapsular resection, and experience of the surgeon. A total of 401 patients underwent 432 endoscopic transsphenoidal surgeries between August 1997 and June 2016 at the Pituitary Research Centre of Kocaeli University. The remission rates were evaluated according to the 2010 consensus criteria using preoperative and postoperative data including overall remission, cavernous sinus invasiveness, extrapseudocapsular resection, resection rate, and preoperative and postoperative GH levels. Total resection was performed in 311 (77.56%) of 401 patients according to early (24-hour) postoperative magnetic resonance imaging. Overall, remission was achieved in 273 (68.1%) of 401 patients. Remission was achieved in 186 (63.3%) of 294 patients with macroadenomas, 87 (81.3%) of 107 patients with microadenomas, and 35 (40.7%) of 86 patients with cavernous sinus invasion. Remission was seen in 21 (75%) of 28 patients who underwent pseudocapsular resection. According to preoperative GH levels, remission was achieved in 205 (72.4%) of 273 patients with GH levels below 20 ng/mL but decreased to 11 (37.9%) of 29 patients with GH levels over 60 ng/mL. There was, conversely, a very strongly significant correlation with cavernous sinus invasion (P < 0.001; r:-0.953) and also a very strongly significant correlation with extrapseudocapsular resection (P < 0.001; r: 0.810). However, remission was very weakly but reversely significantly correlated with adenoma size and volume. The most significant factors for remission are cavernous sinus invasion and extrapseudocapsular resection. Higher remission rates can be achieved with the removal of small remnants by meticulous sweeping and by total resection. Preoperative and postoperative GH levels are predictive of remission.