Abstract
Objective To investigate the efficacy of transsphenoidal endoscopic surgery for acromegaly. Methods The clinical data of 210 consecutive patients with acromegaly operated with transsphenoidal endoscopic surgery from January 2007 to January 2014 were analyzed retrospectively. The patients with preoperative higher surgical risk used long-acting somatostatin analogue octreotide. Surgery was conducted in combination with intraoperative high field magnetic vesonance imaging and neuronavigation, postoperative head MRI and endocrine were followed up, including biochemical indicators, such as growth hormone and insulin-like growth factor-1. The patients with residual tumor and without remission of endocrine chose octreotide or radiosurgery according to the specific situation. Results There were 129 males and 81 females, their age ranged from 21 to 67 years old (mean 40.7 years). Preoperative MRI revealed that the maximum diameter of the tumors in 183 patients (87.1%) was >1 cm. Three patients were treated with octreotid before procedure. The tumors of 171 patients (81.4%) were resected completely, 22 (10.5%) were resected subtotally, and 17 (8.1%) were resected partially. There were no procedure-related deaths in this group. Postoperative achieved endocrine remission in 148 cases (70.5%). The average growth hormone level before procedure was decreased from 27 ng/mL (range 4 to 150 ng/mL) to 5 ng/mL (range 0 to 32 ng/mL) after procedure. A total of 184 patients were follow-up for 3 to 84 months (mean 27.5 months). During the follow-up period, the subjective symptoms of 161 patients (87.5%) were improved and returned to the daily work and study. In patients who had residual tumors and did not achieve endocrine remission after procedure, 34 were treated with octreotide after procedure and 29 accepted radiosurgery. Conclusion Transsphenoidal endoscopic surgery is the preferred treatment option for acromegaly. Patients should regularly examine the head MRI and endocrine after procedure. The treatments of octreotide and radiosurgery may control the residual tumors and improve endocrine. Key words: Pituitary neoplasms; Acromegaly; Endoscopic; Neurosurgical procedures
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