Transsphenoidal microhypophysectomy in acromegaly

Abstract

✓ From July, 1970, to March, 1975, 62 transsphenoidal operations were performed on 61 acromegalic patients (39 males, 22 females). Of these patients, 58 presented with symptoms of hypersecretion of human growth hormone (HGH), with relatively infrequent local effects. Each patient was evaluated neuroradiologically, and each tumor was classified as an enclosed or an invasive adenoma, with or without suprasellar extension. Anterior pituitary function was also evaluated for each patient, pre- and postoperatively. During the transsphenoidal procedure, selective gross total removal of the adenomatous tissue was attempted, and was successful in 53 patients; selective subtotal tumor removal was performed in eight patients. In 38 patients who had not undergone prior therapy, a selective total excision was achieved in 36; of these, 30 patients were considered cured, on the basis of relief of clinical symptoms and reduction of the serum HGH level to below 10 mg/ml. There was no significant difference in cure rates between the enclosed and the invasive adenomas, and no cures were achieved by any procedure short of selective total tumor removal. In these latter cases, postoperative irradiation was employed. Eighteen patients had received prior therapy in the forms of cryohypophysectomy (eight cases), cryohypophysectomy and irradiation (two cases), craniotomy (two cases), craniotomy and irradiation (two cases), and irradiation alone (four cases). The treatment results in this group were less favorable. In the entire series of 62 operations, complications occurred in eight patients in the form of cerebrospinal fluid leak, meningitis, sinusitis, nasal-oral fistula, transient diabetes insipidus (six cases), and carotid and cavernous injuries. In the group of 43 previously untreated patients, endocrine complications occurred in five, of which only three have permanent deficits. In the previously treated 18 patients, one developed compromised pituitary function from the transsphenoidal procedure. In the entire series, there was no surgical mortality, although two patients died of surgically unrelated causes.