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  • Endoscopic Versus Microsurgical Transsphenoidal Surgery for Acromegaly: Outcomes in a Concurrent Series of Patients Using Modern Criteria for Remission

    Final Number:

    Robert M. Starke MD MSc; Daniel Raper MBBS; Spencer Payne MD; Mary Lee Vance MD; Edward H. Oldfield MD; John Jane, Jr

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: It is unclear whether endoscopic transsphenoidal surgery (ETSS) or microsurgical transsphenoidal surgery (MTS) is superior for pituitary adenomas. In this study we assess the outcome of surgery with ETSS and MTS by experienced pituitary surgeons using recently updated consensus criteria of remission for acromegaly.

    Methods: In this study, we retrospectively review the prospectively recorded outcomes of 115 patients undergoing surgery for acromegaly. Remission was defined as a normal IGF-I and either suppressed growth hormone (GH) <0.4ng/ml during an oral glucose tolerance test or random GH <1.0ng/ml. Youden Indices were calculated to determine optimal cutoffs for using immediate post-operative GH levels to predict the results of later testing for remission.

    Results: Preoperative demographics and tumor characteristics were not significantly different between patients undergoing ETSS (72 patients) or MTS (43 patients). Overall, postoperative remission was achieved in 21 of 24 microadenomas (89%) and 60 of 91 macroadenomas (66%). Remission rates and perioperative complications were not significantly different between ETSS and MTS groups, except for self-reported sinusitis and alterations in taste or smell which were significantly higher in patients treated with ETSS. Pre-operative variables predicting remission in multivariate analysis included GH <50ng/ml (OR=6.8, p=0.008) and Knosp score 0- 2 (OR=7.8, p<0.001). Post-operative in-hospital GH <1.15ng/ml provided the best predictor of remission (OR=7.7, p<0.002; sensitivity of 73%, specificity of 74%) defined by follow-up testing.

    Conclusions: Outcomes of transsphenoidal surgery for acromegaly by experienced pituitary surgeons do not differ between endoscopic and microscopic techniques. Regardless of the mode of resection, patients with high pre-operative GH levels and Knosp scores are less likely to achieve remission. Immediate post-operative GH of less than 1.15 ng/ml provides the best immediate predictor of remission.

    Patient Care: 1) Help determine predictors of remission and complicaitons following transsphenoidal surgery for acromegaly. 2) Review updated guidelines for remission criteria for acromegaly. 3) Develop thresholds by which patients may be likely to achieve remission or necessitate further therapy

    Learning Objectives: 1) To determine remission rates for acromegaly according to the recently updated consensus criteria. 2) To compare the outcomes of surgery with ETSS and MTS for for acromegaly. 2) To determine predictors of complicaitons and remission following surgery


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