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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Repeat endoscopic transsphenoidal surgery for acromegaly: remission and complications
Thomas J Wilson1, Erin L McKean, Ariel L Barkan
1Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, Room 3552 TC, Ann Arbor, MI, 48109-5338, USA.
Pituitary
|January 12, 2013
Summary
Repeat surgery for acromegaly using an endoscopic endonasal approach is safe and effective. This procedure offers a viable option for patients who did not achieve remission after initial surgery, with a 57% success rate.
Area of Science:
- Neurosurgery
- Endocrinology
Background:
- Acromegaly treatment often involves surgery, but remission rates vary, leaving few options for persistent disease.
- The efficacy and safety of reoperation for acromegaly remain debated.
Purpose of the Study:
- To evaluate the outcomes of repeat endoscopic endonasal surgery for acromegaly in patients with persistent disease.
- To determine factors associated with successful remission after reoperation.
Main Methods:
- Retrospective chart review of patients with acromegaly undergoing repeat endoscopic endonasal pituitary adenoma resection.
- Biochemical remission defined as postoperative GH <1 ng/mL and normal IGF-1 without medical therapy.
Main Results:
- Eight of 14 patients (57%) achieved biochemical remission after repeat surgery.
- Lower preoperative GH levels correlated with a higher chance of remission (P = 0.048).
- Complications included transient diabetes insipidus (14%) and aseptic meningitis (14%), with no mortality.
Conclusions:
- Repeat endoscopic endonasal surgery for acromegaly is a safe and effective option for patients with persistent disease.
- This approach offers a reasonable alternative with minimal morbidity for hard-to-treat acromegaly cases.
