Journal Article

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

Chen, Ching-Jen, Pomeraniec, I. Jonathan, Taylor, Davis G., Chivukula, Srinivas, Dallapiazza, Robert F., Ding, Dale, Lee, Cheng-Chia, Bergsneider, Marvin, Ironside, Natasha, Buell, Thomas J.

2017

Overview

Purpose The aim of this systematic review is to evaluate the long-term endocrine outcomes and postoperative complications following endoscopic vs. microscopic transsphenoidal resection (TSR) for the treatment of acromegaly. Methods A literature review was performed, and studies with at least five patients who underwent TSR for acromegaly, reporting biochemical remission criteria and long-term remission outcomes were included. Data extracted from each study included surgical technique, perioperative complications, biochemical remission criteria, and long-term remission outcomes. Results Fifty-two case series from 1976 to 2016 met the inclusion criteria, comprising 4375 patients. Thirty-six reports were microsurgical ( n  = 3144) and 13 were endoscopic ( n  = 940). Three studies compared microsurgical ( n  = 111) to endoscopic TSR outcomes ( n  = 180). The overall initial and long-term remission rates were 58.2 vs. 57.4% and 69.2 vs. 70.2% for the microsurgical and endoscopic groups, respectively. For microadenomas, the initial and long-term remission rates were 77.6 vs. 82.2% and 76.9 vs. 73.5% for microsurgical and endoscopic approaches, respectively. For macroadenomas, the initial and long-term remission rates were 46.9 vs. 60.0% and 40.2 vs. 61.5% for microsurgical and endoscopic approaches, respectively. The rates of postoperative CSF leak were 3.0 vs. 2.3% for the microscopic and endoscopic groups, respectively. The rates of hypopituitarism and transient diabetes insipidus were 6.7 vs. 6.4% and 9.0 vs. 7.8% for the microscopic and endoscopic groups, respectively. Conclusions Both endoscopic and microsurgical approaches for TSR of growth hormone-secreting adenomas are viable treatment options for patients with acromegaly, and yield similarly high rates of remission under the most current consensus criteria.

• Publisher: Springer Vienna,Springer Nature B.V
• Subject: Acromegaly / Acromegaly - surgery / Cerebrospinal Fluid Leak - epidemiology / Diabetes insipidus / Endoscopy / Endoscopy - methods / Growth Hormone-Secreting Pituitary Adenoma - surgery / Growth hormones / Humans / Hypopituitarism / Interventional Radiology / Literature reviews / Medicine / Medicine & Public Health / Microsurgery - methods / Minimally Invasive Surgery / Neurology / Neuroradiology / Neurosurgery / Pituitary Neoplasms - surgery / Postoperative Complications / Remission / Review Article - Brain Tumors / Sphenoid Bone - surgery / Surgical Orthopedics / Treatment Outcome