The Outcome of Transsphenoidal Microsurgery for Acromegaly

Kim, Il Man; Yim, Man Bin; Lee, Chang Young

Abstract

OBJECTIVE
The authors present a retrospective clinical analysis of transsphenoidal surgery for acromegaly including preoperative factors determining the therapeutic outcome.
METHODS
Forty-three patients(24 females, mean age 45.3 years) harboring growth hormone(GH)-secreting adenomas(13 microadenomas and 30 macroadenomas) were treated between the years 1987 and 2001. The mean duration of follow-up was 69 months.
RESULTS
The average estimated duration of symptoms prior to diagnosis was 8 years. The control rate following surgery was 51%(22 out of 43 cases). Of the patients with postoperative persistent disease, 11 patients had had additional bromocriptine therapy with or without irradiation, and consequently 7 patients achieved biochemical remission. The overall remission rate of multimodality treatment was 67%. The preoperative GH value, tumor size, extrasellar extension of tumor, the number of surgeons, and the extent of the surgical removal were significant univariative predictors of outcome(p<0.05).
CONCLUSION
This study suggests that surgical outcome for acromegaly could be achieved by a experienced neurosurgeon. In the group of the patients of large or invasive adenomas, with the less probability of surgical control, adjunctive medical or radiation therapy to control GH hypersecretion should be considered.