Endoscopic endonasal transsphenoidal approach for growth hormone-producing pituitary adenomas. Preliminary results

Background: An endoscopic endonasal transsphenoidal approach is reported as less invasive, allowing an earlier discharge. Published series have never focused on its use in acromegalic patients. Objective: To assess the effectiveness of an endoscopic endonasal transsphenoidal approach in the management of growth hormone-secreting adenomas. Patients and methods: Nineteen consecutively operated patients were assessed with a prospective follow-up of one year. Results: Sex ratio was 0.7/1 and gross total removal was obtained in 16 cases (84%), subtotal in three (16%). The only complication was a cerebrospinal fluid leak requiring spinal drainage. The median in-hospital stay was 2.5 days. Sixteen patients experienced clinical improvement (84%) and no changes were observed in three (16%). Residual tumor was seen in two cases (11%). Growth hormone levels < 2 ng/dl were seen in 17 cases (89%) and only two patients (11%) had a level > 2 ng/dl. Insulin-like growth factor-1 levels were normalized in 16 cases (84%) and remained elevated in three patients (16%). One patient presented an isolated elevated level of insulin-like growth factor-1. Patients with residual tumor and elevated growth hormone and insulin-like growth factor-1 levels underwent complementary radiosurgery. Conclusions: The endoscopic endonasal transsphenoidal approach seems to be useful in acromegaly, with a high rate of clinical and biochemical cure among other benefits.