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Comparative Study
. 2017 Nov;159(11):2193-2207.
doi: 10.1007/s00701-017-3318-6. Epub 2017 Sep 14.

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

Ching-Jen Chen  1 , Natasha Ironside  2 , I Jonathan Pomeraniec  3 , Srinivas Chivukula  4 , Thomas J Buell  3 , Dale Ding  4 , Davis G Taylor  3 , Robert F Dallapiazza  3 , Cheng-Chia Lee  5 , Marvin Bergsneider  6
Affiliations
Comparative Study

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

Ching-Jen Chen et al. Acta Neurochir (Wien). 2017 Nov.

Abstract

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.

Keywords: Acromegaly; Endoscopic; Growth hormone; Microscopic; Pituitary adenoma; Review; Transsphenoidal.

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Conflict of interest statement

Conflict of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Figure 1.
Figure 1.
Flow chart demonstrating the literature review process and selection of case series.
Figure 2:
Figure 2:
Summary of remission and relapse rates according to surgical approach and tumor size. Abbreviations: f/u = follow-up.
Figure 3:
Figure 3:
Summary of remission and relapse rates according to surgical approach and tumor size. Abbreviations: f/u = follow-up.
See this image and copyright information in PMC

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