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

  • Review Article - Brain Tumors
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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.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA, 22908, USA

    Ching-Jen Chen, I. Jonathan Pomeraniec, Thomas J. Buell, Davis G. Taylor & Robert F. Dallapiazza

  2. Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand

    Natasha Ironside

  3. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Srinivas Chivukula & Dale Ding

  4. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Chia Lee

  5. Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Marvin Bergsneider

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  1. Ching-Jen Chen
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  2. Natasha Ironside
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  3. I. Jonathan Pomeraniec
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  4. Srinivas Chivukula
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  5. Thomas J. Buell
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  6. Dale Ding
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  7. Davis G. Taylor
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  8. Robert F. Dallapiazza
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  9. Cheng-Chia Lee
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  10. Marvin Bergsneider
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Correspondence to Ching-Jen Chen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chen, CJ., Ironside, N., Pomeraniec, I.J. et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir 159, 2193–2207 (2017). https://doi.org/10.1007/s00701-017-3318-6

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  • DOI: https://doi.org/10.1007/s00701-017-3318-6

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