Endoscopic Transsphenoidal Surgery for the Treatment of Growth Hormone-Secreting Tumors Involving the Cavernous Sinus

Objective: Review of our endoscopic surgical experience for the treatment of GH-secreting tumors invading the cavernous sinus.

Design: Retrospective at a single institution.

Patients/Materials and Methods: Endoscopic transnasal transsphenoidal surgery was performed on 13 patients suffering from acromegaly. The median patient age was 45 years. Three patients had undergone prior transsphenoidal surgery. All tumors extended into the cavernous sinus and had biochemical evidence of acromegaly. The median follow-up after surgery was 10 months. Normal insulin-like growth factor 1 level and suppressed growth hormone to less than 0.4 ng/mL on an oral glucose tolerance test defined remission.

Results: All patients suffered from macroadenomas invading the cavernous sinus (Knosp grade 1 [n = 5], grade 2 [n = 3], grade 3 [n = 4], and grade 4 [n = 1]). Endoscopic transsphenoidal approaches were performed, with intraoperative image guidance and neurophysiological monitoring; intraoperative CT scan was performed to ensure complete resections. Nine patients had evidence of complete biochemical remission. There were no new cranial neuropathies, carotid artery injuries, CSF leaks, or persistent diabetes insipidus. There was one case of panhypopituitarism in a patient who had prior surgery. We will discuss the surgical technique in detail with video footage.

Conclusions: Endoscopic transsphenoidal surgery for growth hormone secreting tumors of the cavernous sinus can result in biochemical remissions with minimal morbidity. Longer-term follow-up is needed to ensure longstanding cure.