Transsphenoidal Surgery for GH-Producing Pituitary Adenomas: Technical Innovations and Outcome

Background: Transsphenoidal surgery (TSS) is safe and effective in patients with GH-producing pituitary adenomas (GHomas). We report the endocrinological follow-up results of a large cohort of such patients who underwent TSS after the introduction of some technical innovations.

Patients and Methods: The study includes 150 patients (55 males, 95 females) with GHomas operated on consecutively by TSS between September 1998 and November 2010. Ages of the patients ranged from 10–73 years (average, 47.9 years). These cases were classified into three periods: early 50 cases (I), intermediate 50 cases (II), and last 50 cases (III). We removed the main bulk and the microsurgical pseudocapsule of the tumor under microscope, and rigid 30- and 70-degree endoscopes were consecutively introduced to remove residual tumor at the far lateral and superior sides using curved suction with extension tube, angled irrigation suction, and flexible forceps. We have recently taken care to prevent endocrine dysfunctions such as GH deficiency.

Results: Remission rates based on the Cortina consensus showed improvement comparing the three periods, indicating 46%, 62%, and 86% as a whole for series I, II, and III, respectively; and 56.8%, 76.7%, and 100% for Knosp grade 0- 1 in each of the three periods, respectively; and 40%, 53.3%, and 86.7% in Knosp grade 2–3, respectively. Severe GH deficiency was found in five patients (10%) for series III.

Conclusions: Our data confirm that technical innovations and proficiency in endoscopic manipulation improve the remission rate of GHomas, and it has been improved further by using high-definition endoscopic visualization since 2011.