Results of Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly

Background: The endoscopic endonasal transsphenoidal approach (EETA) is becoming increasingly popular and is replacing the microscopic transsphenoidal approaches for pituitary tumors. However, endocrinological results are still sparse, and superiority of this approach has not been proven yet.

Objective: To evaluate the results of EETA in acromegaly and compare these with historical results of the microsurgical approach.

Methods: A retrospective study was performed of all charts and laboratory results of all patients with acromegaly operated on by EETA since its introduction to our department in 1997. Forty-seven patients were included (25 women, 22 men), of which 40 (85%) had a macroadenoma. Intentional curative surgery was performed in all but 4 patients, in whom only partial removal was intended. Remission was defined as normalization (age and gender adjusted) of IGF-1 and GH-suppression <2 mE/L in the OGTT.

Results: Remission of acromegaly was reached in 51% of all patients and in 50% of the macroadenomas. The cure rate for macroadenomas was 33% in the first 5 years and 64% in the last 5 years. If the 4 patients with intentional partial removal are excluded, the cure rate increased to 78%. In 33% of patients, 1 or more pituitary axes were hormonally substituted, but new postoperative hormonal deficits and postoperative improvement of pituitary deficiency were in perfect balance.

Conclusion: The results of EETA in acromegaly are comparable with those of the microsurgical approach. However, the learning curve of the EETA shows a tendency toward an improvement of the remission rate as surgeons gain experience with the procedure.