A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission

Ünal, Tuğrul Cem; Aydöseli, Aydın; Özgen, Utku; Dolaş, İlyas; Sabancı, Pulat Akın; Aras, Yavuz; Öztürk, Muzaffer; Ozata, Musa Samet; Gül, Nurdan; Üzüm, Ayşe Kubat; Mutlu, Ümmü; Bılgıç, Bilge; Saka, Esra; Yarman, Sema; Sencer, Altay

doi:10.1080/02688697.2021.1947977

Cited by 5 publications

(8 citation statements)

References 32 publications

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“…Based on the complex anatomy of the cavernous sinus, the surgeons often avoid excessive removal of tumors in the cavernous sinus to protect the normal vascular structure. In current studies, Unal et al 21 and Cardinal et al 22 observed that cavernous sinus invasion, preoperative IGF-1 and early postoperative GH were correlated with postoperative remission rate of patients who received EETS. Besides, many studies have shown that early postoperative GH levels, postoperative IGF-1 levels and postoperative nadir GH levels are predictors of postoperative biochemical remission 8,20,[24][25][26] .…”

Section: Discussionmentioning

confidence: 59%

“…The tumor size and invasiveness are important predictors of postoperative biochemical remission in many studies [19][20][21][22][23] . Specifically, pituitary adenomas invading the cavernous sinus are more difficult to be completely removed.…”

Section: Discussionmentioning

confidence: 99%

“…studies that include cases of microscopic and endoscopic surgeries, but we focused more on preoperative factors [19][20][21][22]24 . Unlike previous studies, the logistic regression analysis suggested that preoperative nadir GH is also an independent predictor of surgical remission.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Geng

Dong

Cong

et al. 2023

J Neurol Surg B Skull Base

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Objective: Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas. Methods: The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons’ experience, preoperative insulin-like growth factor 1 (IGF1), basal growth hormone (GH) levels, nadir GH levels and the tumor characteristics were analyzed for their relationships with endocrine outcomes. The 98 patients were included for single factor analysis and regression analysis. They were divided into 3 groups according to the admission chronologic order. Results: The overall remission rate of the patients was 57% (56/98) for all the patients over ten years. In the single factor analysis, we found that the tumor size, cavernous invasion and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the non-invasive group and the invasive group. The preoperative IGF1 level (P=0.166), basal GH level (P=0.001) and nadir GH level (P=0.004) were also different between the remission group and the non-remission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio [OR]=0.930, 95% confidence interval [CI]=0.891-0.972, p=0.001) was a significant predictor for the endocrine outcomes after surgery.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Geng

Dong

Cong

et al. 2023

J Neurol Surg B Skull Base

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“…However, the study by Unal et al, 8 reported that there were 57 macroadenomas (78%) and 16 microadenomas (22%) were surgically treated. The mean tumor volume was 2,073 mm3.…”

Section: Discussionmentioning

confidence: 98%

Endoscopic Endonasal Transsphenoidal Approach for Growth Hormone Secreting Pituitary Adenoma

Ahmed

Almelesy²,

Alazzazi³

2022

Al-Azhar International Medical Journal

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Background: The use of endoscopic endonasal trans-sphenoid surgery (EETS) as the first-line therapy for most pituitary adenomas is gaining popularity. Aim of the work: The primary goal of this research was to see how transsphenoidal endoscopic technique for a growth hormone-secreting pituitary adenoma affected hormonal reduction in relation to surgical excision extent. Patients and Methods: This prospective research was carried out at the Al Azhar University Hospitals' neurosurgery department (Al-Hussein and Bab El-Shaeria). This study was conducted on 15 cases with Growth hormone secreting pituitary adenoma that had undergone total or subtotal resection performed by endoscopic endonasal transsphenoidal surgery. Result: there was highly statistically substantial (p-value < 0.001) decreased post-operative growth hormone (3.4 ± 1.2) when compared with pre-operative growth hormone (38.1 ± 29.8). Highly statistically significant (p-value < 0.001) decreased post-operative IGF-1 (242.3 ± 102.1) when compared with pre-operative IGF-1 (665 ± 253). No statistically significant difference (p-value > 0.05) between pre-operative and post-operative the following hormones (ACTH, cortisol, T3, T4, TSH, testosterone, FSH, LH and PRL, estradiol). Conclusion:In individuals with acromegaly, the endoscopic endonasal transsphenoidal technique is an efficacious and secure treatment for adenomas. We discovered that using an endoscopic endonasal transsphenoidal technique reduced growth hormone and insulin-like growth factor-1 levels considerably.

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“…Имеются данные, что при сравнении микрохирургического и эндоскопического подхода при лечении акромегалии эффективность каждого примерно одинаковая и составляет 68 % [6]. Цель оперативного лечения -нормализация уровней СТГ и инсулиноподобного фактора роста 1 (ИФР-1) за счет тотального удаления опухоли, а при невозможности радикального удаления -за счет уменьшения ее массы [7][8][9][10]. Пациенты, которые не смогли достигнуть гормональной ремиссии после хирургического лечения, направляются на лечение с помощью дополнительных методов консервативной, лучевой терапии [5,11].…”

Section: Introductionunclassified

Intraoperative characteristics of somatotropinomas

Senko

Крылов

Dashyan

et al. 2023

Nejrohirurgiâ (Mosk.)

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Background. Acromegaly is a rare disease associated with insulin‑like growth factor 1 hyperproduction due to the presence of pituitary adenoma in the patient. The first‑line treatment of such patients is surgical removal of the formation in order to normalize hormonal status. The main predictors of the ineffectiveness of surgical treatment and relapse of the disease are large tumor size, tumor invasion into the cavernous sinus, and high preoperative levels of growth hormone, as well as Ki‑6 % expression. The search for additional risk factors for disease recurrence, which according to various sources is approximately 30 % after primary surgical treatment, is an urgent task for researchers. In our work, we studied the intraoperative characteristics of the tumor, size of pituitary adenomas according to preoperative magnetic resonance imaging of the brain, degree of invasion of the tumor into the cavernous sinus according to the Knosp classification and compared them with disease outcomes after a year of follow‑up after surgical treatment.Aim. To identify new markers of aggressive progression of pituitary tumors.Materials and methods. A retrospective analysis of medical documentation, protocols of operations of 90 patients aged between 19 and 73 years with the diagnosis of growth hormone‑secreting pituitary adenoma was performed. The dia gnosis was confirmed based on clinical picture, laboratory and instrumental examination methods. All patients underwent endoscopic transsphenoidal removal of pituitary adenoma by one surgeon in one medical institution between 2017 and 2019.Results. Intraoperative characteristics of the tumor, such as the color of the solid component, density, degree of vascularization were compared with the results of laboratory and instrumental data, as well as the results of surgical treatment after a year of follow‑up.Conclusion. Such intraoperative characteristics of growth hormone‑secreting pituitary adenomas as the purplish‑gray color of the solid component, high vascularization, as well as dense‑elastic consistency of the tumor, can be considered high risk factors for continued tumor growth in the first 6 months after surgical treatment or relapse of the disease during a year of follow‑up.

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A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission

Cited by 5 publications

References 32 publications

Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Endoscopic Endonasal Transsphenoidal Approach for Growth Hormone Secreting Pituitary Adenoma

Intraoperative characteristics of somatotropinomas

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