Surgery and Radiosurgery for Acromegaly: A Review of Indications, Operative Techniques, Outcomes, and Complications
Open Access
- 1 March 2012
- journal article
- review article
- Published by Hindawi Limited in International Journal of Endocrinology
- Vol. 2012, 1-7
- https://doi.org/10.1155/2012/386401
Abstract
Among multimodality treatments for acromegaly, the goals of surgical intervention are to balance maximal tumor resection while preserving normal pituitary function and maintaining patient safety. The resection of growth hormone-(GH-) secreting pituitary adenomas in the hands of experienced surgeons results in hormonal remission in 50–70% of patients. Acromegalic patients often have medical comorbidities and anatomical variations complicating anesthesia and surgical management. Despite these challenges, complications such as CSF leak or new hypopituitarism following surgery remain uncommon. Over the past decade, endoscopic approaches to pituitary tumors have improved visualization and facilitated identification of additional tumor using angled telescopes. Patients with persistent acromegaly following surgery require continued medical and/or radiation-based interventions. The adjunctive use of stereotactic radiosurgery offers hormonal remission in 40–50% of patients. In this article, the current preoperative evaluation, indications for surgery, surgical approaches, role of radiosurgery, complications, and remission criteria following operative resection of GH adenomas are reviewed.Keywords
This publication has 57 references indexed in Scilit:
- Efficacy and complications of neurosurgical treatment of acromegalyPituitary, 2010
- Patterns of extrasellar extension in growth hormone–secreting and nonfunctional pituitary macroadenomasNeurosurgical Focus, 2010
- Acromegaly pathogenesis and treatmentJCI Insight, 2009
- MASEP gamma knife radiosurgery for secretory pituitary adenomas: experience in 347 consecutive casesJournal of Experimental & Clinical Cancer Research, 2009
- Stereotactic Radiosurgery with the CyberKnife for Pituitary AdenomasJournal of Korean Neurosurgical Society, 2009
- A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegalyActa Endocrinologica, 2008
- GAMMA KNIFE RADIOSURGERY FOR ACROMEGALYNeurosurgery, 2008
- Assessment of long-term remission of acromegaly following surgeryJournal of Neurosurgery, 2003
- Surgical Management of GH-Secreting Pituitary Adenomas: An Outcome Study Using Modern Remission CriteriaJournal of Clinical Endocrinology & Metabolism, 2001
- Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegalyJournal of Neurosurgery, 1998