Transsphenoidal Surgery for Acromegaly, Assessment of Extent of Resection and Post-operative Biochemical Remission

Background: Acromegaly is a complex medical and surgical problem, biochemical remission is difficult to achieve, and the biological character of growth hormone secreting pituitary adenoma differ. Most of lesions on diagnosis can show suprasellar and parasellar extension, which render curability questionable in such a disease. Objective: To assess the effectiveness of trans-sphenoid surgery in achievement of biochemical remission of growth hormone secreting adenomas in correlation with the pattern of tumor extension. Patients and Methods: Twenty five patients who underwent trans-sphenoidal approach for the treatment of GH-secreting pituitary tumors at the Neurosurgery department, Mansoura University over the period 2003 to 2009 were followed up to assess the efficacy of trans-sphenoidal surgery to achieve endocrinological control. Results: Clinical follow-up ranged from 36 to 96 months (mean 46.4 months). Biochemical remission and surgical cure was achieved in twelve patients (48%). The surgical cure was highest in cases with minimal suprasellar and parasellar extension (Hardy grade A (100%) and grade B (75%) tumor extension) while the rate of cure was low in Hardy grade C (14.2%) tumor extension. No case with cavernous sinus invasion (Hardy grade D) showed surgical cure. Conclusion: Acromegaly is a complex problem and lesions with sellar, minimal parasellar and/or suprasellar extension are amenable for cure and biochemical remission and regression of all features of acromegaly. Lesions with extensive parasellar extension (in the cavernous sinus) biochemical remission was not possible and adjuvant therapy was needed, while marked suprasellar extension with complete surgical excision biochemical remission was possible.