Acromegaly surgery
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Acromegaly surgery On the Web |
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American Roentgen Ray Society Images of Acromegaly surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Surgery is a rapid and effective treatment, of which there are two alternative methods. The first method, a procedure known as Endonasal Transphenoidal surgery, involves the surgeon reaching the pituitary through an incision in the nasal cavity wall. The wall is reached by passing through the nostrils with microsurgical instruments. The second method is Transphenoidal surgery during which an incision is made into the gum beneath the upper lip. Further incisions are made to cut through the septum to reach the nasal cavity, where the pituitary is located. Endonasal Transphenoidal surgery is a less invasive procedure with a shorter recovery time than the older method of Transphenoidal surgery, and the likelihood of removing the entire tumor is greater with reduced side-effects. Consequently, Endosnasal Transphenoidal surgery is often used as a first option, with Transphenoidal and other treatments, such as, medicinal therapy or radiostatic neurosurgery being used to reduce the remaining adverse effects of the remaining tumor.
These procedures normally relieve the pressure on the surrounding brain regions and lead to a lowering of GH levels. If the surgery is successful, facial appearance and soft tissue swelling improve within a few days. Surgery is most successful in patients with blood GH levels below 40 ng/ml before the operation and with pituitary tumors no larger than 10 mm in diameter. Success depends on the skill and experience of the surgeon. The success rate also depends on what level of GH is defined as a cure. The best measure of surgical success is normalization of GH and IGF-1 levels. Ideally, GH should be less than 2 ng/ml after an oral glucose load. A review of GH levels in 1,360 patients worldwide immediately after surgery revealed that 60 percent had random GH levels below 5 ng/ml. Complications of surgery may include cerebrospinal fluid leaks, meningitis, or damage to the surrounding normal pituitary tissue, requiring lifelong pituitary hormone replacement.
Even when surgery is successful and hormone levels return to normal, patients must be carefully monitored for years for possible recurrence. More commonly, hormone levels may improve, but not return completely to normal. These patients may then require additional treatment, usually with medications.
Overview
Surgery
- Surgery is the mainstay of treatment for acromegaly due to pituitary adenoma. The goal of the surgery will be the removal of the pituitary mass that causes acromegaly. The surgery to be performed is endonasal transsphenoidal surgery.[1]
- Endonasal transsphenoidal surgery:
- Most of the patients with acromegaly due to pituitary adenoma undergo transsphenoidal surgery. It is a challenging operation due to the anatomical location of the pituitary gland.
- It is important to remove the pituitary masses for this reasons:
- They may invade the cavernous sinus.
- They may be associated with microaneurysms.
- MRI and CT imaging are used in guidance during the surgery and they have been linked with high safety and effectiveness of the surgery.
- In case the surgery is performed successfully, the acral features of acromegaly will improve within days.
- Although it is very rare, adverse effects for the surgery may occur. These effects include the following:
- Local hemorrhage
- CSF leakage
- Diabetes insipidous
- Infection
- Postoperatively, somatostatin analogs and radiotherapy are recommended to prevent recurrence.
Indications
References
- ↑ Fahlbusch R, Honegger J, Buchfelder M (1992). "Surgical management of acromegaly". Endocrinol Metab Clin North Am. 21 (3): 669–92. PMID 1521518.