The Endoscopic Transsphenoidal Technique for Acromegaly: Evaluating Remission

Objectives The primary strategy for managing acromegaly involves transsphenoidal surgical intervention, with the achievement of post-surgical remission playing a pivotal role in patient prognosis. Factors such as pre-surgery GH (growth hormone) as well as insulin-like growth factor-1 levels, tumour size, invasion into the cavernous sinus and the extent of tumour resection outside the capsule have been recognised as crucial for determining remission outcomes. Material and Methods Between January 2017 and April 2023, 89 patients underwent endoscopic transsphenoidal surgery at the Mahatma Gandhi University of Medical Sciences and Technology in Jaipur. The study assessed preoperatively along with postoperative parameters such as overall remission, cavernous sinus invasion, the extent of resection beyond the tumour capsule, resection rates and GH levels before and after surgery. Remission rates were evaluated based on the consensus criteria from 2010. Results Of the 89 patients, 79 (88.8%) achieved complete tumour resection. Remission was observed in 70 patients (78.7%), with 61 of 78 patients (78.2%) having larger tumours (macroadenomas), 9 of 11 (81.9%) with smaller tumours (microadenomas), and 7 of 18 (38.9%) with tumours invading the cavernous sinus achieving remission. Remarkably, 68 of 72 patients (82.9%) who had a pseudocapsular resection entered remission. Patients with preoperative GH levels below 20 ng/mL saw an 87.5% remission rate, which dropped to 33.3% for those with levels above 60 ng/mL. The study found strong associations between remission rates and factors such as extra-pseudocapsular resection and cavernous sinus invasion, with a negative correlation to tumour size and volume. Conclusion The key determinants of remission include the extent of tumour invasion into the cavernous sinus and the completeness of tumour excision. Achieving optimal remission outcomes requires meticulous surgical removal of the tumour, including any residual fragments, with preoperative as well as postoperative GH levels serving as prognostic indicators of remission success.