gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Predictive value of tumor size and cavernous sinus invasion for the outcome of transsphenoidal surgery in acromegaly

Meeting Abstract

  • Florian Grimm - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Roland Maurus - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Tsambika Psaras - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Kathrin Schmalisch - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Jürgen Honegger - Neurochirurgische Klinik, Universitätsklinikum Tübingen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 081

doi: 10.3205/13dgnc498, urn:nbn:de:0183-13dgnc4980

Veröffentlicht: 21. Mai 2013

© 2013 Grimm et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Acromegaly is associated with increased morbidity and mortality unless serum growth hormone (GH) levels are persistently normalized after treatment. Insulin-like growth factor (IGF-1) is a sensitive measure of integrated GH production and closely correlates with disease activity. The transsphenoidal surgical resection remains the best therapeutical option for a stable endocrinological remission. Early normalization of IGF-I is associated with persistent cure. In long-term follow-up approximately 40% of patients undergoing surgical resection show a normalization of IGF-1 without further radiotherapy or medical treatment. Our aim was to correlate tumor size and cavernous sinus invasion to disease control measured by IGF-1 normalization in postoperative follow-up.

Method: Preoperative MRI of 104 consecutive patients with newly diagnosed acromegaly who were surgically treated between 2005 and 2012 were assessed. Mean tumor diameter was calculated from the 3 diameters (anterior-posterior, right-left, superior-inferior). Cavernous sinus invasion was evaluated applying the Knosp Grades 1–4. The criterion for remission was normalization of sex- and age-adjusted insulin-like growth factor 1 (IGF 1) value 3-6 months after surgery. None of the patients was under medical treatment at the time of assessment.

Results: Overall, endocrinological remission with normal IGF-1 was attained in 64.4% of the patients. 19% of the adenomas were in the microadenoma stage (<10 mm). The majority of adenomas (58%) had a mean diameter of 2–3 cm. Normalization was IGF-1 was found in 95% of microadenomas, in 65% of macroadenomas with a diameter of 1–2 cm, in 45% of macroadenomas with a diameter of 2–3 cm and in none of the adenomas greater than 3 cm. Normalization of IGF-1 was achieved in 79% of non-invasive adenomas (Knosp grade 1+2). Remission was achieved in 63% of patients with questionable cavernous sinus invasion (Knosp 3) and in only 36% of the patients with obvious invasion (Knops 4+5).

Conclusions: Tumor size and cavernous sinus invasion are highly predictive for endocrinological remission in pituitary surgery. Disease control could be attained in most of the non-invasive microadenomas. In macroadenomas > 3cm normalization of IGF-1 could not be achieved.