This review aimed to highlight the history, diagnostic criteria, preoperative prognostic factors, surgical management, and multimodal adjuvant therapies recommended to provide a comprehensive and multifaceted understanding of and clinical approach to treating growth hormone-secreting pituitary adenomas (GHPAs) in patients with acromegaly. The authors collated and reviewed published studies, many written by skull base neurosurgeons, endocrinologists, and radiation oncologists with expertise in pituitary adenoma management, to produce a practical and contemporary update pertaining to the optimal management of acromegaly for neurosurgeons. Acromegaly is a debilitating disease for which surgery can be curative in more than two-thirds of patients. Recent rates of hormonal remission by the authors' group and others following the resection of GHPAs are on the order of 70%-80%, and these increase to more than 85% with the addition of medical therapy in a minority of patients who do not achieve remission with surgery alone. Most tumors are accessible via a direct endoscopic endonasal transsphenoidal approach, which can be augmented with a variety of extended approaches to gain access to suprasellar, clival, and parasellar compartments as needed. Preoperative growth hormone levels, cavernous sinus invasion, and pituitary adenoma consistency are important factors in determining the extent of resection. In most patients with residual or recurrent disease, medical therapy (e.g., somatostatin analogs and dopamine agonists) can be used to help achieve hormonal remission. Repeat surgery can be safely performed in most cases if needed, whereas stereotactic radiosurgery is usually reserved for medically resistant tumors in surgically inaccessible compartments. The neurosurgeon has a primary and often definitive role in the management of acromegaly. The involvement of an integrated and multidisciplinary team consisting of experts from neurosurgery, otolaryngology, endocrinology, and radiation oncology optimizes the chances for a biochemical cure, even in large and aggressive GHPAs.

中文翻译：

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导致肢端肥大症的生长激素分泌垂体腺瘤的治疗：神经外科医生手术和多模式治疗策略的实践回顾。

本综述旨在重点介绍肢端肥大症患者的病史、诊断标准、术前预后因素、手术治疗和多模式辅助治疗，以提供对肢端肥大症患者生长激素分泌型垂体腺瘤（GHPA）治疗的全面、多方面的了解和临床方法。作者整理并回顾了已发表的研究，其中许多研究是由具有垂体腺瘤治疗专业知识的颅底神经外科医生、内分泌学家和放射肿瘤学家撰写的，旨在为神经外科医生提供有关肢端肥大症最佳治疗的实用和当代更新。肢端肥大症是一种使人衰弱的疾病，超过三分之二的患者可以通过手术治愈。作者小组和其他人在 GHPA 切除后最近的激素缓解率约为 70%-80%，并且在少数没有接受药物治疗的患者中加上药物治疗后，激素缓解率会增加到 85% 以上。仅通过手术即可达到缓解。大多数肿瘤可通过直接内窥镜鼻内经蝶入路进入，该入路可通过各种扩展方法进行增强，以根据需要进入鞍上、斜坡和鞍旁室。术前生长激素水平、海绵窦侵犯和垂体腺瘤一致性是决定切除范围的重要因素。对于大多数有残留或复发性疾病的患者，可以使用药物治疗（例如生长抑素类似物和多巴胺激动剂）来帮助实现激素缓解。如果需要，在大多数情况下可以安全地进行重复手术，而立体定向放射外科手术通常用于手术无法进入的隔室中的耐药肿瘤。神经外科医生在肢端肥大症的治疗中起着主要且通常是决定性的作用。由神经外科、耳鼻喉科、内分泌科和放射肿瘤科专家组成的综合性多学科团队的参与，可以优化生化治愈的机会，即使是在大型且侵袭性的 GHPA 中也是如此。