Among multimodality treatments for
acromegaly, the goals of surgical intervention are to balance maximal
tumor resection while preserving normal pituitary function and maintaining patient safety. The resection of
growth hormone-(
GH-) secreting pituitary adenomas in the hands of experienced surgeons results in hormonal remission in 50-70% of patients. Acromegalic patients often have medical comorbidities and anatomical variations complicating
anesthesia and surgical management. Despite these challenges, complications such as CSF leak or new
hypopituitarism following surgery remain uncommon. Over the past decade, endoscopic approaches to
pituitary tumors have improved visualization and facilitated identification of additional
tumor using angled
telescopes. Patients with persistent
acromegaly following surgery require continued medical and/or radiation-based interventions. The adjunctive use of stereotactic radiosurgery offers hormonal remission in 40-50% of patients. In this article, the current preoperative evaluation, indications for surgery, surgical approaches, role of radiosurgery, complications, and remission criteria following operative resection of GH
adenomas are reviewed.