Primary Endoscopic Transnasal Transsphenoidal Surgery for Magnetic Resonance Image-Positive Cushing Disease: Outcomes of a Series over 14 Years.

Abstract

BACKGROUND:

There are scant data of endoscopic transsphenoidal surgery (ETS) with adjuvant therapies of Cushing disease (CD).

OBJECTIVE:

To report the remission rate, secondary management, and outcomes of a series of CD patients.

METHODS:

Patients with CD with magnetic resonance imaging (MRI)-positive adenoma who underwent ETS as the first and primary treatment were included. The diagnostic criteria were a combination of 24-hour urine-free cortisol, elevated serum cortisol levels, or other tests (e.g., inferior petrosal sinus sampling). All clinical and laboratory evaluations and radiological examinations were reviewed.

RESULTS:

Forty consecutive CD patients, with an average age of 41.0 years, were analyzed with a mean follow-up of 40.2 ± 29.6 months. These included 22 patients with microadenoma and 18 with macroadenoma, including 9 cavernous invasions. The overall remission rate of CD after ETS was 72.5% throughout the entire follow-up. Patients with microadenoma or noninvasive macroadenoma had a higher remission rate than those who had macroadenoma with cavernous sinus invasion (81.8% or 77.8% vs. 44.4%, P = 0.02). After ETS, the patients who had adrenocorticotropic hormone-positive adenoma had a higher remission rate than those who had not (76.5% vs. 50%, P = 0.03). In the 11 patients who had persistent/recurrent CD after the first ETS, 1 underwent secondary ETS, 8 received gamma-knife radiosurgery (GKRS), and 2 underwent both. At the study end point, two (5%) of these CD patients had persistent CD and were under the medication of ketoconazole.

CONCLUSION:

For MRI-positive CD patients, primary (i.e., the first) ETS yielded an overall remission rate of 72.5%. Adjuvant therapies, including secondary ETS, GKRS, or both, yielded an ultimate remission rate of 95%.

• Authors: Chao-Hung Kuo, Yu-Shu Yen, Jau-Ching Wu, Yu-Chun Chen, Wen-Cheng Huang, Henrich Cheng
• Journal: World neurosurgery (World Neurosurg) Vol. 84 Issue 3 Pg. 772-9 (Sep 2015) ISSN: 1878-8769 [Electronic] United States
• PMID: 25957728 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Adenoma (pathology, surgery)
• Adult
• Cavernous Sinus (pathology, surgery)
• Endoscopy (adverse effects, methods)
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Nasal Cavity (surgery)
• Neoplasm Recurrence, Local (surgery)
• Neurosurgical Procedures (adverse effects, methods)
• Pituitary ACTH Hypersecretion (pathology, surgery)
• Radiosurgery
• Treatment Outcome