Outcome of Microscopic Transsphenoidal Surgery in Cushing Disease: A Case Series of 96 Patients.

Abstract

OBJECTIVE:

To analyze the results of transsphenoidal surgery in patients with Cushing disease and outcome.

METHOD:

Retrospective analysis of the records of 96 patients with Cushing disease from 1997 to 2012.

RESULTS:

There were 73 females and 23 males, with a mean follow-up of 44 months (range, 3-13 years). The sex ratio was significantly different in children and teenagers versus adults. Magnetic resonance imaging showed microadenoma, macroadenoma, and no adenoma in 66, 18, and 12 patients, respectively. There was no surgical mortality. Early remission (normal 24-hour urinary free cortisol and basal serum cortisol <5 μg/dL) was achieved in 94.8%. Regression analysis showed that only tumor size, cavernous sinus extension, and tumor consistency influenced remission. Recurrence was seen in 21.9%. Regression analysis showed that age, preoperative basal cortisol levels, and follow-up duration influenced recurrence. Correlation analysis showed that there was a significant negative correlation between patient age and the follow-up period. After detection of recurrence, 17 patients underwent repeat transsphenoidal surgery that resulted in remission in 12 patients (70.6%). The other 5 patients were referred for gamma knife radiosurgery or bilateral adrenalectomy.

CONCLUSIONS:

Transsphenoidal surgery is a safe and highly efficient procedure in the treatment of Cushing disease. Macroadenomas, cavernous sinus invasion, and harder tumor consistencies, however, are associated with lower remission rates (higher disease persistence) and younger age, higher preoperative cortisol levels, and longer follow-up periods are associated with higher recurrence.

• Authors: Manochehr Shirvani, Rouzbeh Motiei-Langroudi, Homa Sadeghian
• Journal: World neurosurgery (World Neurosurg) Vol. 87 Pg. 170-5 (Mar 2016) ISSN: 1878-8769 [Electronic] United States
• PMID: 26704208 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Hydrocortisone

Topics

• Adenoma (surgery)
• Adolescent
• Adult
• Age Factors
• Child
• Child, Preschool
• Female
• Humans
• Hydrocortisone (blood)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neoplasm Recurrence, Local (epidemiology)
• Neurosurgical Procedures (methods)
• Pituitary ACTH Hypersecretion (surgery)
• Pituitary Neoplasms (surgery)
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Risk Factors
• Sex Ratio
• Sphenoid Bone (surgery)
• Treatment Outcome
• Young Adult