Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 7/2017

01-07-2017 | Original Article - Brain Tumors

Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing’s disease in 230 patients with positive and negative MRI

Authors: Hélène Cebula, Bertrand Baussart, Chiara Villa, Guillaume Assié, Anne Boulin, Luc Foubert, Sorin Aldea, Saad Bennis, Michèle Bernier, François Proust, Stephan Gaillard

Published in: Acta Neurochirurgica | Issue 7/2017

Login to get access

Abstract

Object

The primary objective was to assess the remission rate, and the secondary objectives were to evaluate the early complications and recurrence rate and to define the predictive factors for the remission and recurrence rates.

Patients and methods

This prospective single-center study included 230 consecutive patients, operated on by a single surgeon for Cushing’s disease via a transsphenoidal endoscopic endonasal approach, over a 6-year period (2008–2013). The patients included in this series were all adults (>18 years of age), who presented with clinical and biological characteristics of Cushing’s disease confirmed based on dedicated MRI pituitary imaging. Biochemical remission was defined as a postoperative serum cortisol level <5 μg/dl on the 2nd day following surgery that required glucocorticoid replacement therapy.

Results

The remission rate for the global population (n = 230) with a follow-up of 21 ± 19.2 months concerned 182 patients (79.1%) divided into 132 patients (82.5%) with positive MRI and 50 patients (71.4%) with negative MRI with no statistically significant difference (p = 0.077). Complications occurred in 77 patients with no deaths. A total of 22% of patients had transient diabetes insipidus and 6.4% long-term diabetes insipidus, and no postoperatively CSF leakage was observed. The recurrence rate was 9.8% with a mean time of 32.7 ± 15.2 months. The predictive factors for the remission rate were the presence of pituitary microadenoma and a positive histology. No risk factors were involved regarding the recurrence rate.

Conclusion

Whatever the MRI results, the transsphenoidal endonasal endoscopic approach remains the gold standard treatment for Cushing’s disease. It was maximally effective with a remission rate of 79.1% and lower morbidity.
Literature
1.
2.
Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M (2008) Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 93:2454–2462CrossRefPubMedPubMedCentral
3.
Buchfelder M, Nistor R, Fahlbusch R, Huk WJ (1993) The accuracy of CT and MR evaluation of the sella turcica for detection of adrenocorticotropic hormone-secreting adenomas in Cushing disease. AJNR Am J Neuroradiol 14:1183–1190PubMed
4.
Cannavo S, Almoto B, Dall’Asta C, Corsello S, Lovicu RM, De Menis E, Trimarchi F, Ambrosi B (2003) Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas. Eur J Endocrinol/Eur Fed Endoc Soc 149:195–200CrossRef
5.
Chandler WF, Barkan AL, Hollon T, Sakharova A, Sack J, Brahma B, Schteingart DE (2016) Outcome of transsphenoidal surgery for Cushing disease: a single-center experience over 32 years. Neurosurgery 78:216–223CrossRefPubMed
6.
Chen JC, Amar AP, Choi S, Singer P, Couldwell WT, Weiss MH (2003) Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test. J Neurosurg 98:967–973CrossRefPubMed
7.
Ciric I, Zhao JC, Du H, Findling JW, Molitch ME, Weiss RE, Refetoff S, Kerr WD, Meyer J (2012) Transsphenoidal surgery for Cushing disease: experience with 136 patients. Neurosurgery 70:70–80, discussion 80–71CrossRefPubMedPubMedCentral
8.
De Tommasi C, Vance ML, Okonkwo DO, Diallo A, Laws ER Jr (2005) Surgical management of adrenocorticotropic hormone-secreting macroadenomas: outcome and challenges in patients with Cushing’s disease or Nelson’s syndrome. J Neurosurg 103:825–830CrossRefPubMed
9.
Dickerman RD, Oldfield EH (2002) Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery. J Neurosurg 97:1343–1349CrossRefPubMed
10.
Friedman RB, Oldfield EH, Nieman LK, Chrousos GP, Doppman JL, Cutler GB Jr, Loriaux DL (1989) Repeat transsphenoidal surgery for Cushing’s disease. J Neurosurg 71:520–527CrossRefPubMed
11.
Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, Rahl R, Lu A, Wilson CB (2004) Transsphenoidal microsurgery for Cushing’s disease: initial outcome and long-term results. J Clin Endocrinol Metab 89:6348–6357CrossRefPubMed
12.
Hofmann BM, Hlavac M, Martinez R, Buchfelder M, Muller OA, Fahlbusch R (2008) Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years. J Neurosurg 108:9–18CrossRefPubMed
13.
Jagannathan J, Sheehan JP, Jane JA Jr (2007) Evaluation and management of Cushing syndrome in cases of negative sellar magnetic resonance imaging. Neurosurg Focus 23, E3CrossRefPubMed
14.
Jho HD, Carrau RL, Ko Y, Daly MA (1997) Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213–222, discussion 222–213CrossRefPubMed
15.
16.
McCance DR, Gordon DS, Fannin TF, Hadden DR, Kennedy L, Sheridan B, Atkinson AB (1993) Assessment of endocrine function after transsphenoidal surgery for Cushing’s disease. Clin Endocrinol 38:79–86CrossRef
17.
Mehta GU, Lonser RR, Oldfield EH (2012) The history of pituitary surgery for Cushing disease. J Neurosurg 116:261–268CrossRefPubMed
18.
Netea-Maier RT, van Lindert EJ, den Heijer M, van der Eerden A, Pieters GF, Sweep CG, Grotenhuis JA, Hermus AR (2006) Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease. Eur J Endocrinol/Eur Fed Endoc Soc 154:675–684CrossRef
19.
Nieman LK (2015) Cushing’s syndrome: update on signs, symptoms and biochemical screening. Eur J Endocrinol/Eur Fed Endoc Soc 173:M33–38CrossRef
20.
Nieman LK, Biller BM, Findling JW, Murad MH, Newell-Price J, Savage MO, Tabarin A, Endocrine S (2015) Treatment of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 100:2807–2831CrossRefPubMedPubMedCentral
21.
Patil CG, Veeravagu A, Prevedello DM, Katznelson L, Vance ML, Laws ER Jr (2008) Outcomes after repeat transsphenoidal surgery for recurrent Cushing’s disease. Neurosurgery 63:266–270, discussion 270–261CrossRefPubMed
22.
Pereira AM, van Aken MO, van Dulken H, Schutte PJ, Biermasz NR, Smit JW, Roelfsema F, Romijn JA (2003) Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J Clin Endocrinol Metab 88:5858–5864CrossRefPubMed
23.
Prevedello DM, Pouratian N, Sherman J, Jane JA Jr, Vance ML, Lopes MB, Laws ER Jr (2008) Management of Cushing’s disease: outcome in patients with microadenoma detected on pituitary magnetic resonance imaging. J Neurosurg 109:751–759CrossRefPubMed
24.
Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF (2002) Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol 56:541–551CrossRef
25.
Salenave S, Gatta B, Pecheur S, San-Galli F, Visot A, Lasjaunias P, Roger P, Berge J, Young J, Tabarin A, Chanson P (2004) Pituitary magnetic resonance imaging findings do not influence surgical outcome in adrenocorticotropin-secreting microadenomas. J Clin Endocrinol Metab 89:3371–3376CrossRefPubMed
26.
Semple PL, Laws ER Jr (1999) Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing’s disease. J Neurosurg 91:175–179CrossRefPubMed
27.
Semple PL, Vance ML, Findling J, Laws ER Jr (2000) Transsphenoidal surgery for Cushing’s disease: outcome in patients with a normal magnetic resonance imaging scan. Neurosurgery 46:553–558, discussion 558–559CrossRefPubMed
28.
Sheehan JM, Lopes MB, Sheehan JP, Ellegala D, Webb KM, Laws ER Jr (2000) Results of transsphenoidal surgery for Cushing’s disease in patients with no histologically confirmed tumor. Neurosurgery 47:33–36, discussion 37–39CrossRefPubMed
29.
Shimon I, Ram Z, Cohen ZR, Hadani M (2002) Transsphenoidal surgery for Cushing’s disease: endocrinological follow-up monitoring of 82 patients. Neurosurgery 51:57–61, discussion 61–52CrossRefPubMed
30.
Simmons NE, Alden TD, Thorner MO, Laws ER Jr (2001) Serum cortisol response to transsphenoidal surgery for Cushing disease. J Neurosurg 95:1–8CrossRefPubMed
31.
Starke RM, Reames DL, Chen CJ, Laws ER, Jane JA Jr (2013) Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission. Neurosurgery 72:240–247, discussion 247CrossRefPubMed
32.
Swearingen B, Biller BM, Barker FG 2nd, Katznelson L, Grinspoon S, Klibanski A, Zervas NT (1999) Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 130:821–824CrossRefPubMed
33.
Teramoto A, Yoshida Y, Sanno N, Nemoto S (1998) Cavernous sinus sampling in patients with adrenocorticotrophic hormone-dependent Cushing’s syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients. J Neurosurg 89:762–768. doi:10.​3171/​jns.​1998.​89.​5.​0762 CrossRefPubMed
34.
Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB, Savage MO, Afshar F, Besser GM (1993) Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol 38:73–78CrossRef
35.
Vallette-Kasic S, Dufour H, Mugnier M, Trouillas J, Valdes-Socin H, Caron P, Morange S, Girard N, Grisoli F, Jaquet P, Brue T (2000) Markers of tumor invasion are major predictive factors for the long-term outcome of corticotroph microadenomas treated by transsphenoidal adenomectomy. Eur J Endocrinol/Eur Fed Endoc Soc 143:761–768CrossRef
36.
Wagenmakers MA, Netea-Maier RT, van Lindert EJ, Timmers HJ, Grotenhuis JA, Hermus AR (2009) Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing’s disease (CD). Clin Endocrinol 70:274–280CrossRef
37.
Wind JJ, Lonser RR, Nieman LK, DeVroom HL, Chang R, Oldfield EH (2013) The lateralization accuracy of inferior petrosal sinus sampling in 501 patients with Cushing’s disease. J Clin Endocrinol Metab 98:2285–2293CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing’s disease in 230 patients with positive and negative MRI
Authors
Hélène Cebula
Bertrand Baussart
Chiara Villa
Guillaume Assié
Anne Boulin
Luc Foubert
Sorin Aldea
Saad Bennis
Michèle Bernier
François Proust
Stephan Gaillard
Publication date
01-07-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3140-1

Other articles of this Issue 7/2017

Acta Neurochirurgica 7/2017 Go to the issue

Case Report - Vascular

De novo vertebral artery dissecting aneurysm after internal trapping of the contralateral vertebral artery

Case Report - Neurosurgical Techniques

Correlation of electrode position and clinical outcomes in globus pallidus stimulation for dystonia

Original Article - Neurosurgical Anatomy

An experimental animal model for percutaneous procedures used in trigeminal neuralgia

Original Article - Functional

Outcome after brachial plexus injury surgery and impact on quality of life

Original Article - Vascular

Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage

Original Article - Vascular

Cerebral aneurysm neck diameter is an independent predictor of progressive occlusion after stent-assisted coiling