Introduction: Effective surgical treatment of Cushing's disease is required to decrease related morbidity. It is difficult to assess the results of new surgical techniques, due to the several factors that affect the postoperative evaluation of Cushing's disease.
This is a retrospective study of 105 cases with Cushing disease treated by endoscopic transsphenoidal surgery. The efficacy of different surgical strategies are evaluated to achieve better remission and cure rates for Cushing's disease.
Methods: Between September 1997 and March 2015, 1189 cases were operated by an endoscopic transsphenoidal approach in Kocaeli University, Turkey. In this series, 94 patients with ACTH-adenomas were operated. We have performed 105 operations for these patients.
Endoscopic surgical treatment was selective adenomectomy between 1997 and 2011. Pseudocapsular dissection was aimed endoscopically in patients who were operated after December 2011. A more aggressive surgical approach was preferred in order to evaluate the possibility of a second adenoma or diffuse corticotroph hyperplasia and multiple vertical incisions were made to the pituitary tissue after adenomectomy during the last 35 operations.
Results: The mean age of the patients was 36,5 years, 71% (n:75) were female. According to the MRI reports, 70% (n:74) of the lesions were microadenomas. Cavernous sinus invasion was observed in 11 (10%) of the cases. The mean follow-up was 32.8 months in ACTH-adenomas. Eighty-six percent of the patients achieved remission. Hypercortisolism resolved after the 59 of first 70 operations. Recurrence was observed in 29% of these patients. Because of the relapse rates, aggressive surgical approach was performed in the last 35 operations, and 9 discrete lesions or semiliquid material were observed in a different localization other than primary adenoma.
Conclusions: Endoscopic transsphenoidal surgery offers a wide exposure of the sella. Resection via pseudocapsular dissection and aggressive surgical management contributes to better resection and remission rates. Macroadenoma and cavernous sinus invasion have effects on remission.
Patient Care: The efficacy of different surgical strategies are evaluated to achieve better remission and cure rates for Cushing's disease.
Learning Objectives: 1-Definition of Cushing disease
2-Surgical techniques for treatment
3-Remission criteria and rates