Pure endoscopic transsphenoidal surgery for functional pituitary adenomas: outcomes with Cushing’s disease

Abstract Background Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing’s disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD. Methods A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012–February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission. Results A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4–79) months. Conclusion Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.

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Endoscopic Transsphenoidal Surgery for Cushing’s Disease: A Review

Cureus ◽

10.7759/cureus.5254 ◽

2019 ◽

Author(s):

Mirza Zain Baig ◽

Altaf Ali Laghari ◽

Aneela Darbar ◽

Umm E Hani Abdullah ◽

Sumiya Abbasi

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Endoscopic Transsphenoidal Surgery

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Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushing’s disease: surgical outcome, mortality, and complications

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-019-1038-0 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Leonie H. A. Broersen ◽

Femke M. van Haalen ◽

Nienke R. Biermasz ◽

Daniel J. Lobatto ◽

Marco J. T. Verstegen ◽

...

Keyword(s):

Cushing’S Disease ◽

Surgical Outcome ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Endoscopic Transsphenoidal Surgery ◽

Outcome Mortality

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Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

Journal of Neurosurgery ◽

10.3171/jns.1997.87.1.0044 ◽

1997 ◽

Vol 87 (1) ◽

pp. 44-51 ◽

Cited By ~ 456

Author(s):

Hae-Dong Jho ◽

Ricardo L. Carrau

Keyword(s):

Cavernous Sinus ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Elevated Serum ◽

Cushing's Disease ◽

Serum Prolactin ◽

Subtotal Resection ◽

Operating Microscope ◽

Endoscopic Endonasal

✓ An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14–88 years). Initially, four patients underwent operation via a sublabial—transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

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Endoscopic Transsphenoidal Surgery: Institutional Experience in Cushing's Disease

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1370511 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

Oscar Feo

Keyword(s):

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Endoscopic Transsphenoidal Surgery ◽

Institutional Experience

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Endoscopic Transsphenoidal Surgery for Pituitary Adenoma in Cushing's Disease: Results and Outcomes

Skull Base ◽

10.1055/s-2011-1274237 ◽

2011 ◽

Vol 21 (S 01) ◽

Author(s):

Fadi Delly ◽

Jay Jagannathan ◽

Nathan Deckard ◽

Sandeep Mittal ◽

Adam Folbe ◽

...

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Endoscopic Transsphenoidal Surgery

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Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.6.1 ◽

1999 ◽

Vol 6 (6) ◽

pp. E1 ◽

Cited By ~ 2

Author(s):

Patrick L. Semple ◽

Edward R. Laws

Keyword(s):

Deep Vein Thrombosis ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Perioperative Period ◽

Cushing's Disease ◽

Medical Complications ◽

Vein Thrombosis ◽

The University ◽

Deep Vein

Object Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone-secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease. Methods Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia). Conclusions Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

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Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease

Journal of Neurosurgery ◽

10.3171/jns.1999.91.2.0175 ◽

1999 ◽

Vol 91 (2) ◽

pp. 175-179 ◽

Cited By ~ 149

Author(s):

Patrick L. Semple ◽

Edward R. Laws

Keyword(s):

Deep Vein Thrombosis ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Medical Complications ◽

Content Type ◽

Vein Thrombosis ◽

Deep Vein ◽

Fine Print

Object. Transsphenoidal surgery is the usual treatment of choice for adrenocorticotropic hormone—secreting pituitary adenomas associated with Cushing's disease. In this paper the authors investigate the complications of transsphenoidal surgery in the treatment of a contemporary series of patients with Cushing's disease.Methods. Between January 1992 and December 1997, 105 patients with Cushing's disease underwent transsphenoidal surgery at the University of Virginia Health Sciences Center. A retrospective analysis of the complications was conducted, and the mortality rate was found to be 0.9% and permanent morbidity was 1.8%. The overall number of complications was 14 (13.3%), which included seven complications directly related to surgery; one instance of permanent diabetes insipidus; one syndrome of inappropriate secretion of antidiuretic hormone; and five medical complications (four patients developed deep vein thrombosis and one developed pneumonia).Conclusions. Transsphenoidal surgery for Cushing's disease has a higher complication rate than that for pituitary adenomas in general. This is primarily related to a greater number of medical complications, most notably deep vein thrombosis, resulting from the generally debilitated state of most patients with Cushing's disease. In view of the high incidence of deep vein thrombosis in these patients, prophylaxis for thromboembolism during the perioperative period is recommended.

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