Document Detail

Pure Endoscopic Transsphenoidal Surgery for Cushing's Disease: Techniques, Outcomes, and Predictors of Remission.
MedLine Citation:
PMID:  23149974     Owner:  NLM     Status:  Publisher    
BACKGROUND:: The efficacy of endoscopic transsphenoidal surgery (ETS) for Cushing's Disease has not been clearly established. OBJECTIVE:: To assess efficacy of a pure endoscopic approach for treatment of Cushing's disease and determine predictors of remission. METHODS:: A prospectively acquired database of 61 patients undergoing ETS was reviewed. Remission was defined as postoperative morning serum cortisol of <5 μcg/dl or normal or decreased 24-hour UFC level in follow-up. RESULTS:: Overall, hypercortisolemia resolved in 58 of 61 patients (95%) by discharge. Tumor size did not predict resolution of hypercortisolemia at discharge [microadenomas (97%), MRI-negative Cushing's (100%), macroadenomas (87%)]. At 2-3 month evaluation, 45 of 49 patients (91.8%) were in remission. Fifty patients were followed for at least 12 months (mean 28 months, range 12-72). Forty-two (84%) achieved remission from a single ETS. In these patients, there was no significant difference in remission rates between microadenomas (93%), MRI-negative (70%), and macroadenomas (77%). Patients with history of prior surgery (N=14, 23%) were 9 times less likely to achieve follow-up remission (p=0.021). In-house cortisol level of <5.7 μcg/dl provided the best prediction of follow-up remission (sensitivity 88.6%, specificity 83.3%). Postoperative diabetes insipidus occurred transiently in 7 patients (9%) and permanently in 3 (5%). One patient experienced post-operative CSF leak that resolved with further surgery. CONCLUSION:: ETS for Cushing's disease provides high rates of remission with low rates of complications regardless of size. Although patients with a history of prior surgery are less likely to achieve remission, the majority can still achieve remission following treatment.
Robert M Starke; Davis L Reames; Ching-Jen Chen; Edward R Laws; John A Jane
Related Documents :
23120664 - Use of diode laser in oral submucous fibrosis with trismus: prospective clinical study.
23878974 - Pre-harvest treatments with fungicides and post-harvest dips in sodium bicarbonate to c...
23019304 - Mr-guided focus ultrasound (mrgfus) for symptomatic uterine fibroids: predictors of tre...
23922904 - Patterns of treatment interruption among patients with multidrug-resistant tb (mdr tb) ...
9647304 - Long term results of botulinum toxin type a (dysport) in the treatment of hemifacial sp...
24944554 - Idiopathic granulomatous mastitis: comparison of wide local excision with or without co...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-10
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Autologous Iliac Bone Graft with Anterior Plating is Advantageous Over the Stand-alone Cage for Segm...
Next Document:  Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain.