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Pure Endoscopic Transsphenoidal Surgery for Cushing's Disease: Techniques, Outcomes, and Predictors of Remission.
MedLine Citation:
PMID:  23149974     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Robert M Starke; Davis L Reames; Ching-Jen Chen; Edward R Laws; John A Jane
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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:  -    
Affiliation:
1Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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