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

Abstract

ETS allows for enhanced intrasellar identification of adenomatous tissue, providing remission rates that are comparable to traditional microsurgery for CD. The best predictor of remission remains induction of profound hypocortisolemia in the early postoperative period.

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

“…Compared with microscopic surgery, endoscopic transsphenoidal tumor resection seems to lead to improved patient outcomes, especially in those patients with cavernous sinus invasion ( 14 , 15 , 16 , 17 , 18 , 19 , 20 ). In patients with CD, though a few studies do indicate a lower recurrence rate ( 15 , 21 , 22 ), it is still unclear whether the endoscopic technique has any advantages. Indeed, follow-up time in these studies was relatively short.…”

Endoscopic endonasal resection of ACTH secreting pituitary microadenoma; how I do it

“…Such an approach for microadenomas, particularly in Cushing's disease, has been criticized due to absence of three-dimensional (3D) vision and inability to perform meticulous microsurgical dissection. However, several studies have confirmed the efficacy of this approach [3][4][5][6]8].…”

“…A negative MRI finding mandates an IPSS. We do not systematically perform a pre-operative CT. 2) Steroids are not administered during surgery to allow for an accurate early basal cortisol level the day after surgery [8]. Remission of Cushing disease is defined as postoperative eucortisolism or hypocortisolism.…”

“…Remission rates after surgical resection in Cushing's disease approach 90 % and complications rates range from 0 to 53 % [2,[5][6][7][8]. The endoscopic exposure provides a panoramic view of critical structures and better resection rate [3][4][5].…”

Current management of Cushing's disease

“…It is therefore not surprising that the outcome of TSS is significantly influenced by the experience and expertise of the pituitary neurosurgeon . In expert hands, postoperative remission of hypercortisolism, usually defined as very low morning serum cortisol levels in the early postoperative period [and in some centres, supported by very low 24‐hour urine free cortisol (UFC) and late‐night salivary cortisol (LNSC) during that time ], is achieved in up to ~90% of patients with microadenomas and ~65% of patients with macroadenomas (Table ) . Other predictors of postoperative remission include preoperative or intraoperative tumour visualization and pathological confirmation of the diagnosis .…”