Endoscopic Endonasal Surgery for Cushing's Disease

Background: This study was performed to assess the remission rate and postoperative complications following endoscopic endonasal surgery (EES) for Cushing's disease (CD).

Methods: Data were analyzed from 21 consecutive patients with CD who underwent EES using neuronavigation between 2013 and 2021. The radiological evaluation included an examination of preoperative magnetic resonance images (MRIs), inferior petrosal sinus sampling (IPSS), for cases with normal renal function. Postoperative 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.

Results: A single surgeon performed 23 EES in 21 patients. In preoperative MRI tumor was verified in 19 (90.5%) cases: 2 macroadenoma and 17 microadenoma. IPSS was performed in 16 (76.2%) patients. The rate of hormonal remission was 85.7% (18/21). There was 3 cases of recurrence of CD during the follow-up period. Postoperatively, there were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient diabetes insipidus occurred in 6 (28.6%) patients.

Conclusion: EES provides excellent remission rates and low morbidity for the treatment of CD. The endoscope provides wide surgical field and good intrasellar illumination, which allow easier tumor identification and high rate of gross total resection.

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Artikel online veröffentlicht:
05. Februar 2024