Abstract
Background This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal
adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD)
after unsuccessful first TSA.
Material and Methods Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent
a second surgery or GKRS as the next therapeutic approach. They were followed for
a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement
as well as magnetic resonance imaging.
Results No significant difference was observed in sex ratio, mean age, adenoma type, follow-up
duration, and initial hormone level between the two groups. No significant relationship
was found between preoperative 24-hour free urine cortisol and disease-free months
or tumor volume among both groups. Our statistical analysis showed higher recurrence-free
interval in the GKRS group compared with TSA group.
Conclusion With longer recurrence-free interval, GKRS could be considered a good treatment alternative
to repeated TSA in recurrent CD.
Keywords
transsphenoidal surgery - gamma knife radiosurgery - Cushing disease