Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing's disease in 230 patients with positive and negative MRI

被引:41
作者
Cebula, Helene [1 ]
Baussart, Bertrand [2 ]
Villa, Chiara [3 ]
Assie, Guillaume [4 ,5 ,6 ,7 ,8 ]
Boulin, Anne [9 ]
Foubert, Luc [2 ]
Aldea, Sorin [2 ]
Bennis, Saad [2 ]
Bernier, Michele [3 ]
Proust, Francois [1 ]
Gaillard, Stephan [2 ]
机构
[1] Hop Hautepierre, Dept Neurosurg, 1 Ave Moliere, F-67100 Strasbourg, France
[2] Hop Foch, Dept Neurosurg, Suresnes, France
[3] Hop Foch, Dept Pathol, Suresnes, France
[4] Inst Cochin, INSERM, U1016, 22 Rue Mech, F-75014 Paris, France
[5] CNRS, UMR8104, Paris, France
[6] Univ Paris 05, Sorbonne Paris Cite, Paris, France
[7] AP HP, Ctr Rare Adrenal Dis, Dept Endocrinol, Paris, France
[8] Hop Cochin, Paris, France
[9] Hop Foch, Dept Neuroradiol, Suresnes, France
关键词
Cushing's disease; Remission rate; Transsphenoidal; Endoscopic; Adenoma; Venous sampling; PITUITARY SURGERY; SERUM CORTISOL; EXPERIENCE; RECURRENT; MICROSURGERY; PERSISTENT; MANAGEMENT; ACCURACY;
D O I
10.1007/s00701-017-3140-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The primary objective was to assess the remission rate, and the secondary objectives were to evaluate the early complications and recurrence rate and to define the predictive factors for the remission and recurrence rates. This prospective single-center study included 230 consecutive patients, operated on by a single surgeon for Cushing's disease via a transsphenoidal endoscopic endonasal approach, over a 6-year period (2008-2013). The patients included in this series were all adults (> 18 years of age), who presented with clinical and biological characteristics of Cushing's disease confirmed based on dedicated MRI pituitary imaging. Biochemical remission was defined as a postoperative serum cortisol level < 5 mu g/dl on the 2nd day following surgery that required glucocorticoid replacement therapy. The remission rate for the global population (n = 230) with a follow-up of 21 +/- 19.2 months concerned 182 patients (79.1%) divided into 132 patients (82.5%) with positive MRI and 50 patients (71.4%) with negative MRI with no statistically significant difference (p = 0.077). Complications occurred in 77 patients with no deaths. A total of 22% of patients had transient diabetes insipidus and 6.4% long-term diabetes insipidus, and no postoperatively CSF leakage was observed. The recurrence rate was 9.8% with a mean time of 32.7 +/- 15.2 months. The predictive factors for the remission rate were the presence of pituitary microadenoma and a positive histology. No risk factors were involved regarding the recurrence rate. Whatever the MRI results, the transsphenoidal endonasal endoscopic approach remains the gold standard treatment for Cushing's disease. It was maximally effective with a remission rate of 79.1% and lower morbidity.
引用
收藏
页码:1227 / 1236
页数:10
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