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. 2023 Jul 1;9(1):V7.
doi: 10.3171/2023.4.FOCVID2318. eCollection 2023 Jul.

Management protocol and surgical techniques for MRI-Negative Cushing's disease: a series of 6 cases

Nidhisha Sadhwani  1 , Ashish Suri  1 , Amol Raheja  1 , Santanu Kumar Bora  1 , Rajesh Khadgawat  2 , Mehar Chand Sharma  3 , Ajay Garg  4 , Rajni Sharma  5
Affiliations

Management protocol and surgical techniques for MRI-Negative Cushing's disease: a series of 6 cases

Nidhisha Sadhwani et al. Neurosurg Focus Video. .

Abstract

Up to 40% of Cushing's disease (CD) patients show no evidence of an adenoma on dynamic contrast-enhanced MRI. Inferior petrosal sinus sampling (IPSS) remains the gold standard for diagnosis in these patients. Remission rates in MRI-Negative CD are far less at 50%-71%, compared with patients in whom an adenoma is identified on MRI. Endoscopic endonasal transsphenoidal surgery is the surgical approach of choice in these cases. Various adjuncts can be used to localize an adenoma. In this video, the authors highlight their additional usage of pituitary perfusion MRI for identification of the adenoma. They present their stepwise management algorithm and surgical techniques for sellar and suprasellar exploration in 6 cases of MRI-Negative CD operated on by the senior author (A.S.). The video can be found here: https://stream.cadmore.media/r10.3171/2023.4.FOCVID2318.

Keywords: Cushing’s disease; MRI negative; endoscopic transsphenoidal surgery; pituitary exploration; pituitary perfusion; pituitary surgery.

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Conflict of interest statement

Disclosures Dr. Sadhwani reported a grant (no. BT/PR13455/CoE/34/24/2015) from the Department of Biotechnology, Ministry of Science and Technology, Government of India. Professor Suri reported being a principal investigator during the conduct of the study.Dr. Sadhwani reported a grant (no. BT/PR13455/CoE/34/24/2015) from the Department of Biotechnology, Ministry of Science and Technology, Government of India. Professor Suri reported being a principal investigator during the conduct of the study.

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