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. 2024 Mar;67(2):237-248.
doi: 10.3340/jkns.2023.0100. Epub 2024 Feb 29.

Medium and Long-Term Data from a Series of 96 Endoscopic Transsphenoidal Surgeries for Cushing Disease

Buruç Erkan  1   2 , Muhammed Bayındır  1 , Ebubekir Akpınar  1 , Osman Tanrıverdi  1 , Ozan Haşimoğlu  1 , Lütfi Şinasi Postalcı  1 , Didem Acarer Bugün  3 , Dilara Tekin  4 , Sema Çiftçi  2   3 , İlkay Çakır  2   3 , Meral Mert  2   3 , Ömür Günaldı  1   2 , Esra Hatipoğlu  2   4
Affiliations

Medium and Long-Term Data from a Series of 96 Endoscopic Transsphenoidal Surgeries for Cushing Disease

Buruç Erkan et al. J Korean Neurosurg Soc. 2024 Mar.

Abstract

Objective: Postoperative data on Cushing's disease (CD) are equivocal in the literature. These discrepancies may be attributed to different series with different criteria for remission and variable follow-up durations. Additional data from experienced centers may address these discrepancies. In this study, we present the results obtained from 96 endoscopic transsphenoidal surgeries (ETSSs) for CD conducted in a well-experienced center.

Methods: Pre- and postoperative data of 96 ETSS in 87 patients with CD were included. All cases were handled by the same neurosurgical team between 2014 and 2022. We obtained data on remission status 3-6 months postoperatively (medium-term) and during the latest follow-up (long-term). Additionally, magnetic resonance imaging (MRI) and pathology results were obtained for each case.

Results: The mean follow-up duration was 39.5±3.2 months. Medium and long-term remission rates were 77% and 82%, respectively. When only first-time operations were considered, the medium- and long-term remission rates were 78% and 82%, respectively. The recurrence rate in this series was 2.5%. Patients who showed remission between 3-6 months had higher longterm remission rates than did those without initial remission. Tumors >2 cm and extended tumor invasion of the cavernous sinus (Knosp 4) were associated with lower postoperative remission rates.

Conclusion: Adenoma size and the presence/absence of cavernous sinus invasion on preopera-tive MRI may predict long-term postoperative remission. A tumor size of 2 cm may be a supporting criterion for predicting remission in Knosp 4 tumors. Further studies with larger patient populations are necessary to support this finding.

Keywords: Complete remission; Neuroendoscopy; Pituitary-dependant Cushing syndrome; Treatment outcome.

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Conflict of interest statement

Conflicts of interest

No potential conflicts of interest relevant to this study exist.

Figures

Fig. 1.
Fig. 1.
Number of operations and patients included in the study.
Fig. 2.
Fig. 2.
Survival analysis after the first operation in cases with remission at 3–6 months. Dashed line represents cases with recurrence and, straight line represents cases with sustained remission during long-term follow-up.
Fig. 3.
Fig. 3.
Results of the cases who had operation for the first time.
Fig. 4.
Fig. 4.
Results of the reoperations in our center.
See this image and copyright information in PMC

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