Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study

doi:10.1007/s10143-025-03656-1

. 2025 Jun 5;48(1):483.

doi: 10.1007/s10143-025-03656-1.

Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study

Bertrand Baussart^#^{1

2}, Benoit Hudelist^#³, Chiara Villa^{4

5}, Mirella Hage^{6

7}, Anne Jouinot⁴, Vincent Reina³, Maxime Barat^{8

9}, Delphine Leclercq¹⁰, Thibault Passeri¹¹, Philippe Touraine¹², Hélène Cebula¹³, Laurence Guignat¹⁴, Carine Courtillot¹², Philippe Chanson¹⁵, Camille Vatier^{16

17}, Sébastien Froelich¹¹, Jérôme Bertherat^{4

14}, Guillaume Assié^{4

14}, Stephan Gaillard⁴

Affiliations

¹ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, 2 Rue Ambroise Paré, Paris, 75010, France. bertrand.baussart@aphp.fr.
² CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, F-75014, France. bertrand.baussart@aphp.fr.
³ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France.
⁴ CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, F-75014, France.
⁵ Department of Neuropathology, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, Paris, France.
⁶ Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
⁷ Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France.
⁸ Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
⁹ Université Paris Cité, 85 Boulevard Saint-Germain, Paris, 75006, France.
¹⁰ Department of Functional and Diagnostic Neuroradiology, AP-HP, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
¹¹ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, 2 Rue Ambroise Paré, Paris, 75010, France.
¹² Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
¹³ Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
¹⁴ Department of Endocrinology, Hôpital Cochin, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁵ Physiologie et Physiopathologie Endocriniennes, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Inserm, Le Kremlin-Bicêtre, France.
¹⁶ Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
¹⁷ INSERM UMRS938, Saint-Antoine Research Center, Sorbonne University, Paris, 75012, France.

^# Contributed equally.

PMID: 40471392
DOI: 10.1007/s10143-025-03656-1

Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study

Bertrand Baussart et al. Neurosurg Rev. 2025.

. 2025 Jun 5;48(1):483.

doi: 10.1007/s10143-025-03656-1.

Authors

Affiliations

¹ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, 2 Rue Ambroise Paré, Paris, 75010, France. bertrand.baussart@aphp.fr.
² CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, F-75014, France. bertrand.baussart@aphp.fr.
³ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France.
⁴ CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, F-75014, France.
⁵ Department of Neuropathology, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, Paris, France.
⁶ Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
⁷ Université de Versailles Saint-Quentin-en-Yvelines UFR des Sciences de la Santé Simone Veil, Montigny-le-Bretonneux, France.
⁸ Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
⁹ Université Paris Cité, 85 Boulevard Saint-Germain, Paris, 75006, France.
¹⁰ Department of Functional and Diagnostic Neuroradiology, AP-HP, Pitié-Salpêtrière Hospital, F-75013, Paris, France.
¹¹ Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, 2 Rue Ambroise Paré, Paris, 75010, France.
¹² Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
¹³ Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
¹⁴ Department of Endocrinology, Hôpital Cochin, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁵ Physiologie et Physiopathologie Endocriniennes, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Inserm, Le Kremlin-Bicêtre, France.
¹⁶ Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
¹⁷ INSERM UMRS938, Saint-Antoine Research Center, Sorbonne University, Paris, 75012, France.

^# Contributed equally.

PMID: 40471392
DOI: 10.1007/s10143-025-03656-1

Abstract

Background and objectives: In Cushing's disease, the rate of endocrine remission after surgery reaches 80% in expert centers. However, due to the tumor's capacity to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve the likelihood of remission, tumor resection can be extended to the dura in patients who show basal dura invasion. The objective was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.

Methods: Endoscopic surgery was performed in 89 adult patients with no obvious cavernous invasion. The basal dura was systematically removed whenever a macroscopic invasion was suspected. Three groups were defined: (i) resected but noninvaded dura (n = 14); (ii) resected and invaded dura (n = 16); and (iii) nonresected dura (n = 59). The studied cohort was compared to a control personal series of Cushing's patients with no systematic focus on the basal dura.

Results: The mean follow-up duration was 19.9 ± 9.4 months. Endocrine remission was achieved in 15/16 (94%) patients with invaded dura, 14/15 (93%) patients with resected noninvaded dura and 50/59 (85%) patients with nonresected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients respectively. Compared to the control series, our remission rate was significantly higher (88% vs. 75%, P =.019).

Conclusion: Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dura invasion, endocrine remission is high when the dura is removed. A systematic focus on the basal dura can optimize endocrine outcomes.

Keywords: Adenoma; Cushing’s disease; Dural invasion; Dural resection; Endoscopy; PitNet.

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Conflict of interest statement

Declarations. Ethics approval: The study was approved by the Ethical Review Committee for Publications (CLEP, N°AAA-2024-10003). Clinical trial number: not applicable. Consent to participate: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

References

1. Lindholm J (2000) Cushing’s syndrome: historical aspects. Pituitary 3:97–104. https://doi.org/10.1023/a:1009905808033 - DOI - PubMed
1. Organisation mondiale de la santé, Centre international de recherche sur le cancer (2021) Central nervous system tumours, 5th edn. International agency for research on cancer, Lyon
1. Villa C, Vasiljevic A, Jaffrain-Rea ML, Ansorge O, Asioli S, Barresi V, Chinezu L, Gardiman MP, Lania A, Lapshina AM, Poliani L, Reiniger L, Righi A, Saeger W, Soukup J, Theodoropoulou M, Uccella S, Trouillas J, Roncaroli F (2019) A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European pituitary pathology group (EPPG) proposal. Virchows Arch 475:687–692. https://doi.org/10.1007/s00428-019-02655-0 - DOI - PubMed
1. Melmed S (2017) The pituitary, Fourth edition. Elsevier/Academic Press, London, United Kingdom; San Diego, CA
1. Reincke M, Fleseriu M (2023) Cushing syndrome: a review. JAMA 330:170–181. https://doi.org/10.1001/jama.2023.11305 - DOI - PubMed

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[1] Lindholm J (2000) Cushing’s syndrome: historical aspects. Pituitary 3:97–104. https://doi.org/10.1023/a:1009905808033 - DOI - PubMed

[2] Lindholm J (2000) Cushing’s syndrome: historical aspects. Pituitary 3:97–104. https://doi.org/10.1023/a:1009905808033 - DOI - PubMed

[3] Organisation mondiale de la santé, Centre international de recherche sur le cancer (2021) Central nervous system tumours, 5th edn. International agency for research on cancer, Lyon

[4] Organisation mondiale de la santé, Centre international de recherche sur le cancer (2021) Central nervous system tumours, 5th edn. International agency for research on cancer, Lyon

[5] Villa C, Vasiljevic A, Jaffrain-Rea ML, Ansorge O, Asioli S, Barresi V, Chinezu L, Gardiman MP, Lania A, Lapshina AM, Poliani L, Reiniger L, Righi A, Saeger W, Soukup J, Theodoropoulou M, Uccella S, Trouillas J, Roncaroli F (2019) A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European pituitary pathology group (EPPG) proposal. Virchows Arch 475:687–692. https://doi.org/10.1007/s00428-019-02655-0 - DOI - PubMed

[6] Villa C, Vasiljevic A, Jaffrain-Rea ML, Ansorge O, Asioli S, Barresi V, Chinezu L, Gardiman MP, Lania A, Lapshina AM, Poliani L, Reiniger L, Righi A, Saeger W, Soukup J, Theodoropoulou M, Uccella S, Trouillas J, Roncaroli F (2019) A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European pituitary pathology group (EPPG) proposal. Virchows Arch 475:687–692. https://doi.org/10.1007/s00428-019-02655-0 - DOI - PubMed

[7] Melmed S (2017) The pituitary, Fourth edition. Elsevier/Academic Press, London, United Kingdom; San Diego, CA

[8] Melmed S (2017) The pituitary, Fourth edition. Elsevier/Academic Press, London, United Kingdom; San Diego, CA

[9] Reincke M, Fleseriu M (2023) Cushing syndrome: a review. JAMA 330:170–181. https://doi.org/10.1001/jama.2023.11305 - DOI - PubMed

[10] Reincke M, Fleseriu M (2023) Cushing syndrome: a review. JAMA 330:170–181. https://doi.org/10.1001/jama.2023.11305 - DOI - PubMed

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Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study

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Specific focus on the basal dura for improving Cushing's disease surgery: a cohort study

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