Acta Neurochirurgica

, Volume 159, Issue 7, pp 1227–1236 | Cite as

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

  • Hélène CebulaEmail author
  • Bertrand Baussart
  • Chiara Villa
  • Guillaume Assié
  • Anne Boulin
  • Luc Foubert
  • Sorin Aldea
  • Saad Bennis
  • Michèle Bernier
  • François Proust
  • Stephan Gaillard
Original Article - Brain Tumors



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.

Patients and methods

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 μg/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.


Cushing’s disease Remission rate Transsphenoidal Endoscopic Adenoma Venous sampling 



The authors are grateful to Richard Medeiros, Medical Editor of Medical Editing International, for copy editing the manuscript and to Prof. Anheim Mathieu, Professor of Neurology, Dr. Chibbaro and Dr. Spatola for reviewing this article. We are also grateful for the various multidisciplinary discussions regarding these data during the EUROPIT Postgraduate course (2016, Annecy, France), which helped with the interpretation of our results. No funding was received for this research.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Hélène Cebula
    • 1
    Email author
  • Bertrand Baussart
    • 2
  • Chiara Villa
    • 3
  • Guillaume Assié
    • 4
    • 5
    • 6
    • 7
    • 8
  • Anne Boulin
    • 9
  • Luc Foubert
    • 2
  • Sorin Aldea
    • 2
  • Saad Bennis
    • 2
  • Michèle Bernier
    • 3
  • François Proust
    • 1
  • Stephan Gaillard
    • 2
  1. 1.Department of NeurosurgeryHôpital HautepierreStrasbourgFrance
  2. 2.Department of NeurosurgeryHôpital FochSuresnesFrance
  3. 3.Department of PathologyHôpital FochSuresnesFrance
  4. 4.Institut National de la Santé et de la Recherche Médicale U1016Institut CochinParisFrance
  5. 5.Centre national de la recherche scientifique UMR8104ParisFrance
  6. 6.Sorbonne Paris CitéUniversité Paris DescartesParisFrance
  7. 7.Department of EndocrinologyCenter for Rare Adrenal Diseases Assistance Publique Hôpitaux de ParisParisFrance
  8. 8.Hôpital CochinParisFrance
  9. 9.Department of NeuroradiologyHôpital FochSuresnesFrance

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