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Early promising results for the endoscopic surgical treatment of Cushing’s disease

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Abstract

High levels of endogenous cortisol due to Cushing’s disease cause significant mortality and morbidity. Treatment of Cushing’s disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon’s armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing’s disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing’s disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing’s disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.

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Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey

    Mustafa Berker & Ilkay Işikay

  2. Department of Endocrinology and Metabolism, Ankara Numune Training and Research Hospital, Ankara, Turkey

    Dilek Berker

  3. Department of Endocrinology and Metabolism, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Miyase Bayraktar & Alper Gürlek

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  1. Mustafa Berker
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  2. Ilkay Işikay
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Correspondence to Mustafa Berker.

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Comments

Paolo Cappabianca, Naples, Italy

It can be claimed as real progress of a surgical procedure both the improvement of the outcomes and the reduction of complications. The article from Dr. Berker confirms that the growing experience in endoscopic endonasal technique leads to results at least similar to those achieved by means of the microsurgical transsphenoidal approach [2, 4–11]. Up to now, it has not been possible to compare the large microsurgical series with smaller endoscopic ones, but the outcomes are promising. Prospective studies should be performed to give conclusive remarks.

On the other hand, the complication rate of the endoscopic endonasal technique appeared immediately lower as compared to the conventional microsurgical transsphenoidal technique [1, 3].

At the beginning of the 2000s, a foreign neurosurgeon who came to Naples for our workshop on endoscopic endonasal pituitary surgery told us that not that far away from his hospital there was a neurosurgeon who was still approaching the sellar area via a lateral rhinotomy and who did not intend to change his mind. We understand that it can be quite difficult to adopt a new surgical technique when the previous well-established one has been proven to be effective, according to the personal neurosurgical armamentarium and know-how. Nevertheless, it can be useful to adopt new strategies and techniques for the sake of our patients rather than being anchored to one’s own already good experience and attitude. In the case of the endoscopic endonasal technique for pituitary adenomas, many authors have shown the safety and the effectiveness of such method, and the present contribution adds another brick to this new building.

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Berker, M., Işikay, I., Berker, D. et al. Early promising results for the endoscopic surgical treatment of Cushing’s disease. Neurosurg Rev 37, 105–114 (2014). https://doi.org/10.1007/s10143-013-0506-6

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