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Radiosurgery for Cushing's disease after failed transsphenoidal surgery
J M Sheehan1, M L Vance, J P Sheehan
1Department of Neurological Surgery, University of Virginia, Charlottesville, USA.
Journal of Neurosurgery
|November 4, 2000
Summary
Gamma knife radiosurgery (GKRS) offers a safe and effective treatment for Cushing's disease resistant to pituitary surgery. Long-term follow-up is crucial due to potential delayed recurrences and new hormone deficiencies.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiation Oncology
Background:
- Transsphenoidal surgery is standard for Cushing's disease but often fails to normalize cortisol.
- Recalcitrant Cushing's disease requires alternative treatment strategies.
Purpose of the Study:
- To investigate the safety and efficacy of gamma knife radiosurgery (GKRS) for Cushing's disease after transsphenoidal surgery failure.
- To evaluate treatment outcomes, including hormonal remission, recurrence, and complications.
Main Methods:
- Retrospective review of patients undergoing GKRS for Cushing's disease post-transsphenoidal surgery.
- Assessment of 24-hour urinary free cortisol (UFC) levels for treatment success.
- Evaluation of tumor size changes, endocrine deficiencies, and visual complications.
Main Results:
- GKRS achieved normal UFC levels in 63% of 43 patients (mean follow-up 39.1 months).
- Tumor size decreased in 73% of evaluated patients; no increase was observed.
- New endocrine deficiencies occurred in 16% of patients, with 3 recurrences noted.
Conclusions:
- GKRS is a safe and effective option for Cushing's disease refractory to pituitary surgery.
- Long-term surveillance is essential to monitor for delayed recurrences and new endocrine deficits.