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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Management of Cushing's disease using cavernous sinus sampling: effectiveness in tumor lateralization
Nurperi Gazioglu1, Mustafa Onur Ulu, Fatma Ozlen
1Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. nurperi@istanbul.edu.tr
Clinical Neurology and Neurosurgery
|March 4, 2008
Summary
Bilateral cavernous sinus sampling (CSS) accurately lateralized pituitary adenomas in 85% of Cushing's disease (CD) patients, aiding surgical planning. This safe diagnostic tool helps identify tumor location for improved treatment outcomes.
Area of Science:
- Endocrinology
- Neurosurgery
- Diagnostic Imaging
Background:
- Cushing's disease (CD) diagnosis and management require precise tumor localization.
- Preoperative lateralization of pituitary adenomas is crucial for successful transsphenoidal surgery (TS).
- Bilateral cavernous sinus sampling (CSS) is a technique used to assess pituitary hormone secretion lateralization.
Purpose of the Study:
- To evaluate the accuracy of bilateral cavernous sinus sampling (CSS) for preoperative tumor lateralization in patients with Cushing's disease (CD).
- To assess the safety and diagnostic value of CSS in guiding surgical intervention for pituitary adenomas.
Main Methods:
- Retrospective analysis of 26 consecutive patients with CD who underwent CSS followed by TS.
- Inclusion criteria: MRI showing normal pituitary or lesions ≤6mm.
- Simultaneous bilateral CSS with corticotropin-releasing hormone (CRH) stimulation, correlated with MRI, intraoperative, and pathological findings.
Main Results:
- Early remission was achieved in 88% of patients.
- CSS correctly predicted adenoma lateralization in 85% of cases (22/26 patients).
- No complications were reported related to CSS; false positives occurred in 4 cases.
Conclusions:
- Bilateral cavernous sinus sampling (CSS) is a valuable and safe diagnostic tool for Cushing's disease.
- CSS demonstrates high accuracy (85%) in predicting pituitary adenoma location, aiding surgical planning.
- The technique contributes to improved patient outcomes by facilitating targeted surgical approaches.
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