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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Outcomes after repeat transsphenoidal surgery for recurrent Cushing's disease
Chirag G Patil1, Anand Veeravagu, Daniel M Prevedello
1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. chiragpatil@gmail.com
Neurosurgery
|September 18, 2008
Summary
Repeat transsphenoidal surgery offers a chance for remission in recurrent Cushing's disease, though less successful than initial operations. Alternative treatments are available if surgery fails.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Cushing's disease, caused by pituitary corticotroph adenomas, often requires surgical intervention.
- Recurrence of Cushing's disease after initial transsphenoidal surgery necessitates further treatment strategies.
Purpose of the Study:
- To systematically analyze patient outcomes following repeat transsphenoidal (TS) surgery for recurrent Cushing's disease.
- To evaluate the efficacy and predictors of remission after a second TS intervention.
Main Methods:
- Retrospective review of 36 patients undergoing repeat TS surgery for recurrent Cushing's disease (1992-2006).
- Definition of remission based on postoperative 24-hour urine free cortisol or need for glucocorticoid replacement.
- Multivariate logistic regression analysis to identify predictors of remission.
Main Results:
- Remission was achieved in 61% (22/36) of patients after repeat TS surgery.
- The odds of failure were 3.7 times higher compared to first-time TS surgery (85.5% remission rate).
- Overall remission, including subsequent therapies, was achieved in 83.3% of patients.
Conclusions:
- Repeat TS surgery provides a viable option for achieving remission in recurrent Cushing's disease, despite lower success rates than initial surgery.
- For persistent or recurrent disease post-surgery, alternative treatments like pituitary radiation, medical therapy, or bilateral adrenalectomy are crucial.
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