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Outcomes After Repeat Transsphenoidal Surgery for Recurrent Cushing Disease: Updated
William T Burke1, David L Penn2, Caroline S Repetti2
1University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky.
Neurosurgery
|May 30, 2019
Summary
Repeat transsphenoidal surgery (TSS) for Cushing disease (CD) offers a safe and effective treatment option for recurrent cases. This approach can lead to sustained remission, making it a viable alternative to radiation or medical therapies.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Transsphenoidal surgery (TSS) is the primary treatment for Cushing disease (CD).
- High recurrence rates after initial TSS present a significant clinical challenge.
Purpose of the Study:
- To systematically review the indications for repeat TSS in recurrent CD.
- To evaluate the outcomes of repeat TSS for Cushing disease.
Main Methods:
- Retrospective review of patients undergoing repeat TSS for recurrent CD between 2008-2018.
- Analysis of a combined cohort including previously published data (1992-2006).
- Inclusion criteria required a minimum 12-month postoperative follow-up.
Main Results:
- In the current cohort (2008-2018), 15 patients underwent repeat TSS for recurrent CD.
- Immediate postoperative remission was achieved in 86.7% of patients, with 68.8% experiencing persistent remission at an average follow-up of 34.7 months.
- The combined cohort (n=51) showed 68.6% had evidence of recurrence on preoperative MRI, with 60.8% achieving continued remission at follow-up.
Conclusions:
- Repeat TSS is a viable and safe therapeutic option for managing recurrent Cushing disease.
- This surgical approach can be considered before pursuing radiation or medical treatments for CD recurrence.
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