[The results of neurosurgical treatment in Itsenko-Cushing's disease]

Fifty three consecutive patients with Cushing's disease were operated on in the Neurosurgical Institute from 1987 to 1995. In all cases the diagnosis was based on clinical and laboratory data, as well as radiographic images. Ten patients with false-negative CT scans had MRI confirming the presence of microadenomas less than 5 mm in size. The majority of patients (n = 51) were operated via transsphenoidal approach, transcranial route was utilized in 2 cases. Among the pathological findings, corticotropinomas were revealed in 49 cases, 4 patients were considered to have hyperplasia of the anterior pituitary without well demarcated adenoma. All patients were divided into 2 groups based on the history of previous treatment. Group 1 included 37 primary patients who had not been treated before admission. Group 2 included 16 patients treated surgically (e.g. neurosurgical operations, bilateral/unilateral adrenalectomy), or with irradiation therapy, including proton beam irradiation prior to admission. We came to conclusion that the following principles were essential in the management of Cushing's disease. 1. Properly interpreted clinical signs and symptoms along with biochemical data and radiographic imaging (including MRI) are extremely helpful in the preoperative evaluation of such patients. Our approach helped us reveal corticotropinomas with 98% accuracy. 2. Microsurgical removal was proved to be effective in up to 83% of patients, which was demonstrated by clinical and biochemical remission. 3. It should be emphasized that the results of treatment were significantly better in the first group versus the second one. In group 1, remission was reached in 91.1% of patients as compared to 62.5% in Group 2. 4. In primary patients, the trauma associated with surgical procedure is less and tumors demonstrate a less aggressive biological behavior.