Retrospective analysis of the outcomes of endoscopic transsphenoidal surgery for Cushing’s disease

Q3 Medicine
Anurag Srivastava, Anmol Anant Dobriyal, Anmol Singh Randhawa, Pavan Kumar Jain, Shiteez Agrawal, Jitendra Singh Verma, Pankaj Gupta, Bhawani Shanker Sharma, Yogesh Agrawal, Medha Bhardwaj
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Abstract

The first-line surgical management of an adrenocorticotropic hormone (ACTH)--secreting pituitary adenoma causing Cushing’s disease (CD) is endoscopic transsphenoidal resection of the tumor. This study was performed to assess postoperative (postop) complications and remission in endoscopic surgically resected cases of CD. Data of patients who underwent endoscopic transsphenoidal surgery (ETSS) for CD were collected from the neurosurgery department at a tertiary care center in a retrospective manner from January 2015 to February 2022 and analyzed. Postoperative remission was categorized as – early morning serum cortisol <138 nmol/L within 7 days of the surgery, as per the Endocrine Society Guidelines, with significant clinical improvement in features of hypercortisolism in the operated patient and strict cutoff rate of <50 nmol/L at postop day 3 was also utilized, to look for the early identification of remission. A total of 41 patients were identified who underwent 44 ETSS during the same timeframe. Preoperative magnetic resonance imaging localized an adenoma in all 41 patients, out of which 32 were microadenoma, and nine were macroadenoma (2 with cavernous sinus invasion). Intrapetrosal sinus sampling was performed in 35 (85%) patients. The rate of remission for the initial surgery was 85.4% using the standard criteria and 68.3% using strict criteria. Three patients underwent early repeat surgery for the persistent disease as the day 3 cortisol was high (306–555 nmol/L). Once the outcome of this surgery was also included, the overall rate of remission was 90.2% (37/41). None of the patients had meningitis, cerebrospinal fluid leakage, visual deterioration, or vascular injury. Permanent and transient diabetes insipidus (DI) occurred in 9.75% and 26.8% following the first ETSS, respectively. We also noted a single case of CD recurrence in 9 months during the total follow-up period of 84 months. ETSS has satisfactory rates of remission for the primary treatment of CD, with rates being higher for microadenomas. A long follow-up period is needed to assess the rates of recurrence. Patients must be counseled regarding the risk of postop DI, whether transient or permanent, as a possible complication.
内窥镜经蝶窦手术治疗库欣氏病疗效的回顾性分析
分泌促肾上腺皮质激素(ACTH)的垂体腺瘤导致库欣病(CD)的一线手术治疗方法是内镜下经蝶窦切除肿瘤。这项研究旨在评估内镜手术切除的CD病例的术后并发症和缓解情况。研究人员以回顾性方式收集了2015年1月至2022年2月期间某三级医疗中心神经外科接受内镜经蝶手术(ETSS)治疗CD的患者数据,并对其进行了分析。根据内分泌学会指南,术后缓解被归类为--术后7天内清晨血清皮质醇<138 nmol/L,且手术患者高皮质醇血症的临床特征明显改善,同时还采用术后第3天血清皮质醇<50 nmol/L的严格临界值,以寻找缓解的早期识别。术前磁共振成像确定了所有 41 例患者的腺瘤位置,其中 32 例为微腺瘤,9 例为大腺瘤(2 例伴有海绵窦侵犯)。35名患者(85%)进行了海绵窦内取样。根据标准标准,初次手术的缓解率为 85.4%,根据严格标准,缓解率为 68.3%。有三名患者由于第 3 天皮质醇偏高(306-555 nmol/L)而再次接受了早期手术。如果将这次手术的结果也计算在内,总缓解率为 90.2%(37/41)。没有一名患者出现脑膜炎、脑脊液漏、视力恶化或血管损伤。首次 ETSS 后,分别有 9.75% 和 26.8% 的患者出现永久性和一过性糖尿病(DI)。我们还注意到,在总计 84 个月的随访期中,有一例 CD 病例在 9 个月后复发。ETSS 对 CD 的初级治疗具有令人满意的缓解率,微腺瘤的缓解率更高。要评估复发率,需要长时间的随访。必须告知患者术后DI的风险,无论是暂时性还是永久性的,这都是可能出现的并发症。
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来源期刊
CiteScore
1.30
自引率
0.00%
发文量
623
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