Berker Mustafa, Işikay Ilkay, Berker Dilek, Bayraktar Miyase, Gürlek Alper
Department of Neurosurgery, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey,
Neurosurg Rev. 2013 Nov 15. doi: 10.1007/s10143-013-0506-6.
High levels of endogenous cortisol due to Cushing's disease cause significant mortality and morbidity. Treatment of Cushing's disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon's armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing's disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing's disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing's disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.
库欣病导致的高水平内源性皮质醇会引起显著的死亡率和发病率。库欣病的治疗具有挑战性。多年来，经蝶窦显微手术切除腺瘤一直是首选治疗方法。然而，最近神经内镜已在神经外科医生的器械库中占据一席之地，内镜经蝶窦切除垂体肿瘤已成为一种常见的方法。我们的目的是展示单纯内镜手术治疗促肾上腺皮质激素瘤的结果，以便与先前的内镜和显微手术系列结果进行比较。我们对2006年至2012年间接受手术的90例库欣病诊断患者进行了回顾性分析。在90例患者中，共有81例（90.0%）病情缓解（29例大腺瘤中有28例（96.6%），61例微腺瘤患者中有53例（86.9%））。值得注意的是，69例初治患者（即在我们中心接受手术的患者）中有66例（95.7%）以及先前在其他中心接受手术的21例患者中有15例（71.4%）达到了低/正常皮质醇血症状态。实现了与先前内镜系列相当的缓解率。有9例患者根本无法实现缓解。另一方面，我们的病例中只有4例（5.6%）复发，再次手术后，所有这些患者都再次缓解。据我们所知，我们的系列是研究内镜手术治疗促肾上腺皮质激素分泌腺瘤的最大系列。我们的结果表明，内镜方法为库欣病的治疗开辟了一条新途径，库欣病此前对临床医生和神经外科医生来说都是治疗挑战。内镜方法治疗库欣病对患者显然更好，因为其发病率低且住院时间短。另一方面，对我们患者的长期随访将表明这些有利观察结果是否会持续。
