Cebula Hélène, Baussart Bertrand, Villa Chiara, Assié Guillaume, Boulin Anne, Foubert Luc, Aldea Sorin, Bennis Saad, Bernier Michèle, Proust François, Gaillard Stephan
Department of Neurosurgery, Hôpital Hautepierre, 1 avenue Molière, 67100, Strasbourg, France.
Department of Neurosurgery, Hôpital Foch, Suresnes, France.
Acta Neurochir (Wien). 2017 Jul;159(7):1227-1236. doi: 10.1007/s00701-017-3140-1. Epub 2017 Mar 9.
The primary objective was to assess the remission rate, and the secondary objectives were to evaluate the early complications and recurrence rate and to define the predictive factors for the remission and recurrence rates.
This prospective single-center study included 230 consecutive patients, operated on by a single surgeon for Cushing's disease via a transsphenoidal endoscopic endonasal approach, over a 6-year period (2008-2013). The patients included in this series were all adults (>18 years of age), who presented with clinical and biological characteristics of Cushing's disease confirmed based on dedicated MRI pituitary imaging. Biochemical remission was defined as a postoperative serum cortisol level <5 μg/dl on the 2nd day following surgery that required glucocorticoid replacement therapy.
The remission rate for the global population (n = 230) with a follow-up of 21 ± 19.2 months concerned 182 patients (79.1%) divided into 132 patients (82.5%) with positive MRI and 50 patients (71.4%) with negative MRI with no statistically significant difference (p = 0.077). Complications occurred in 77 patients with no deaths. A total of 22% of patients had transient diabetes insipidus and 6.4% long-term diabetes insipidus, and no postoperatively CSF leakage was observed. The recurrence rate was 9.8% with a mean time of 32.7 ± 15.2 months. The predictive factors for the remission rate were the presence of pituitary microadenoma and a positive histology. No risk factors were involved regarding the recurrence rate.
Whatever the MRI results, the transsphenoidal endonasal endoscopic approach remains the gold standard treatment for Cushing's disease. It was maximally effective with a remission rate of 79.1% and lower morbidity.
主要目的是评估缓解率，次要目的是评估早期并发症和复发率，并确定缓解率和复发率的预测因素。
这项前瞻性单中心研究纳入了230例连续患者，在6年期间（2008 - 2013年）由同一外科医生经鼻内镜经蝶窦入路手术治疗库欣病。本系列纳入的患者均为成年人（>18岁），根据专门的垂体MRI成像确诊具有库欣病的临床和生物学特征。生化缓解定义为术后第2天血清皮质醇水平<5μg/dl且需要糖皮质激素替代治疗。
对230例患者进行了随访，随访时间为21±19.2个月，缓解率为182例患者（79.1%），其中MRI阳性患者132例（82.5%），MRI阴性患者50例（71.4%），差异无统计学意义（p = 0.077）。77例患者发生并发症，无死亡病例。共有22%的患者发生短暂性尿崩症，6.4%的患者发生长期性尿崩症，未观察到术后脑脊液漏。复发率为9.8%，平均时间为32.7±15.2个月。缓解率的预测因素是垂体微腺瘤的存在和组织学阳性。复发率方面未涉及危险因素。
无论MRI结果如何，经鼻内镜经蝶窦入路仍然是库欣病的金标准治疗方法。它效果极佳，缓解率为79.1%，发病率较低。
