Baussart Bertrand, Hudelist Benoit, Villa Chiara, Hage Mirella, Jouinot Anne, Reina Vincent, Barat Maxime, Leclercq Delphine, Passeri Thibault, Touraine Philippe, Cebula Hélène, Guignat Laurence, Courtillot Carine, Chanson Philippe, Vatier Camille, Froelich Sébastien, Bertherat Jérôme, Assié Guillaume, Gaillard Stephan
Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, Lariboisière University Hospital, 2 Rue Ambroise Paré, Paris, 75010, France.
CNRS, INSERM, Institut Cochin, Université Paris Cité, Paris, F-75014, France.
Neurosurg Rev. 2025 Jun 5;48(1):483. doi: 10.1007/s10143-025-03656-1.
In Cushing's disease, the rate of endocrine remission after surgery reaches 80% in expert centers. However, due to the tumor's capacity to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve the likelihood of remission, tumor resection can be extended to the dura in patients who show basal dura invasion. The objective was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.
Endoscopic surgery was performed in 89 adult patients with no obvious cavernous invasion. The basal dura was systematically removed whenever a macroscopic invasion was suspected. Three groups were defined: (i) resected but noninvaded dura (n = 14); (ii) resected and invaded dura (n = 16); and (iii) nonresected dura (n = 59). The studied cohort was compared to a control personal series of Cushing's patients with no systematic focus on the basal dura.
The mean follow-up duration was 19.9 ± 9.4 months. Endocrine remission was achieved in 15/16 (94%) patients with invaded dura, 14/15 (93%) patients with resected noninvaded dura and 50/59 (85%) patients with nonresected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients respectively. Compared to the control series, our remission rate was significantly higher (88% vs. 75%, P =.019).
Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dura invasion, endocrine remission is high when the dura is removed. A systematic focus on the basal dura can optimize endocrine outcomes.
在库欣病中，专业中心手术后内分泌缓解率达80%。然而，由于肿瘤侵犯周围硬脑膜结构的能力，20%的患者高皮质醇血症持续存在或15%的患者复发。为提高缓解的可能性，对于显示基底硬脑膜侵犯的患者，肿瘤切除可扩展至硬脑膜。目的是评估基于系统关注基底硬脑膜的手术策略的益处。
对89例无明显海绵窦侵犯的成年患者进行内镜手术。每当怀疑有肉眼可见的侵犯时，系统地切除基底硬脑膜。定义了三组：(i)切除但未侵犯的硬脑膜（n = 14）；(ii)切除且侵犯的硬脑膜（n = 16）；(iii)未切除的硬脑膜（n = 59）。将研究队列与未系统关注基底硬脑膜的库欣病患者的对照个人系列进行比较。
平均随访时间为19.9±9.4个月。16例侵犯硬脑膜的患者中有15例（94%）实现内分泌缓解，15例切除未侵犯硬脑膜的患者中有14例（93%）实现内分泌缓解，59例未切除硬脑膜的患者中有50例（85%）实现内分泌缓解。垂体前叶功能减退和尿崩症分别发生在3%和9%的患者中。与对照系列相比，我们的缓解率显著更高（88%对75%，P = 0.019）。
扩展至基底硬脑膜的肿瘤切除术是一种安全的手术，可最大限度地进行手术切除。尽管硬脑膜受侵犯，但切除硬脑膜时内分泌缓解率很高。系统关注基底硬脑膜可优化内分泌结果。
