title: [Successful treatment of Cushing disease with the sphenoid sinus of conchal type: usefulness of inferior petrosal sinus sampling and STEALTH navigation system: a case report].
abstract: We report a case of Cushing disease whose microadenoma was not identified by MRI with dynamic study and whose sphenoid sinus was conchal in type. Venous sampling test in the bilateral inferior petrosal sinus demonstrated ACTH hypersecretion on the right side. The patient underwent transsphenoidal surgery. A poorly pneumatized sphenoid sinus was drilled effectively, guided by the STEALTH navigation system. After the first operation, the patient's serum ACTH concentration was still high, suggesting that tumor removal was incomplete. Then she underwent the second operation and the residual tumor was completely removed with the assistance of the STEALTH navigation system again. Postoperatively, her serum ACTH concentration dropped below 5 pg/ml. In this case, inferior petrosal sinus sampling was extremely helpful for the diagnosis of Cushing disease, and operations were able to be performed safely using the neuronavigation system in drilling of the incompletely pneumatized sphenoid sinus.
authors.affiliation: Department of Neurosurgery, Kanazawa University School of Medicine, Ishikawa, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Osamu
authors.initials: O
authors.lastname: Tachibana
authors.forename: Hironori
authors.initials: H
authors.lastname: Fujisawa
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Miyashita
authors.forename: Junko
authors.initials: J
authors.lastname: Yamashita
authors.forename: Toshinari
authors.initials: T
authors.lastname: Takamura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Mistu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007016:Hypophysectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000601:surgery*; D012086:Reoperation; D013101:Sphenoid Sinus / Q000601:surgery
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone