Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas.
OBJECTIVE
To assess whether the type of surgical approach to the sella (sublabial transseptal vs transnasal) affects surgical outcome among patients with Cushing disease.


METHODS
Both procedures were performed at our institution from January 1, 1995, through January 31, 2003. From a total of 106 patients with Cushing disease who had had surgery, we identified 42 adults undergoing an initial surgery, with microadenoma (<1 cm) determined by magnetic resonance imaging and a minimal follow-up of 3 months.


RESULTS
We identified 21 patients (4 male, 17 female) for sublabial transseptal transsphenoidal microsurgery. Mean+/-SD age was 45.0+/-12.9 years (range, 27.0-69.0 years); median duration of symptoms was 2.5 years (range, 1.5-7.5 years). Median follow-up was 1.0 year (range, 0.3-11.0 years). We identified another 21 patients (5 male, 16 female) for endoscopic transsphenoidal microsurgery whose mean+/-SD age was 43.8+/-14.1 years (range, 19.0-70.0 years); median duration of symptoms was 2.4 years (range, 0.2-6.0 years). Median follow-up was 2.5 years (range, 0.3-8.7 years). Complications (cerebrospinal fluid leak and transient diabetes insipidus) and cure (86% initial cure; 76% relapse-included cure) were equivalent between the 2 procedures. However, the endoscopic approach was associated with shorter anesthesia time, less blood loss, and shorter hospital stays.


CONCLUSIONS
The endoscopic transnasal surgical approach led to shorter total anesthesia time, less blood loss, and shorter hospital stay when compared with the sublabial transseptal approach. However, we found no difference between the 2 surgical procedures with respect to cure or complications, suggesting that outcome is more closely related to the experience of the operating team.
Atkinson
John L D
JL
Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Young
William F
WF
Meyer
Fredric B
FB
Davis
Dudley H
DH
Nippoldt
Todd B
TB
Erickson
Dana
D
Vella
Adrian
A
Natt
Neena
N
Abboud
Charles F
CF
Carpenter
Paul C
PC
D049913:ACTH-Secreting Pituitary Adenoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D004724:Endoscopy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery; D012658:Sella Turcica / Q000601:surgery