title: Repeated transsphenoidal surgery or gamma knife radiosurgery in recurrent cushing disease after transsphenoidal surgery.
abstract: BACKGROUND
  This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA.
  
  
  METHODS
  Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging.
  
  
  RESULTS
  No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-hour free urine cortisol and disease-free months or tumor volume among both groups. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group.
  
  
  CONCLUSIONS
  With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.
authors: Department of Neuroradiosurgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors: Mohammad
authors: M
authors: Bodaghabadi
authors: Department of Neurosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Islamic Republic of Iran.
authors: Hooman
authors: H
authors: Riazi
authors: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors: Shima
authors: S
authors: Aran
authors: Department of Neuroradiosurgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors: Mohammad Ali
authors: MA
authors: Bitaraf
authors: Department of Neuroradiosurgery, Iran Gamma Knife Center, Tehran, Islamic Republic of Iran.
authors: Mazdak
authors: M
authors: Alikhani
authors: Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors: Mahmud
authors: M
authors: Alahverdi
authors: Department of Neuroradiosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Islamic Republic of Iran.
authors: Masoumeh
authors: M
authors: Mohamadi
authors: Department of Radiology, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
authors: Keivan
authors: K
authors: Shalileh
authors: Department of Neuroradiosurgery, Iran Gamma Knife Center, Tehran, Islamic Republic of Iran.
authors: Maziar
authors: M
authors: Azar
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000473:pathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult