title: Outcome of Microscopic Transsphenoidal Surgery in Cushing Disease: A Case Series of 96 Patients.
abstract: OBJECTIVE
  To analyze the results of transsphenoidal surgery in patients with Cushing disease and outcome.
  
  
  METHODS
  Retrospective analysis of the records of 96 patients with Cushing disease from 1997 to 2012.
  
  
  RESULTS
  There were 73 females and 23 males, with a mean follow-up of 44 months (range, 3-13 years). The sex ratio was significantly different in children and teenagers versus adults. Magnetic resonance imaging showed microadenoma, macroadenoma, and no adenoma in 66, 18, and 12 patients, respectively. There was no surgical mortality. Early remission (normal 24-hour urinary free cortisol and basal serum cortisol <5 μg/dL) was achieved in 94.8%. Regression analysis showed that only tumor size, cavernous sinus extension, and tumor consistency influenced remission. Recurrence was seen in 21.9%. Regression analysis showed that age, preoperative basal cortisol levels, and follow-up duration influenced recurrence. Correlation analysis showed that there was a significant negative correlation between patient age and the follow-up period. After detection of recurrence, 17 patients underwent repeat transsphenoidal surgery that resulted in remission in 12 patients (70.6%). The other 5 patients were referred for gamma knife radiosurgery or bilateral adrenalectomy.
  
  
  CONCLUSIONS
  Transsphenoidal surgery is a safe and highly efficient procedure in the treatment of Cushing disease. Macroadenomas, cavernous sinus invasion, and harder tumor consistencies, however, are associated with lower remission rates (higher disease persistence) and younger age, higher preoperative cortisol levels, and longer follow-up periods are associated with higher recurrence.
authors.affiliation: Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Tehran Clinic Hospital, Tehran, Iran. Electronic address: dmshirvani@gmail.com.
authors.forename: Manochehr
authors.initials: M
authors.lastname: Shirvani
authors.affiliation: Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Rouzbeh
authors.initials: R
authors.lastname: Motiei-Langroudi
authors.affiliation: Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
authors.forename: Homa
authors.initials: H
authors.lastname: Sadeghian
mesh_terms: D000236:Adenoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012744:Sex Ratio; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Cushing disease; Outcome; Recurrence; Remission; Transsphenoidal surgery