J Neurol Surg A Cent Eur Neurosurg 2014; 75(02): 091-097
DOI: 10.1055/s-0033-1345688
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease After Transsphenoidal Surgery

Mohammad Bodaghabadi
1   Department of Neuroradiosurgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
Hooman Riazi
2   Department of Neurosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Islamic Republic of Iran
,
Shima Aran
3   Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Mohammad Ali Bitaraf
1   Department of Neuroradiosurgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
4   Department of Neuroradiosurgery, Iran Gamma Knife Center, Tehran, Islamic Republic of Iran
,
Mazdak Alikhani
4   Department of Neuroradiosurgery, Iran Gamma Knife Center, Tehran, Islamic Republic of Iran
,
Mahmud Alahverdi
5   Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
Masoumeh Mohamadi
6   Department of Neuroradiosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Islamic Republic of Iran
,
Keivan Shalileh
7   Department of Radiology, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
,
Maziar Azar
4   Department of Neuroradiosurgery, Iran Gamma Knife Center, Tehran, Islamic Republic of Iran
› Author Affiliations
Further Information

Publication History

02 August 2012

13 February 2013

Publication Date:
21 August 2013 (online)

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.

Material and 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.

Conclusion With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.

 
  • References

  • 1 Katavetin P, Cheunsuchon P, Swearingen B, Hedley-Whyte ET, Misra M, Levitsky LL. Review: pituitary adenomas in children and adolescents. J Pediatr Endocrinol Metab 2010; 23 (5) 427-431
  • 2 Benbassat CA, Tsvetov G, Shefet D, Weinstein R, Rappaport ZH. [Cushing disease: long-term follow-up after transsphenoidal surgery]. Harefuah 2004; 143 (9) 636-638 , 696, 695
  • 3 Swearingen B, Biller BM, Barker II FG , et al. Long-term mortality after transsphenoidal surgery for Cushing disease. Ann Intern Med 1999; 130 (10) 821-824
  • 4 Liu JK, Fleseriu M, Delashaw Jr JB, Ciric IS, Couldwell WT. Treatment options for Cushing disease after unsuccessful transsphenoidal surgery. Neurosurg Focus 2007; 23 (3) E8
  • 5 Burch W. A survey of results with transsphenoidal surgery in Cushing's disease [letter]. N Engl J Med 1983; 308 (2) 103-104
  • 6 Castinetti F, Nagai M, Dufour H , et al. Gamma knife radiosurgery is a successful adjunctive treatment in Cushing's disease. Eur J Endocrinol 2007; 156 (1) 91-98
  • 7 Gopalan R, Dassoulas K, Rainey J, Sherman JH, Sheehan JP. Evaluation of the role of Gamma Knife surgery in the treatment of craniopharyngiomas. Neurosurg Focus 2008; 24 (5) E5
  • 8 Jagannathan J, Sheehan JP, Pouratian N, Laws ER, Steiner L, Vance ML. Gamma Knife surgery for Cushing's disease. J Neurosurg 2007; 106 (6) 980-987
  • 9 Brada M, Ajithkumar TV, Minniti G. Radiosurgery for pituitary adenomas. Clin Endocrinol (Oxf) 2004; 61 (5) 531-543
  • 10 Laws ER, Sheehan JP, Sheehan JM, Jagnathan J, Jane Jr JA, Oskouian R. Stereotactic radiosurgery for pituitary adenomas: a review of the literature. J Neurooncol 2004; 69 (1-3) 257-272
  • 11 Thorén M, Höybye C, Grenbäck E, Degerblad M, Rähn T, Hulting AL. The role of gamma knife radiosurgery in the management of pituitary adenomas. J Neurooncol 2001; 54 (2) 197-203
  • 12 Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws Jr ER. Radiosurgery for Cushing's disease after failed transsphenoidal surgery. J Neurosurg 2000; 93 (5) 738-742
  • 13 Kobayashi T, Kida Y, Mori Y. Gamma knife radiosurgery in the treatment of Cushing disease: long-term results. J Neurosurg 2002; 97 (5, Suppl): 422-428
  • 14 Petrovich Z, Yu C, Giannotta SL, Zee CS, Apuzzo ML. Gamma knife radiosurgery for pituitary adenoma: early results. Neurosurgery 2003; 53 (1) 51-59 , discussion 59–61
  • 15 Kobayashi T. Long-term results of stereotactic gamma knife radiosurgery for pituitary adenomas. Specific strategies for different types of adenoma. Prog Neurol Surg 2009; 22: 77-95
  • 16 Höybye C, Grenbäck E, Rähn T, Degerblad M, Thorén M, Hulting AL. Adrenocorticotropic hormone-producing pituitary tumors: 12- to 22-year follow-up after treatment with stereotactic radiosurgery. Neurosurgery 2001; 49 (2) 284-291 , discussion 291–292
  • 17 Hentschel SJ, McCutcheon IE. Stereotactic radiosurgery for Cushing disease. Neurosurg Focus 2004; 16 (4) E5
  • 18 Feigl GC, Bonelli CM, Berghold A, Mokry M. Effects of gamma knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg 2002; 97 (5, Suppl): 415-421
  • 19 Oyesiku NM. Stereotactic radiosurgery for Cushing disease: a review. Neurosurg Focus 2007; 23 (6) E14
  • 20 Malik MU, Aberle JC, Flitsch J. CSF fistulas after transsphenoidal pituitary surgery—a solved problem?. J Neurol Surg A Cent Eur Neurosurg 2012; 73 (5) 275-280
  • 21 Indrayan A, Bansal AK. The methods of survival analysis for clinicians. Indian Pediatr 2010; 47 (9) 743-748
  • 22 Pouratian N, Prevedello DM, Jagannathan J, Lopes MB, Vance ML, Laws Jr ER. Outcomes and management of patients with Cushing's disease without pathological confirmation of tumor resection after transsphenoidal surgery. J Clin Endocrinol Metab 2007; 92 (9) 3383-3388
  • 23 Lamas Oliveira C, Estrada García J. [Treatment of Cushing's disease. Transsphenoidal surgery and pituitary radiotherapy]. Endocrinol Nutr. 2009; 56 (3) 123-131
  • 24 Ram Z, Nieman LK, Cutler Jr GB, Chrousos GP, Doppman JL, Oldfield EH. Early repeat surgery for persistent Cushing's disease. J Neurosurg 1994; 80 (1) 37-45