J Neurol Surg B 2019; 80(03): 306-309
DOI: 10.1055/s-0038-1669956
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Long Term Follow-up after Endoscopic Endonasal Approach for the Treatment of Cushing's Disease

Alexandre Bossi Todeschini
1  Neurosurgery Division of the Department of Surgery, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
,
Américo Rubens Leite dos Santos
1  Neurosurgery Division of the Department of Surgery, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
,
Ricardo Landini Lutaif Dolci
2  Department of Otorhinolaryngology, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
,
José Viana Lima Junior
3  Endocrinology Division of the Department of Internal Medicine, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
,
Nilza Maria Scalissi
3  Endocrinology Division of the Department of Internal Medicine, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
,
Paulo Roberto Lazarini
2  Department of Otorhinolaryngology, Central Hospital–Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil
› Author Affiliations
Further Information

Publication History

07 May 2018

27 July 2018

Publication Date:
20 September 2018 (online)

Abstract

Introduction Surgery has been the standard treatment for Cushing's disease. Currently, the endoscopic endonasal approach (EEA) is the most widely used technique. However, among some endocrinologists and neurosurgeons used to the microscope assisted technique, there are still questions about the effectiveness and safety of transitioning to the EEA. We aim to show our initial experience with such transition.

Method Retrospective review of medical records of patients, who underwent EEA in our center as a first treatment for Cushing's disease, and with a minimum 18 months of follow-up, from March 2004 to March 2014

Results Our cohort had 16 patients (14 females and 2 males), with a mean age of 33.7 years. The mean follow-up was 52.0 months. Magnetic resonance imaging (MRI) identified an adenoma in 93.8% of the patients (56.2% microadenomas and 37.5% macroadenomas). Postoperative cerebrospinal fluid (CSF) leak was observed in two patients (12.5%). No new neurological deficits were present after surgery. The early remission and sustained remission rates after a single procedure were 87.5 and 68.75%, respectively. Weight reduction, improved control of blood pressure, and lower serum glucose levels were documented in 68.75, 60, and 55.5% of patients, respectively, after remission.

Conclusion Despite the need for specialized training, equipment and team building by ENT (Ear, Nose and Throat) and neurosurgery, the transition from microscope assisted pituitary surgery to endoscopic endonasal approach is possible and safe. The clinical outcomes, even in the early years, are similar to the previous microscope assisted treatment, and over time, with greater experience and knowledge, there is a tendency for improvement.

Submission Statement

The contents of this manuscript have not been copyrighted or published previously.


An abstract version of this data was presented as a poster at the 28th Annual North American Skull Base Society Meeting in February 16–18, 2018.


IRB Review Statement/Ethics Guidelines

This study was conducted in accordance to the local ethics committee guidelines.