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DOI: 10.1055/s-0029-1241207
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Ultrasound-assisted Microsurgery for Cushing's Disease
Publication History
received 30.07.2009
first decision 24.08.2009
accepted 21.09.2009
Publication Date:
11 December 2009 (online)

Abstract
Objective: Localization of microadenomas in Cushing's disease may be difficult as in up to 45% of patients sellar MRI fails to detect a pituitary tumor. Intraoperative transsphenoidal ultrasound may identify microadenomas as hyperechoic structures. We report on the first 18 consecutive cases with intraoperative use of a new device for direct contact high-frequency-ultrasound in patients with Cushing's disease.
Patients and technique: 18 patients (14 female, 4 male, age 24–71 years) with typical endocrinological findings for Cushing's disease were included in the study. One macroadenoma and 13 microadenomas were suspected or identified preoperatively by MRI. In 4 cases, two of them with recurrent disease, sellar MRIs were negative. During transsphenoidal microsurgery an end fire ultrasound-probe (B-mode frequency range 7.5–13 Mhz, field of view 5 mm, penetration 20 mm) was introduced after opening of sellar floor. The pituitary gland was scanned in direct contact to the capsule.
Results: In 13 out of 17 cases (77%) with later on proven microadenomas high-frequency-ultrasound identified the tumors as hyperechoic masses, including 3 of the 4 cases with negative preoperative MRI. In 2 cases ultrasound correctly localized the tumor at a site different from MRI finding (MRI false positive). In the macroadenoma, identification of the border between tumor and anterior pituitary gland was not possible. In all 18 patients postoperative early decline of serum cortisol to subnormal levels confirmed remission of hypercortisolism (100%). Other pituitary functions were unaltered in 17 cases (94%).
Conclusions: Intraoperative scanning of the pituitary gland with high-frequency-ultrasound probes may identify intrapituitary anatomy and pathologies even in MRI-negative cases. This may prevent extensive exploration of the gland with the risk of subsequent hypopituitarism.
Key words
Cushing's disease - intraoperative imaging - microadenoma - pituitary tumor - transsphenoidal surgery - ultrasound
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Correspondence
PD Dr. med. U. J. Knappe
Department of Neurosurgery
Johannes Wesling Klinikum
Hans-Nolte-Straße 1
D-32429 Minden
Germany
Phone: +49/571/790 3301
Fax: +49/571/790 29 2929
Email: ulrich.knappe@klinikum-minden.de