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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Intraoperative identification of ACTH-secreting adenomas in Cushing's disease using high-frequency direct contact ultrasound. Preleminary results

Erste Ergebnisse von intraoperativer Identifizierung ACTH-sezernierende Adenome bei M. Cushing mittels hoch-Frequenz Ultraschall im Direkt-Kontakt-Modus

Meeting Abstract

  • corresponding author U.J. Knappe - Neurochirurgische Klinik, Johannes Wesling Klinikum, Minden
  • W. A. Mann - Endokrinologikum Frankfurt/Main
  • M. Engelbach - Endokrinologische Gemeinschaftspraxis Frankfurt/Main
  • K. Konz - Fachbereich Endokrinologie, Deutsche Klinik für Diagnostik, Wiesbaden
  • R. Schönmayr - Klinik für Neurochirurgie, Dr. Horst Schmidt Klinik, Wiesbaden

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 030

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc298.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Knappe et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Up to 40% of cases with endocrinologically and surgically proven Cushing's disease are MRI-negative [1]. With intraoperative transsphenoidal ultrasound 72% of microadenomas in Cushing's disease (CD) were identified as hyperechogenic structure [2]. We report on the first 9 cases with intraoperative use of direct contact high-frequency ultrasound (hf-us) in patients with Cushing's disease.

Methods: Patients: All 9 cases (all female, age 31–71 years) revealed typical symptoms of Cushing's disease. Two patients suffered from recurrent CD.

Technique: During direct transnasal microsurgical operations the sellar compartment was investigated in axial and sagittal direction at 12 and 13 MHz, respectively through the pituitary capsule after drilling of the sellar floor by use of a digital ultrasound probe (UST-534, ALOKA, Wallington, CT: B-mode frequency 7.5-13 Mhz, wide of field 5 mm, penetration 20 mm).

Results: In all 4 cases with negative preoperative MRI intraoperative hf-us correctly localized micoadenomas. In 2 out of 5 cases with positive MRI hf-us identified a hyperechogenic structure at the site expected (positive control). In 2 other cases with micoadenomas MRI correctly predicted the site of the tumor, but no identification was possible by hf-us. In the only case with a macroadenoma, identification of the border between tumor and anterior pituitary gland was not possible by use of hf-us. Out of 8 cases with microadenomas, in 6 the tumor was identified by hf-us (75%). Early postoperative decline of serum cortisol to subnormal levels on the first postoperative morning revealed surgically induced remission of hypercortisolism in all 9 cases [1].

Conclusions: Intraoperative, direct contact hf-us may enable the surgeon to identify small ACTH-secreting pituitary adenomas even in cases of negative preoperative MRI, thus preventing these patients from extensive pituitary exploration.


References

1.
Knappe UJ, Lüdecke DK. Transnasal microsurgery in children and adolescents with Cushing's disease. Neurosurgery. 1996;39(3):484-93.
2.
Ram Z, Shawker TH, Bradford MH, Doppman JL, Oldfield EH. Intraoperative ultrasound-directed resection of pituitary tumors. J Neurosurg. 1995;83(2):225-30.