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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

M. Cushing – Outcome after endoscopic transsphenoidal pituitary surgery

Meeting Abstract

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  • Jens Conrad - Neurochirurgische Klinik, Universitätsmedizin Mainz
  • Ali Ayyad - Neurochirurgische Klinik, Universitätsmedizin Mainz
  • Monika Oser - Neurochirurgische Klinik, Universitätsmedizin Mainz
  • Alf Giese - Neurochirurgische Klinik, Universitätsmedizin Mainz

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.10.03

doi: 10.3205/14dgnc322, urn:nbn:de:0183-14dgnc3226

Published: May 13, 2014

© 2014 Conrad et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The transsphenoidal approach to sellar tumors has evolved enormously since its first description in the early 20th century. Despite neurosurgical developments in transsphenoidal surgery such as neuronavigation and endoscopic techniques with the possibility of using angled optics especially surgical management of Morbus Cushing is still difficult. Here we retrospectively analyze the outcome of patients with M. Cushing in an entirely endoscopic transsphenoidal series.

Method: Among 416 endoscopic transsphenoidal resections of different tumors of the sella, operated by a mononostril or binostril approach since 2003, 24 operations in 19 patients were performed in cases of M. Cushing. The subgroup includes 17 women and 2 men, average age is 40.2 years. Follow-up is 2 months to 9 years.

Results: In 17 patients treatment started at primary diagnosis. 12 patients were cured by first surgery (71%), in 2 patients no recurrence occurred after second resection (Follow-up 8 years) and in one patient after third transsphenoidal resection of a recurrent tumor (Follow-up 5 years). One patient after unsuccessful first surgery underwent a bilateral adrenalectomy (Follow-up 2 years). With progressive symptoms one patient required bilateral adrenalectomy and subsequently developed a Nelson tumor which was removed transsphenoidaly. Radiation is planned for residual tumor in the cavernous sinus. In one patient who presented with recurrent tumor we performed the second resection and no further tumor has recurred (Follow-up 6 years). Another patient was operated twice unsuccessfully using a microscopic transsphenoidal technique. With two further transsphenoidal endoscopic resections he was not cured. Pasireotid caused side effects, radiotherapy was rejected by the patient and bilateral adrenalectomy is now discussed.

Conclusions: Despite modern techniques in transsphenoidal surgery the cure rate of M. Cushing is still limited. However even with repeated endoscopic procedures required in some recurrent tumors long term control can be achieved. A successful treatment often involves the cooperation of neurosurgeon, endocrinologist, neuroradiologist, abdominal surgeon and radiation therapist.