Outcome of Transphenoid Surgery for Corticotroph Pituitary Tumors

Background & Importance: The aim of this study was to demonstrate the result of transsphenoid microsurgery for Cushing disease in our center and comparing the results in details with other articles, to achieve the best decision for patients management in future. Case Presentation: Between 1991 to 2015, 50 patients suffering from Cushing disease were operated. Before operation, endocrine tests and neuroimaging examinations were done for all patients and all of them were operated via transsphenoid approach. They were followed up in clinic with endocrine tests and imaging in regular intervals. During this study, 50 Cushing cases including 47 primary and three secondary tumors were operated. Thirty four (68%) tumors were microadenoma and 16 (32%) macroadenoma. A patient died due to postoperative fulminant meningitis (mortality=2%). Mean of follow-up was five years. Overall, 40 (80%) patients had remission after operation and 9 (18%) patients achieved no remission, three of them had macroadenoma and six microadenoma. During follow-up period, three (6%) patients had recurrence which needed second operation. In secondary tumor and in macroadenoma with cavernous sinus involvement, the result was not good (33% and 0% remission, respectively). Conclusion: Transsphenoid surgery is a safe and effective first choice method to manage Cushing disease compared to other treatment modalities. In recurrent or resistant cases, other modalities could help to manage patients.