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 detail with other article, to achieve the best decision to manage patients in future.
Between 1991 to 2015, 50 patients suffering from Cushing disease were operated. Before operation, endocrine tests and neuroimaging studies were done for all patients and all the patient were operated via transsphenoid approach. They were followed up in clinic with endocrine tests and imaging in regular intervals. During this study, 50 Cushing disease including 47 primaries and 3 secondary tumors were operated. Thirty-four (68%) of tumors were microadenoma and 16 (32%) patients had macroadenoma. A patient died due to post-operative fulminant meningitis (mortality= 2%). Mean of follow up was 5 years. Overall, 40 (80%) of patients had remission after operation and 9 (18%) patients achieved no remission, 3 of them had macroadenoma and 6 tumors were microadenoma. During follow-up period 3 (6%) patients had recurrence which need second operation. In secondary tumor and in macroadenoma with cavernous sinus involvement the result was not good (33% & 0% remission respectively).
Transsphenoid surgery is a safe and effective first choice method to manage Cushing disease comparing to other treatment modality. In recurrent or resistant cases other modality could help to manage patients.