Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease After Transsphenoidal Surgery

Abstract

Background This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA.

Material and Methods Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging.

Results No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-hour free urine cortisol and disease-free months or tumor volume among both groups. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group.

Conclusion With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.

Keywords

transsphenoidal surgery - gamma knife radiosurgery - Cushing disease

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