Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas

John L.D. Atkinson, William F. Young, Fredric B. Meyer, Dudley H. Davis, Todd B. Nippoldt, Dana Erickson, Adrian Vella, Neena Natt, Charles F. Abboud, Paul C. Carpenter

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

OBJECTIVE: To assess whether the type of surgical approach to the sella (sublabial transseptal vs transnasal) affects surgical outcome among patients with Cushing disease. PARTICIPANTS AND METHODS: Both procedures were performed at our institution from January 1, 1995, through January 31, 2003. From a total of 106 patients with Cushing disease who had had surgery, we identified 42 adults undergoing an initial surgery, with microadenoma (<1 cm) determined by magnetic resonance imaging and a minimal follow-up of 3 months. RESULTS: We identified 21 patients (4 male, 17 female) for sublabial transseptal transsphenoidal microsurgery. Mean ± SD age was 45.0±12.9 years (range, 27.0-69.0 years); median duration of symptoms was 2.5 years (range, 1.5-7.5 years). Median follow-up was 1.0 year (range, 0.3-11.0 years). We identified another 21 patients (5 male, 16 female) for endoscopic transsphenoidal microsurgery whose mean ± SD age was 43.8±14.1 years (range, 19.0-70.0 years); median duration of symptoms was 2.4 years (range, 0.2-6.0 years). Median follow-up was 2.5 years (range, 0.3-8.7 years). Complications (cerebrospinal fluid leak and transient diabetes insipidus) and cure (86% initial cure; 76% relapse-included cure) were equivalent between the 2 procedures. However, the endoscopic approach was associated with shorter anesthesia time, less blood loss, and shorter hospital stays. CONCLUSION: The endoscopic transnasal surgical approach led to shorter total anesthesia time, less blood loss, and shorter hospital stay when compared with the sublabial transseptal approach. However, we found no difference between the 2 surgical procedures with respect to cure or complications, suggesting that outcome is more closely related to the experience of the operating team.

Original languageEnglish (US)
Pages (from-to)550-553
Number of pages4
JournalMayo Clinic proceedings
Volume83
Issue number5
DOIs
StatePublished - May 2008

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas'. Together they form a unique fingerprint.

  • Cite this

    Atkinson, J. L. D., Young, W. F., Meyer, F. B., Davis, D. H., Nippoldt, T. B., Erickson, D., Vella, A., Natt, N., Abboud, C. F., & Carpenter, P. C. (2008). Sublabial transseptal vs transnasal combined endoscopic microsurgery in patients with Cushing disease and MRI-depicted microadenomas. Mayo Clinic proceedings, 83(5), 550-553. https://doi.org/10.4065/83.5.550