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Background and objectives <p>In Cushing’s disease, the rate of endocrine remission after surgery reaches 80% in expert centers. However, due to the tumor’s capacity to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve the likelihood of remission, tumor resection can be extended to the dura in patients who show basal dura invasion. The objective was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.</p> Methods <p>Endoscopic surgery was performed in 89 adult patients with no obvious cavernous invasion. The basal dura was systematically removed whenever a macroscopic invasion was suspected. Three groups were defined: (i) resected but noninvaded dura (<i>n</i> = 14); (ii) resected and invaded dura (<i>n</i> = 16); and (iii) nonresected dura (<i>n</i> = 59). The studied cohort was compared to a control personal series of Cushing’s patients with no systematic focus on the basal dura.</p> Results <p>The mean follow-up duration was 19.9 ± 9.4 months. Endocrine remission was achieved in 15/16 (94%) patients with invaded dura, 14/15 (93%) patients with resected noninvaded dura and 50/59 (85%) patients with nonresected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients respectively. Compared to the control series, our remission rate was significantly higher (88% vs. 75%, <i>P</i> =.019).</p> Conclusion <p>Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dura invasion, endocrine remission is high when the dura is removed. A systematic focus on the basal dura can optimize endocrine outcomes.</p>

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Specific focus on the basal dura for improving Cushing’s disease surgery: a cohort study

  • 期刊论文

  • 发表日期：

    2025年6月5日

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  • Bertrand Baussart,
  • Benoit Hudelist,
  • Chiara Villa,
  • Mirella Hage,
  • Anne Jouinot,
  • Vincent Reina,
  • Maxime Barat,
  • Delphine Leclercq,
  • Thibault Passeri,
  • Philippe Touraine,
  • Hélène Cebula,
  • Laurence Guignat,
  • Carine Courtillot,
  • Philippe Chanson,
  • Camille Vatier,
  • Sébastien Froelich,
  • Jérôme Bertherat,
  • Guillaume Assié,
  • Stephan Gaillard

摘要

Background and objectives

In Cushing’s disease, the rate of endocrine remission after surgery reaches 80% in expert centers. However, due to the tumor’s capacity to invade surrounding dural structures, hypercortisolism persists in 20% of patients or recurs in 15%. To improve the likelihood of remission, tumor resection can be extended to the dura in patients who show basal dura invasion. The objective was to evaluate the benefit of a surgical strategy based on a systematic focus on the basal dura.

Methods

Endoscopic surgery was performed in 89 adult patients with no obvious cavernous invasion. The basal dura was systematically removed whenever a macroscopic invasion was suspected. Three groups were defined: (i) resected but noninvaded dura (n = 14); (ii) resected and invaded dura (n = 16); and (iii) nonresected dura (n = 59). The studied cohort was compared to a control personal series of Cushing’s patients with no systematic focus on the basal dura.

Results

The mean follow-up duration was 19.9 ± 9.4 months. Endocrine remission was achieved in 15/16 (94%) patients with invaded dura, 14/15 (93%) patients with resected noninvaded dura and 50/59 (85%) patients with nonresected dura. Anterior pituitary deficits and diabetes insipidus occurred in 3% and 9% of patients respectively. Compared to the control series, our remission rate was significantly higher (88% vs. 75%, P =.019).

Conclusion

Tumorectomy extended to the basal dura is a safe procedure that maximizes surgical resection. Despite dura invasion, endocrine remission is high when the dura is removed. A systematic focus on the basal dura can optimize endocrine outcomes.