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Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease.
J Neurosurg 2014; 121(3):518-26JN

Abstract

OBJECT

Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the pituitary fossa. It has been suggested to have a negative effect on pituitary surgery; however, outcomes in this cohort have not been defined. This study was performed to determine the effect of ESS on immediate and long-term biochemical outcome after pituitary surgery for Cushing's disease (CD).

METHODS

Using a matched cohort study design, the authors followed patients treated with pituitary surgery for CD with and without ESS. Complete ESS was defined as pituitary gland height ≤ 2 mm, whereas partial ESS was defined as pituitary gland height > 2 mm but less than three-quarters of the total sellar depth. The primary end points were immediate and long-term biochemical outcome. Cerebrospinal fluid leaks were recorded as a secondary end point.

RESULTS

Seventy-eight patients with CD and primary ESS were identified and matched with 78 patients with CD without ESS. After surgical management, immediate biochemical remission was achieved in 69 patients (88%) with ESS and 75 controls (96%, p = 0.10). Long-term remission was achieved in most patients in both groups (5-year cure: 85% vs 92%, p = 0.10). Among patients with ESS, the presence of complete ESS predicted a worse long-term outcome (p = 0.04). Intraoperative CSF leaks were significantly more frequent with ESS (54% vs 24%, p < 0.001), and despite sellar floor repair, the rate of postoperative CSF leaks was also increased (6% vs 3%, p = 0.27).

CONCLUSIONS

Biochemical outcome after pituitary surgery for CD was worse in patients with complete ESS, and the risk of a CSF leak was increased with both partial and complete ESS. However, as outcome remains superior to those following alternative therapies and the biology of these tumors is unchanged in the setting of ESS, pituitary surgery should remain the initial treatment of choice.

Authors+Show Affiliations

Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

24857241

Citation

Mehta, Gautam U., et al. "Effect of Primary Empty Sella Syndrome On Pituitary Surgery for Cushing's Disease." Journal of Neurosurgery, vol. 121, no. 3, 2014, pp. 518-26.
Mehta GU, Bakhtian KD, Oldfield EH. Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease. J Neurosurg. 2014;121(3):518-26.
Mehta, G. U., Bakhtian, K. D., & Oldfield, E. H. (2014). Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease. Journal of Neurosurgery, 121(3), pp. 518-26. doi:10.3171/2014.3.JNS132012.
Mehta GU, Bakhtian KD, Oldfield EH. Effect of Primary Empty Sella Syndrome On Pituitary Surgery for Cushing's Disease. J Neurosurg. 2014;121(3):518-26. PubMed PMID: 24857241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of primary empty sella syndrome on pituitary surgery for Cushing's disease. AU - Mehta,Gautam U, AU - Bakhtian,Kamran D, AU - Oldfield,Edward H, Y1 - 2014/05/23/ PY - 2014/5/27/entrez PY - 2014/5/27/pubmed PY - 2014/11/19/medline KW - ACTH = adrenocorticotropin KW - BMI = body mass index KW - CD = Cushing's disease KW - CRH = corticotropin-releasing hormone KW - Cushing's disease KW - DI = diabetes insipidus KW - ESS = empty sella syndrome KW - GH = growth hormone KW - SIADH = syndrome of inappropriate antidiuretic hormone KW - UFC = urinary free cortisol KW - empty sella syndrome KW - pituitary adenoma KW - pituitary surgery KW - transsphenoidal surgery SP - 518 EP - 26 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 121 IS - 3 N2 - OBJECT: Primary empty sella syndrome (ESS) results from herniation of arachnoid mater into the pituitary fossa. It has been suggested to have a negative effect on pituitary surgery; however, outcomes in this cohort have not been defined. This study was performed to determine the effect of ESS on immediate and long-term biochemical outcome after pituitary surgery for Cushing's disease (CD). METHODS: Using a matched cohort study design, the authors followed patients treated with pituitary surgery for CD with and without ESS. Complete ESS was defined as pituitary gland height ≤ 2 mm, whereas partial ESS was defined as pituitary gland height > 2 mm but less than three-quarters of the total sellar depth. The primary end points were immediate and long-term biochemical outcome. Cerebrospinal fluid leaks were recorded as a secondary end point. RESULTS: Seventy-eight patients with CD and primary ESS were identified and matched with 78 patients with CD without ESS. After surgical management, immediate biochemical remission was achieved in 69 patients (88%) with ESS and 75 controls (96%, p = 0.10). Long-term remission was achieved in most patients in both groups (5-year cure: 85% vs 92%, p = 0.10). Among patients with ESS, the presence of complete ESS predicted a worse long-term outcome (p = 0.04). Intraoperative CSF leaks were significantly more frequent with ESS (54% vs 24%, p < 0.001), and despite sellar floor repair, the rate of postoperative CSF leaks was also increased (6% vs 3%, p = 0.27). CONCLUSIONS: Biochemical outcome after pituitary surgery for CD was worse in patients with complete ESS, and the risk of a CSF leak was increased with both partial and complete ESS. However, as outcome remains superior to those following alternative therapies and the biology of these tumors is unchanged in the setting of ESS, pituitary surgery should remain the initial treatment of choice. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/24857241/Effect_of_primary_empty_sella_syndrome_on_pituitary_surgery_for_Cushing's_disease_ L2 - https://thejns.org/doi/10.3171/2014.3.JNS132012 DB - PRIME DP - Unbound Medicine ER -