{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:30:49Z","timestamp":1761514249245},"reference-count":56,"publisher":"Walter de Gruyter GmbH","issue":"9","license":[{"start":{"date-parts":[[2018,8,11]],"date-time":"2018-08-11T00:00:00Z","timestamp":1533945600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"j_jpem-2018-0262_s_999_w2aab3b7c56b1b6b1aab1c16b1Aa\"><jats:title>Background<\/jats:title><jats:p>Transnasal surgery (TNS) is the first choice in the treatment of pediatric Cushing\u2019s disease. The question is how can high remission rates be achieved with minimally invasive investigations and TNS whilst avoiding radiotherapy or bilateral adrenalectomy in children.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0262_s_998_w2aab3b7c56b1b6b1aab1c16b2Aa\"><jats:title>Methods<\/jats:title><jats:p>Data from a published series 1 (n=55) of surgeon DKL will be compared with his recent series 2 (n=45) until 2009. All patients were operated by direct transnasal microsurgery. Over time, inferior petrosal sinus sampling (IPSS) was replaced by cavernous sinus sampling (CSS), restricted to unclear cases without increase of salivary cortisol in corticotropin-releasing hormone-test, difficult sellar anatomy or negative magnetic resonance imaging (MRI). Multiple direct intra-operative micro-cytology, micro-doppler and adequate visualization techniques are described.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0262_s_997_w2aab3b7c56b1b6b1aab1c16b3Aa\"><jats:title>Results<\/jats:title><jats:p>In series 1, IPSS was performed in 13 (24%) of whom 46% had false adenoma lateralization. All adenomas could be removed with extensive pituitary exploration. Three patients had early successful re-surgery. In series 2, with more refined MRI and endocrinology, CSS was used in only seven patients (15%) and all micro-adenomas were correctly localized. In three of four patients with persistent cortisol excess, repeat-TNS was necessary and successful. Side effects of TNS were minimal. Recurrence rates were 16% and 11% in series 1 and 2, respectively. Only four of 100 children with invasive adenomas were irradiated, significantly less than in other experienced pediatric centers.<\/jats:p><\/jats:sec><jats:sec id=\"j_jpem-2018-0262_s_996_w2aab3b7c56b1b6b1aab1c16b4Aa\"><jats:title>Conclusions<\/jats:title><jats:p>Thus, 98% remission rate could be achieved with fewer invasive pre-surgical investigations, such as central catheter studies, refined TNS and early repeat-TNS. Repeat-TNS in recurrences minimized the need for irradiation.<\/jats:p><\/jats:sec>","DOI":"10.1515\/jpem-2018-0262","type":"journal-article","created":{"date-parts":[[2018,8,11]],"date-time":"2018-08-11T22:16:33Z","timestamp":1534025793000},"page":"1023-1031","source":"Crossref","is-referenced-by-count":16,"title":["A personal series of 100 children operated for Cushing\u2019s disease (CD): optimizing minimally invasive diagnosis and transnasal surgery to achieve nearly 100% remission including reoperations"],"prefix":"10.1515","volume":"31","author":[{"given":"Patricia A.","family":"Crock","sequence":"first","affiliation":[{"name":"Department Paediatric Endocrinology and Diabetes , John Hunter Children\u2019s Hospital , Locked Bag 1, Hunter Region Mail Centre , Newcastle, NSW 2310 , Australia"},{"name":"PRC GrowUpWell , Hunter Medical Research Institute and Department Paediatrics , University of Newcastle , Newcastle, NSW , Australia , Phone: +61249855634, Fax: +61249213599"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieter K.","family":"L\u00fcdecke","sequence":"additional","affiliation":[{"name":"Retired Emeritus Pituitary Surgeon, Department Neurosurgery , University Hospital Eppendorf , Hamburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich J.","family":"Knappe","sequence":"additional","affiliation":[{"name":"Department Neurosurgery, Johannes Wesling Klinikum , University Hospital of the Ruhr University Bochum , Minden , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Saeger","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, Pituitary Pathologist , University Hospital Eppendorf , Hamburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2018,8,11]]},"reference":[{"key":"2021021318143162279_j_jpem-2018-0262_ref_001_w2aab3b7c56b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"Lila AR, Gopal RA, Acharya SV, George J, Sarathi V, et al. 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