{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:59:56Z","timestamp":1783774796543,"version":"3.55.0"},"reference-count":132,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,2]]},"abstract":"\n OBJECT<\/jats:title>\n The purpose of this study was to describe complications associated with the endonasal, transsphenoidal approach for the treatment of adrenocorticotropic hormone (ACTH)\u2013positive staining tumors (Cushing's disease [CD] and silent corticotroph adenomas [SCAs]) performed by 1 surgeon at a high-volume academic medical center.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Medical records from Brigham and Women's Hospital were retrospectively reviewed. Selected for study were 82 patients with CD who during April 2008\u2013April 2014 had consecutively undergone transsphenoidal resection or who had subsequent pathological confirmation of ACTH-positive tumor staining. In addition to demographic, patient, tumor, and surgery characteristics, complications were evaluated. Complications of interest included syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus (DI), CSF leakage, carotid artery injury, epistaxis, meningitis, and vision changes.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of the 82 patients, 68 (82.9%) had CD and 14 (17.1%) had SCAs; 55 patients were female and 27 were male. Most common (n = 62 patients, 82.7%) were microadenomas, followed by macroadenomas (n = 13, 14.7%). A total of 31 (37.8%) patients underwent reoperation. Median follow-up time was 12.0 months (range 3\u201369 months). The most common diagnosis was ACTH-secreting (n = 68, 82.9%), followed by silent tumors\/adenomas (n = 14, 17.1%). ACTH hyperplasia was found in 8 patients (9.8%). Of the 74 patients who had verified tumors, 12 (16.2%) had tumors with atypical features.<\/jats:p>\n The overall (CD and SCA) rate of minor complications was 35.4%; the rate of major complications was 8.5% (n = 7). All permanent morbidity was associated with DI (n = 5, 6.1%). In 16 CD patients (23.5%), transient DI developed. Transient DI was more likely to develop in CD patients who had undergone a second operation (37.9%) than in those who had undergone a first operation only (12.8%, p < 0.05). Permanent DI developed in 4 CD patients (5.9%) and 1 SCA patient (7.1%). For 1 CD patient, intraoperative carotid artery injury required endovascular sacrifice of the injured artery, but the patient remained neurologically intact. For another CD patient, aseptic meningitis developed and was treated effectively with corticosteroids. One CD patient experienced major postoperative epistaxis requiring another operative procedure to achieve hemostasis. For 2 CD patients, development of sinus mucoceles was managed conservatively. For 1 SCA patient, an abdominal wound dehisced at the fat graft site. No patients experienced postoperative CSF leakage, visual impairment, or deep vein thrombosis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Transsphenoidal surgery is the treatment of choice for patients with CD and other ACTH-positive staining tumors. Recent advances in endoscopic technology and increasing surgeon comfort with this technology are making transsphenoidal procedures safer, faster, and more effective. Serious complications are uncommon and can be managed successfully.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.10.focus14705","type":"journal-article","created":{"date-parts":[[2015,2,1]],"date-time":"2015-02-01T03:40:53Z","timestamp":1422762053000},"page":"E12","source":"Crossref","is-referenced-by-count":54,"title":["Complications after transsphenoidal surgery for patients with Cushing's disease and silent corticotroph adenomas"],"prefix":"10.3171","volume":"38","author":[{"given":"Timothy R.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Maher","family":"Hulou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breno","family":"Nery","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Miranda","family":"de Moura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cote","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14705","series-title":"J Neurol Neurosurg Psychiatry","first-page":"843","article-title":"Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis","volume":"84","author":"Ammirati","year":"2013"},{"key":"b2-focus14705","series-title":"Pituitary","first-page":"288","article-title":"Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature","volume":"15","author":"Berker","year":"2012"},{"key":"b3-focus14705","series-title":"Neurosurgery","first-page":"920","article-title":"Incidence and management of complications of transsphenoidal operation for pituitary adenomas","volume":"20","author":"Black","year":"1987"},{"key":"b4-focus14705","series-title":"J Neurosurg","first-page":"293","article-title":"Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas","volume":"97","author":"Cappabianca","year":"2002"},{"key":"b5-focus14705","series-title":"J Neurosurg","first-page":"204","article-title":"Surgical treatment of Cushing's disease","volume":"66","author":"Chandler","year":"1987"},{"key":"b6-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"617","article-title":"Transsphenoidal pituitary surgery in Cushing's disease: can we predict outcome?","volume":"54","author":"Chee","year":"2001"},{"key":"b7-focus14705","series-title":"Neurosurgery","first-page":"225","article-title":"Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal 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Metab","first-page":"6348","article-title":"Transsphenoidal microsurgery for Cushing's disease: initial outcome and long-term results","volume":"89","author":"Hammer","year":"2004"},{"key":"b17-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"431","article-title":"Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas","volume":"50","author":"Hensen","year":"1999"},{"key":"b18-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"560","article-title":"Contemporary microsurgical concept for the treatment of Cushing's disease: endocrine outcome in 83 consecutive patients","volume":"76","author":"Honegger","year":"2012"},{"key":"b19-focus14705","series-title":"J Neurosurg","first-page":"67","article-title":"Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations","volume":"121","author":"Jahangiri","year":"2014"},{"key":"b20-focus14705","series-title":"Neurosurgery","first-page":"8","article-title":"A comprehensive long-term retrospective analysis of silent corticotrophic adenomas vs hormone-negative adenomas","volume":"73","author":"Jahangiri","year":"2013"},{"key":"b21-focus14705","series-title":"J Am Coll Surg","first-page":"651","article-title":"The surgical management of pituitary adenomas in a series of 3,093 patients","volume":"193","author":"Jane","year":"2001"},{"key":"b22-focus14705","series-title":"J Neurooncol","first-page":"187","article-title":"Endoscopic transsphenoidal surgery","volume":"54","author":"Jho","year":"2001"},{"key":"b23-focus14705","series-title":"Endocr J","first-page":"941","article-title":"Review: Pathophysiology and treatment of subclinical Cushing's disease and pituitary silent corticotroph adenomas","volume":"61","author":"Kageyama","year":"2014"},{"issue":"1 Suppl Operative","key":"b24-focus14705","series-title":"Neurosurgery","first-page":"144","article-title":"Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery","volume":"68","author":"Kaptain","year":"2011"},{"key":"b25-focus14705","series-title":"J Neurosurg","first-page":"363","article-title":"Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. Report of nine cases","volume":"83","author":"Kelly","year":"1995"},{"key":"b26-focus14705","series-title":"World Neurosurg","first-page":"329","article-title":"Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of craniopharyngiomas","volume":"77","author":"Komotar","year":"2012"},{"key":"b27-focus14705","series-title":"Laryngoscope","article-title":"Complications following primary and revision transsphenoidal surgeries for pituitary tumors","author":"Krings","year":"2014"},{"key":"b28-focus14705","series-title":"Endocr Pract","first-page":"945","article-title":"Cushing disease: highlighting the importance of early diagnosis for both de novo and recurrent disease in light of evolving treatment patterns","volume":"20","author":"Lamos","year":"2014"},{"key":"b29-focus14705","series-title":"J Neurol Neurosurg Psychiatry","first-page":"829","article-title":"Complications of transsphenoidal surgery: the shortcomings of meta-analysis","volume":"84","author":"Laws","year":"2013"},{"key":"b30-focus14705","series-title":"J Neurosurg","first-page":"823","article-title":"Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients","volume":"63","author":"Laws","year":"1985"},{"key":"b31-focus14705","series-title":"J Neurooncol","first-page":"63","article-title":"Isolated sphenoid sinusitis or mucocele: a potential complication of endonasal transsphenoidal surgery","volume":"91","author":"Lu","year":"2009"},{"key":"b32-focus14705","series-title":"J Clin Neurosci","first-page":"378","article-title":"Rathke's cleft cyst recurrence after transsphenoidal surgery: a meta-analysis of 1151 cases","volume":"21","author":"Mendelson","year":"2014"},{"key":"b33-focus14705","series-title":"Endocr Pathol","first-page":"191","article-title":"The role of mediators of cell invasiveness, motility, and migration in the pathogenesis of silent corticotroph adenomas","volume":"24","author":"Mete","year":"2013"},{"key":"b34-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"359","article-title":"Age-related and gender-related occurrence of pituitary adenomas","volume":"41","author":"Mindermann","year":"1994"},{"key":"b35-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"777","article-title":"Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis","volume":"73","author":"Murad","year":"2010"},{"key":"b36-focus14705","series-title":"J Neurosurg","first-page":"448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut","year":"2005"},{"key":"b37-focus14705","series-title":"Eur J Endocrinol","first-page":"675","article-title":"Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing's disease","volume":"154","author":"Netea-Maier","year":"2006"},{"key":"b38-focus14705","series-title":"J Clin Endocrinol Metab","first-page":"1526","article-title":"The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline","volume":"93","author":"Nieman","year":"2008"},{"key":"b39-focus14705","series-title":"J Neurosurg","first-page":"499","article-title":"Pathophysiology of hyponatremia after transsphenoidal pituitary surgery","volume":"87","author":"Olson","year":"1997"},{"key":"b40-focus14705","series-title":"J Clin Endocrinol Metab","first-page":"85","article-title":"Isolated hyponatremia after transsphenoidal pituitary surgery","volume":"80","author":"Olson","year":"1995"},{"issue":"3","key":"b41-focus14705","series-title":"Neurosurg Focus","first-page":"E7","article-title":"National trends, complications, and outcomes following transsphenoidal surgery for Cushing's disease from 1993 to 2002","volume":"23","author":"Patil","year":"2007"},{"key":"b42-focus14705","series-title":"J Clin Endocrinol Metab","first-page":"3383","article-title":"Outcomes and management of patients with Cushing's disease without pathological confirmation of tumor resection after transsphenoidal surgery","volume":"92","author":"Pouratian","year":"2007"},{"key":"b43-focus14705","series-title":"J Neurosurg","first-page":"751","article-title":"Management of Cushing's disease: outcome in patients with microadenoma detected on pituitary magnetic resonance imaging","volume":"109","author":"Prevedello","year":"2008"},{"key":"b44-focus14705","series-title":"Neurosurgery","first-page":"E191","article-title":"Silent corticotroph adenoma","volume":"73","author":"Rajesh","year":"2013"},{"key":"b45-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"541","article-title":"Long-term follow-up results of transsphenoidal surgery for Cushing's disease in a single centre using strict criteria for remission","volume":"56","author":"Rees","year":"2002"},{"key":"b46-focus14705","series-title":"Mol Cell Endocrinol","first-page":"73","article-title":"The neurosurgical management of Cushing's disease","volume":"197","author":"Reitmeyer","year":"2002"},{"key":"b47-focus14705","series-title":"Neurosurgery","first-page":"723","article-title":"Clinically silent corticotroph tumors of the pituitary gland","volume":"47","author":"Scheithauer","year":"2000"},{"key":"b48-focus14705","series-title":"Pituitary","first-page":"445","article-title":"Post-operative diabetes insipidus after endoscopic transsphenoidal surgery","volume":"16","author":"Schreckinger","year":"2013"},{"key":"b49-focus14705","series-title":"Ann Surg","first-page":"524","article-title":"Surgical experience with Cushing's disease","volume":"185","author":"Scott","year":"1977"},{"key":"b50-focus14705","series-title":"J Neurosurg","first-page":"175","article-title":"Complications in a contemporary series of patients who underwent transsphenoidal surgery for Cushing's disease","volume":"91","author":"Semple","year":"1999"},{"key":"b51-focus14705","series-title":"Neurosurgery","first-page":"553","article-title":"Transsphenoidal surgery for Cushing's disease: outcome in patients with a normal magnetic resonance imaging scan","volume":"46","author":"Semple","year":"2000"},{"key":"b52-focus14705","series-title":"J Endocrinol Invest","first-page":"327","article-title":"Primary hepatic carcinoid tumor presenting as Cushing's syndrome","volume":"30","author":"Shah","year":"2007"},{"key":"b53-focus14705","series-title":"Neurosurgery","first-page":"33","article-title":"Results of transsphenoidal surgery for Cushing's disease in patients with no histologically confirmed tumor","volume":"47","author":"Sheehan","year":"2000"},{"key":"b54-focus14705","series-title":"Neurosurgery","first-page":"57","article-title":"Transsphenoidal surgery for Cushing's disease: endocrinological follow-up monitoring of 82 patients","volume":"51","author":"Shimon","year":"2002"},{"key":"b55-focus14705","series-title":"Neurosurgery","first-page":"240","article-title":"Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission","volume":"72","author":"Starke","year":"2013"},{"key":"b56-focus14705","series-title":"Ann Intern Med","first-page":"821","article-title":"Long-term mortality after transsphenoidal surgery for Cushing disease","volume":"130","author":"Swearingen","year":"1999"},{"key":"b57-focus14705","series-title":"J Neurosurg","first-page":"545","article-title":"Endoscopic pituitary surgery: a systematic review and meta-analysis","volume":"111","author":"Tabaee","year":"2009"},{"key":"b58-focus14705","series-title":"J Neurosurg","first-page":"363","article-title":"Cushing's disease: results of transsphenoidal microsurgery with emphasis on surgical failures","volume":"72","author":"Tindall","year":"1990"},{"key":"b59-focus14705","series-title":"Int J Clin Exp Pathol","first-page":"4415","article-title":"Ectopic cortisol-producing adrenocortical adenoma in the renal hilum: histopathological features and steroidogenic enzyme profile","volume":"7","author":"Tong","year":"2014"},{"key":"b60-focus14705","series-title":"Endocrinol Nutr","first-page":"410","article-title":"Endoscopic endonasal surgery for pituitary tumors. Results in a series of 121 patients operated at the same center and by the same neurosurgeon","volume":"61","author":"Torales","year":"2014"},{"key":"b61-focus14705","series-title":"Handb Clin Neurol","first-page":"221","article-title":"Cushing's disease","volume":"124","author":"Tritos","year":"2014"},{"key":"b62-focus14705","series-title":"Clin Endocrinol (Oxf)","first-page":"481","article-title":"Hypercoagulability in Cushing's syndrome: prevalence, pathogenesis and treatment","volume":"78","author":"van der Pas","year":"2013"},{"key":"b63-focus14705","series-title":"Eur J Endocrinol","first-page":"329","article-title":"Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas","volume":"169","author":"Wagenmakers","year":"2013"},{"key":"b64-focus14705","series-title":"Neurosurgery","first-page":"1076","article-title":"Clinical characteristics of silent corticotrophic adenomas and 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