Endoscopic endonasal approach for MRI-Negative Cushing's microadenoma

Jeffrey J Feng; Stephanie K Cheok; Alexander G Chartrain; John D Carmichael; Mark S Shiroishi; William J Mack; Gabriel Zada

doi:10.3171/2023.4.FOCVID2324

Endoscopic endonasal approach for MRI-Negative Cushing's microadenoma

Neurosurg Focus Video. 2023 Jul 1;9(1):V5. doi: 10.3171/2023.4.FOCVID2324. eCollection 2023 Jul.

Authors

Jeffrey J Feng^{1

2

3

4}, Stephanie K Cheok^{1

2

3}, Alexander G Chartrain¹, John D Carmichael^{1

2

3}, Mark S Shiroishi^{1

2

3}, William J Mack¹, Gabriel Zada^{1

2

3}

Affiliations

¹ Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles.
² University of Southern California Brain Tumor Center, Los Angeles.
³ University of Southern California Pituitary Center, Los Angeles, California; and.
⁴ Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan.

Abstract

A 54-year-old male with a history of diabetes mellitus type 2 for 12 years and hypertension was seen in the clinic due to poorly controlled diabetes. Inferior petrosal sinus sampling (IPSS) confirmed Cushing's disease with primary adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma on the right. However, 3T and subsequent 7T MRI showed no visible tumor. An endoscopic transsphenoidal approach was selected to explore the pituitary gland and resect the presumed microadenoma. Tumor was identified in the lateral recess along the right medial cavernous sinus wall and gross-total resection (GTR) was performed. The normal pituitary gland was preserved, and the patient went into remission. The video can be found here: https://stream.cadmore.media/r10.3171/2023.4.FOCVID2324.

Keywords: 7T MRI; MRI–Negative Cushing’s disease; cavernous sinus wall; pituitary adenoma; tumor resection.