Repeated Transsphenoidal Surgery or Gamma Knife Radiosurgery in Recurrent Cushing Disease after Transsphenoidal Surgery

Mohammad Ali Bitaraf, Mohammad Badaghabadi, Hossein Riazi, Mazdak Alikhani, Mazyar Azar


Background: This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA.

Materials and Methods: Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging.

Results: No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-hour free urine cortisol and disease-free months or tumor volume among both groups. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group.

Conclusion: With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.


Cushing syndrome; Gamma knife; Transsphenoidal Surgery