Endoscopic endonasal resection of ACTH secreting pituitary microadenoma; how I do it.

BACKGROUND: Transsphenoidal selective adenectomy is considered the treatment of choice in patients with Cushing's disease given the possibility for high remission and low complication rates. The endoscopic endonasal surgical nuances for Cushing's disease are not well illustrated in the neurosurgical technique and video collections.

METHODS: We describe the technical nuances of microadenoma resection for two cases of Cushing's disease, one in which the adenoma is visualized on imaging and one in which the pre-operative MRI is negative.

CONCLUSIONS: Transsphenoidal endoscopic selective adenectomy is a safe and effective surgery for patients with Cushing's disease regardless of preoperative MRI findings.