{"id":670286,"date":"2026-09-21T15:20:58","date_gmt":"2026-09-21T13:20:58","guid":{"rendered":"https:\/\/www.neurochirurgie-lariboisiere.com\/2026\/09\/21\/par-dela-la-dichotomie-irm-positive-irm-negative-une-evolution-dans-la-prise-en-charge-chirurgicale-des-maladies-de-cushing\/"},"modified":"2026-09-21T15:27:02","modified_gmt":"2026-09-21T13:27:02","slug":"par-dela-la-dichotomie-irm-positive-irm-negative-une-evolution-dans-la-prise-en-charge-chirurgicale-des-maladies-de-cushing","status":"publish","type":"post","link":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/2026\/09\/21\/par-dela-la-dichotomie-irm-positive-irm-negative-une-evolution-dans-la-prise-en-charge-chirurgicale-des-maladies-de-cushing\/","title":{"rendered":"Par-d\u00e9l\u00e0 la dichotomie IRM positive \/ IRM negative : une \u00e9volution dans la prise en charge chirurgicale des maladies de Cushing"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"670286\" class=\"elementor elementor-670286\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5d6d73c e-flex e-con-boxed e-con e-parent\" data-id=\"5d6d73c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;pix_scale_in&quot;:&quot;none&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-056a514 elementor-widget elementor-widget-text-editor\" data-id=\"056a514\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"adenome-page\">\n\n<div class=\"adenome-intro\">Management of <span class=\"mc\">Cushing&#8217;s disease (CD)<\/span> has traditionally relied on a strict binary paradigm based on MRI findings (MRI-positive vs. MRI-negative cases). In a recent study published in <em>Brain and Spine<\/em>, the Neurosurgery team at Lariboisi\u00e8re Hospital proposes moving beyond this dichotomy by conceptualizing CD as a <strong>radiological, clinical, and functional spectrum<\/strong> guided by a stepwise surgical strategy.<\/div>\n\n<section class=\"section-block\">\n    <h3>Moving Beyond the MRI-Positive \/ MRI-Negative Dichotomy<\/h3>\n    <p>Corticotroph pituitary tumors are microadenomas in up to 90% of cases. Despite advances in high-resolution 3T MRI, no clear lesion is identified in <strong>23% to 50% of patients<\/strong> during initial workup.<\/p>\n    \n    <p>While useful, the classic binary classification fails to reflect the true heterogeneity of corticotroph tumors and intraoperative decision-making. The conceptual framework established by the Lariboisi\u00e8re surgical team redefines CD as a continuous spectrum:<\/p>\n    \n    <ul class=\"traitements-list\">\n        <li><strong>MRI-positive lesions with invasive features:<\/strong> Micro- or macroadenomas with basal dural or cavernous sinus invasion.<\/li>\n        <li><strong>MRI-equivocal findings:<\/strong> Consistent focal or bifocal T1\/T2 signal heterogeneities requiring targeted surgical exploration.<\/li>\n        <li><strong>MRI-negative disease:<\/strong> Absence of a radiological target despite repeated high-resolution MRIs, requiring systematic intraoperative exploration.<\/li>\n    <\/ul>\n<\/section>\n\n<section class=\"section-block\">\n    <h3>A Stepwise Surgical Strategy<\/h3>\n    <p>Drawing from a prospective database of over 980 patients operated for Cushing&#8217;s disease between 2006 and 2025, this study details the decision-making algorithm refined by the expert team using a mononostril endoscopic transsphenoidal approach:<\/p>\n\n    <div class=\"types-grid\" style=\"display: flex; flex-wrap: wrap; gap: 24px; margin-top: 20px;\">\n        <div class=\"type-card\" style=\"flex: 1 1 300px;\">\n            <h4>1. Workup &#038; Repeat Imaging<\/h4>\n            <p>Preoperative cortisol control (e.g., with osilodrostat) improves patient condition and provides time for repeated high-resolution MRI. Over 70% of initially negative MRIs eventually reveal a target on repeat scans. Molecular imaging (FET-PET) and IPSS further guide lateralization.<\/p>\n        <\/div>\n\n        <div class=\"type-card\" style=\"flex: 1 1 300px;\">\n            <h4>2. Targeted Resection &#038; Dural Extension<\/h4>\n            <p>For well-circumscribed tumors, selective adenomectomy is performed. When basal dural or cavernous sinus medial wall invasion is identified, extended dural resection is conducted to maximize endocrine remission rates.<\/p>\n        <\/div>\n\n        <div class=\"type-card\" style=\"flex: 1 1 300px;\">\n            <h4>3. Exploration of MRI-Negative Cases<\/h4>\n            <p>If imaging remains strictly normal, systematic bilateral gland exploration is performed. Resection is tailored based on intraoperative tissue findings (enlarged adenomectomy or partial hypophysectomy).<\/p>\n        <\/div>\n    <\/div>\n<\/section>\n\n<section class=\"section-block\">\n    <h3>Outcomes and Clinical Impact<\/h3>\n    <p>Key results from the illustrative series across the CD spectrum include:<\/p>\n    <ul class=\"traitements-list\">\n        <li><strong>Early Endocrine Remission:<\/strong> Achieved in 6 out of 7 patients, with the remaining patient achieving postoperative eucortisolism.<\/li>\n        <li><strong>Surgical Safety:<\/strong> Transient diabetes insipidus was the only reported complication, with no permanent hypopituitarism or neurovascular injury.<\/li>\n    <\/ul>\n    <p>This dynamic framework demonstrates that an individualized, stepwise surgical strategy delivers high cure rates while preserving pituitary function, even in complex or MRI-negative cases.<\/p>\n<\/section>\n\n<section class=\"section-block\">\n    <h3>Publication Reference<\/h3>\n    <ol class=\"publications-list\">\n        <li><span class=\"pub-authors\">Ferlendis L, Chu HT, Passeri T, Villa C, Leclercq D, Barat M, Fava A, Beccaria K, Assi\u00e9 G, Froelich S, Baussart B.<\/span>\n        Beyond the MRI-positive\/MRI-negative dichotomy: A stepwise surgical strategy for Cushing&#8217;s disease.\n        <em>Brain Spine.<\/em> 2026 Sep 5;6:106668. doi:10.1016\/j.bas.2026.106668.\n        <a href=\"https:\/\/doi.org\/10.1016\/j.bas.2026.106668\" target=\"_blank\" rel=\"noopener\">Read Full Article (Open Access) \u27a4<\/a><\/li>\n    <\/ol>\n<\/section>\n\n<div class=\"adenome-footer\"><strong>General Medical Information:<\/strong> This page provides educational information and does not replace a medical consultation. No health decision should be made without personalized medical advice.<\/div>\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Management of Cushing&#8217;s disease (CD) has traditionally relied on a strict binary paradigm based on MRI findings (MRI-positive vs. MRI-negative cases). In a recent study published in Brain and Spine, the Neurosurgery team at Lariboisi\u00e8re Hospital proposes moving beyond this&#8230;<\/p>\n","protected":false},"author":5,"featured_media":15567,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-670286","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/670286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/comments?post=670286"}],"version-history":[{"count":7,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/670286\/revisions"}],"predecessor-version":[{"id":670293,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/posts\/670286\/revisions\/670293"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media\/15567"}],"wp:attachment":[{"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/media?parent=670286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/categories?post=670286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.neurochirurgie-lariboisiere.com\/en\/wp-json\/wp\/v2\/tags?post=670286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}