MRI–Negative Cushing disease is a very difficult disease to treat medically and surgically. In the past, after negative gland exploration, hemihypophysectomy was commonly performed on the localizing side of inferior petrosal sampling. However, this generally resulted in 50% remission/cure rates. Therefore, other techniques have arisen based on the percent chance of microadenoma tumor being present in the gland. Subtotal gland resection is a technique aimed at removing 75% of the gland that results in a similar chance of remission and a 10% chance of pituitary dysfunction. In this video, the authors demonstrate this important technique for MRI–Negative Cushing disease.
The video can be found here: https://thejns.org/doi/abs/10.3171/2023.4.FOCVID2320