• Michael P Powell, Gulshekra J Narimova, and Zamira J Halimova.
• The Sir Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK. Electronic address: michael.powell@uclh.nhs.uk.
• World Neurosurg. 2017 Jan 1; 97: 213-220.

BackgroundTranssphenoidal surgery (TSS) was introduced into the Republic of Uzbekistan in 2005 and has been developing since then. The principal center for the management of all pituitary disease is a single site for a nation with a population of approximately 30 million. Results in surgery for Cushing disease are a marker of surgical technical skill in TSS. All previously published series come from the developed world, where sophisticated investigations and management are available. Many of these investigations are not available in Uzbekistan.MethodsThis mixed series of 154 patients from 2000 to 2013 presents the data from Uzbekistan. The management of Cushing disease before the introduction of TSS was with unilateral adrenalectomy, a procedure virtually unknown in the West. It reduces cortisol burden but is, in the long-term, only a temporary measure because it allows the tumor to continue to grow. The results of this procedure are presented and show that in the short-term, surprisingly reasonable remission is obtained.ResultsThese results are contrasted with the experience with TSS, for which the impact of the input from an experienced team including an endocrinologist and neurosurgeon from the United Kingdom allowed a transformation in management and enabled outcomes to match what can be expected in the West.ConclusionsTSS for Cushing's Disease achieved an early remission of 68.7% (early morning cortisol of <50 nmol/L), although 4 patients relapsed.Copyright © 2016 Elsevier Inc. All rights reserved.

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