Advanced imaging to improve remission rates in patients undergoing transsphenoidal surgery for Cushings disease: A protocol for systematic review and meta-analysis

INTRODUCTION: Cushings disease is a condition of hypercortisolaemia caused by a functional adrenocorticotropic hormone secreting pituitary adenoma. Surgical management is the first line of treatment for Cushings disease, but remains challenging in some cases. Various imaging modalities have been tried in an attempt to improve surgical remission rates. However, the sizes and certainties of any effect, in comparison to standard preoperative MRI imaging, remain unclear. METHODS: This protocol has been developed according to the PRISMA-P 2015 standards. Searches of PubMed and Embase were conducted on 21 May 2020, and abstract screening commenced. The eligibility criteria, items for data extraction, and the analysis plan are laid out in this protocol, and uploaded prior to commencement of formal data extraction. DISCUSSION: The results of this review will inform decision-making and priority-setting at the clinical, organisational and research levels. The results will be disseminated throughout the international neurosurgical community through presentations and publications.