Endoscopic Endonasal Transcavernous Approach to Pituitary Adenomas with Cavernous Sinus Invasion: A Single-Center Experience
Recommended Citation
Fadel HA, Pawloski J, Shaftel K, Ray A, Eide J, Craig J, Asmaro KP. Endoscopic Endonasal Transcavernous Approach to Pituitary Adenomas with Cavernous Sinus Invasion: A Single-Center Experience. J Neurol Surg B Skull Base 2024; 85(S1).
Document Type
Conference Proceeding
Publication Date
2-5-2024
Publication Title
J Neurol Surg B Skull Base
Abstract
Introduction: Sellar tumors with extension into the cavernous sinus (CS) are associated with higher rates of subtotal resection, failed biochemical remission, recurrence, and potentially devastating vascular injury. Recent advancements in expanded endoscopic transcavernous techniques have provided safe access to the cavernous sinus. However, the improved exposure of paraseller tumors comes with an increased risk of arterial or venous injury and cranial nerve deficits. In particular, the expected low-flow venous cavernous bleeding is managed with light hemostatic matrix packing, presenting an added theoretical threat of iatrogenic venous sinus thrombosis that has not previously been studied. Objective: To report the clinical, radiographic, and vascular outcomes of patients who underwent endoscopic endonasal transcavernous surgery for pituitary adenomas with extension into the cavernous sinus, with a particular focus on potential vascular operative morbidity. Methods: A single-institution database was queried to identify all patients who underwent endoscopic endonasal transcavernous surgery for pituitary adenomas with extension into the cavernous sinus. All included patients had postoperative contrast-enhanced MRIs to evaluate for extent of tumor resection and patency of cavernous arterial and venous vasculature. Clinical, demographic, procedural and survival characteristics were also determined. Results: Between 2022 and 2023, ten patients with pituitary adenomas with cavernous sinus invasion underwent endoscopic endonasal transcavernous surgery. Of the ten patients, 70% were previously inadequately treated and 70% had biochemically functional tumors. Bilateral cavernous sinus invasion was noted in 40% of patients. Gross total resection was achieved in 90% of patients and all functional tumors achieved biochemical remission. No patients were found to have intraoperative vascular injury. On postoperative contrast-enhanced imaging, no patients were found to have venous thrombosis although hemostatic matrix was used freely in all cases. Only one patient was found to have a new cranial nerve deficit postoperatively that improved on long-term follow-up. One patient was found to have transient weakness secondary to a new ischemic stroke thought to be related to resection of a tumor with parenchymal invasion. Median length of stay was 4 days (2-20) and 90% of patients were discharged home postoperatively. Conclusion: Endoscopic endonasal transcavernous surgery for pituitary adenomas that invade the cavernous sinus is safe, effective, and allows for complete resection of previously incompletely treated tumors. We also report that, despite the theoretical risk of venous thrombosis given the increased use of hemostatic matrix packing, no patients were found to have cavernous sinus thrombosis postoperatively.
Volume
85
Issue
S1