Outcomes of Endoscopic Endonasal Transcavernous Surgery for Pituitary Adenomas: A ByCompartment Analysis
Recommended Citation
Lee CK, Asmaro KP, Ljubimov V, Rodrigues AJ, Lamano J, Mohyeldin A, Vigo V, Chang J, Katznelson LJ, Fernandez-Miranda JC. Outcomes of Endoscopic Endonasal Transcavernous Surgery for Pituitary Adenomas: A ByCompartment Analysis. 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
Objective: Endoscopic endonasal transcavernous surgery can be employed effectively and safely to resect pituitary tumors which extend into the cavernous sinus. The cavernous sinus is divided into multiple compartments by the cavernous internal carotid artery. The anatomical configuration and neurovascular contents of each compartment dictates the accessibility and surgical nuance for resecting tumor in that compartment. The purpose of this study was to analyze the cavernous sinus invasion patterns of pituitary adenomas and examine the outcomes of transcavernous surgery on a bycompartment basis. Methods: Prospectively collected data from patients undergoing endoscopic endonasal surgery for functioning and nonfunctioning pituitary adenomas in 2018 to 2023 were analyzed as a retrospective cohort analysis. Cavernous sinus compartment invasion patterns were identified based on intra-operative observations. Patients undergoing first-time surgery and those undergoing repeat surgery for recurrent or residual disease were both included. Results: A total of 320 consecutive endoscopic endonasal surgeries were analyzed, of which 168 (53%) employed transcavernous surgery (TCS). Rates of TCS were higher for repeat surgery patients (85%) compared to first-time surgery patients (45%; p < 0.0001). Rates of TCS were higher for functioning adenomas (67%) than nonfunctioning adenomas (37%; p < 0.0001). There was a higher likelihood of bilateral cavernous sinus involvement in repeat surgery patients (22%) compared to first-time surgery patients (7%; p = 0.008). For first-time surgery patients, there was no difference in surgical outcomes between those with unilateral and bilateral cavernous sinus invasion, in terms of gross total resection rates (82% vs. 88%; p = 0.23) and biochemical remission rates for functioning tumors (82% vs. 83%; p = 0.85). For repeat surgery patients, although there was a higher rate of gross total resection for unilateral cavernous sinus invasion (83%) compared to bilateral cavernous sinus invasion cases (55%; p < 0.0001), there was no difference in biochemical remission rate for patients with functioning tumors after surgery alone (76% vs. 67%; p = 0.16) or after adjuvant-assisted treatment (83% vs 83%; p = 1.0). Analysis of all 336 cavernous sinuses of the 168 TCS patients demonstrated that the probability of medial wall invasion was 53% in our series. Compartment invasion was most frequent for posterior (21%) and superior (20%) compartments, followed by inferior (17%), clinoidal (9%) and lateral (4%) compartments. The likelihood of gross total resection if a given compartment was involved was highest for medial wall (81%) and clinoidal compartment (81%), followed by inferior (79%), superior (68%), posterior (62%) and lateral (50%) compartments. Conclusions: Pituitary adenomas involving the cavernous sinus can be resected via the transcavernous approach to achieve high rates of complete tumor resection and biochemical remission for functioning pituitary adenomas. Differences in clinical outcomes between tumors invading different compartments of the cavernous sinus should be considered when planning transcavernous surgery for these tumors.
Volume
85
Issue
S1