Cavernous Sinus Surgery for Corticotroph Pituitary Adenomas: Distinctive Growth Patterns and Impact on Cushing Disease Remission
Recommended Citation
Alvarez AS, Lamano JB, Banu MA, Palejwala A, Lee CK, Ljubimov VA, Asmaro KP, Vigo V, Fernandez-Miranda JC. Cavernous Sinus Surgery for Corticotroph Pituitary Adenomas: Distinctive Growth Patterns and Impact on Cushing Disease Remission. J Neurol Surg B Skull Base 2026; 87.
Document Type
Conference Proceeding
Publication Date
2-27-2026
Publication Title
J Neurol Surg B Skull Base
Keywords
ACTH secreting adenoma, adult, aggression, cavernous sinus, complication, conference abstract, Cushing disease, drug therapy, human, human tissue, middle aged, radiotherapy, remission, reoperation, retrospective study, sinus surgery, surgery
Abstract
Introduction: Corticotroph pituitary adenomas can be silent or functioning, with distinct growth behavior, cavernous sinus (CS) invasion patterns, and clinical impact. ACTH-secreting tumors cause severe morbidity, and standard endonasal endoscopic approach achieves remission in only 60–80% of cases with frequent recurrences. Reoperation offers limited benefits and higher complication risk. Understanding CS-invasion patterns and improving CS exploration techniques are essential to achieve remission in CS-invasive corticotroph adenomas. Objective: To characterize the invasion patterns of silent and ACTH-secreting adenomas and to determine how surgical resection of CS-invasive disease influences remission in Cushing disease. Methods: 100 consecutive TPIT-positive corticotroph pituitary adenomas resected with curative intent (2018–2024) were reviewed. Cavernous sinus medial wall resection and CS exploration were performed when invasion was suspected. Results: • Silent corticotroph adenomas (SCA) are larger and more invasive, often with medial wall destruction and invasion into the CS compartments (52.4%, p < 0.01) and/or subarachnoid extension (19%, p < 0.05) [[Fig. 1] A-B]. The more aggressive growth pattern of SCAs, combined with more conservative surgery in non-functioning adenomas, results in lower but not statistically significant GTR rates. • ACTH-secreting adenomas have similar CS invasion rates but are typically confined to the medial wall (43.1%, p < 0.0001) [[Fig. 2]] No differences in extent of resection or complications were observed between patients with and without CS invasion in both SCAs and Cushing disease [[Fig. 3]]. No ICA injuries occurred. • In newly diagnosed Cushing patients, 92.3% achieved remission. An increase of 23.1% in remission rates can be achieved through medial wall resection, and a further 5.1% with CS compartment surgery [[Fig. 4]]. • In recurrent Cushing disease, remission was achieved in 57.9% and CS surgery was needed to achieve remission in almost half of patients (36.9% medial-wall resection, 10.2% CS-compartment exploration) [Fig. 5, [Fig. 1 C-D]]. Conclusion: SCAs and ACTH-secreting adenomas have similar CS invasion rates but differ in growth patterns. SCAs often destroy the medial wall and invade multiple CS compartments, complicating resection. ACTH-secreting tumors are typically confined to the medial wall, and its resection substantially improves remission. CS surgery improves remission rates without increasing complications.(Figure presented)
Volume
87
