Endoscopic Transcavernous Surgery for Pituitary Tumors within the Lateral Cavernous Sinus: Advancing towards the Lateral Frontier

Document Type

Conference Proceeding

Publication Date


Publication Title

J Neurol Surg B Skull Base


Background: Recent anatomical advances have divided the cavernous sinus into four partitions, the inferior, superior, posterior, and lateral compartments. The lateral compartment is considered the most difficult and least forgiving due to its intimate relationship with the inferolateral trunk, tentorial artery, dorsal meningeal artery, as well as cranial nerves III-VI.

Objective: We aim to study the role and efficacy of endoscopic transcavernous surgery for cavernoinvasive pituitary pathology located within the lateral compartment of the cavernous sinus.

Methods: A prospectively collected and retrospective cohort analysis of 248 consecutive surgeries for pituitary tumor via an endoscopic endonasal approach between 2018 and 2022.

Results: We identified 12 patients, median age 41.5, 10 were women (83%), 6 (50%) functional tumors who underwent endoscopic TCS in the lateral compartment. The sensitivity of preoperative MRI to detect lateral compartment disease (Knosp: 4) was 50%. The majority (67%) of lateral compartment disease was present when all four compartments were also invaded, but 3 (25%) and 1 (8%) were alongside two and one invaded compartment, respectively. 40% of patients had gross total resection and 3 patients (50%) achieved biochemical remission. Postoperative cranial neuropathy was present in four patients (33%): two CN III, one CN VI, and one patient had both CN III and VI palsies. All patients with postoperative diplopia recovered at 2 weeks (n = 1), 3 months (n = 2), and 6 months (n = 1). There was no incidence of carotid injury or stroke.

Conclusion: Surgery within the lateral cavernous sinus remains challenging but can be performed in the experienced hands with limited, transient morbidity pertaining to diplopia from cranial neuropathy extraocular motility dysfunction. Patient selection is key, as it can be beneficial to patients suffering from uncontrollable functional disease without the untoward side effects of radiotherapy.