Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading cavernous sinus

Abstract

Objective To investigate the effects of endoscopic endonasal transphenoidal approach in the treatment of pituitary adenomas invading the cavernous sinus (CS).Methods A retrospective analysis was performed in 135 pituitary adenomas extending to CS treated via endoscopic endonasal transphenoidal approach between April 2008 and April 2013.The most common adenoma type was non-functioning pituitary adenomas (NFPAs) (86 cases,63.7％),followed by PRL-secreting adenomas (28 cases,20.7％),growth hormone (GH)-secreting adenomas (18 cases,13.3％),ACTH-secreting adenomas (2 cases,1.5％),and TSH-secreting adenomas(1 cases,0.7％).The average diameter of the tumors was (30.0 ± 1.1)mm(10-69 mm).The shapes of the tumors were as the following:round (97 cases,72.6％),dumb bell (8 cases,5.9％),and multi-lobe (30 cases,21.5％).The patients were divided into two groups according to the Knosp classification:third grade (57 cases,42.2％) and fourth grade (78 cases,57.8％).Results Gross total resection was achieved in 40 patients (29.6％),subtotal (＞90％) in 45 (33.3％),partial (＞70％) in 42 (31.1％),and decompression (＜70％) in 8 (5.9％).There were 4 patients (3.0％) accompanied with postoperative cerebraospinal fluid leak,2 with visual decrease,and 5 with transient diabetes insipidus.One paient died due to postoperative intracranial hematoma.In 18 patients with GH-secreting adenomas,4 achieved endocrinological remission after surgery,and 9 significant GH decrease.In 28 patients with PRL-secreting adenomas,6 had a normal serum PRL level within one week postoperatively,and 21 remarkable PRL decrease.Conclusions The endoscopic endonasal transphenoidal approach was a safe and effective option for the resection of pituitary adenomas invading the CS. Key words: Pitutiary adenomas;  Invasive;  Caverous sinus ;  Neuroendoscope ;  Endonasal transsphenoidal approach