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J Neurol Surg B Skull Base 2018; 79(S 04): S311-S315
DOI: 10.1055/s-0038-1667123
WFSBS 2016
Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of Cavernous Sinus Lesion in Patients with Nonfunctioning Pituitary Adenomas via the Endoscopic Endonasal Approach

Masahiro Toda
1   Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
,
Kenzo Kosugi
1   Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
,
Hiroyuki Ozawa
2   Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
,
Kaoru Ogawa
2   Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
,
Kazunari Yoshida
1   Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
› Author Affiliations
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Publication History

26 February 2018

10 June 2018

Publication Date:
16 July 2018 (online)

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Abstract

Objective The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA).

Design Retrospective study.

Setting Keio University Hospital.

Participants Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis.

Main Outcome Measures Clinical presentation, extent of resection, and surgical complications.

Results Gross total and near total resection of CS tumors was achieved in 12/30 (40%) cases of Knosp grade 4 NFPA. The average resection rate of CS lesions in these 30 patients was 73.5%; 77.3% in primary cases and 70.1% in recurrent cases that did not vary significantly. Preoperative visual disturbance and oculomotor nerve palsy improved in 12/19 (63.1%) and ⅗ (60%) cases, respectively. Complications associated with CS via the EEA were postoperative cerebrospinal leakage (1/30, 3.3%), meningitis (1/30, 3.3%), and transient cranial nerve palsy (2/30, 6.7%). These complications except a case of mild transient abducens nerve palsy occurred in recurrent cases with subdural lesions.

Conclusions Although the optimal management of CS lesions in NFPA is controversial, debulking via the EEA is an effective and safe option that improves neurological symptoms and enables effective adjuvant radiotherapy. Recurrent cases with subdural invasion are technically challenging, even using the EEA, and special care is required to avoid complications.

Keywords

skull base - complications - pituitary adenoma
 

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