Cavernous Sinus Invasion by Pituitary Adenomas: Not an Issue

Introduction: Although the use of endoscopy has improved our visualization for pituitary surgery, there is much debate about whether this has had any impact on outcomes. Traditionally, cavernous sinus invasion by adenomas portends a worse prognosis, either due to inoperability or persistent hyperfunctioning states. This study may help to answer the important question of the efficacy of endoscopic pituitary surgery compared with microsurgical techniques.

Methods: The charts of the last 160 consecutive patients with pituitary disorders were examined, and, when information was missing, patients were contacted by telephone. Patients were divided into those with overt cavernous sinus invasion and those without. Cure was determined by both radiological and serological postoperative assessment.

Results: Most tumors were nonfunctioning, and the overall cure rate was 84%. The cure rate for those with cavernous sinus invasion compared with those without was 82% versus. 84%. Although overall numbers were small, there was no statistical difference in the two groups.

Conclusion: Endoscopy allows the direct visualization of the cavernous sinus component of pituitary adenomas and in so doing permits a better degree of tumor resection. Cavernous sinus invasion is no longer a negative prognosticator when it comes to the surgical management of pituitary adenomas.