TY - JOUR
T1 - Cavernous sinus invasion by pituitary adenomas
T2 - Role of endoscopic endonasal surgery
AU - Zoli, Matteo
AU - Milanese, Laura
AU - Bonfatti, Rocco
AU - Sturiale, Carmelo
AU - Pasquini, Ernesto
AU - Frank, Giorgio
AU - Mazzatenta, Diego
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background: cavernous sinus (cs) invasion is one of the most unfavorable features of pituitary adenomas. The most widely used classifcation was proposed by Knosp in 1993 and revised in 2015. The aim of this study is to extend our previous experience by comparing the preoperative neuroradiological assessment with the intra-operative endoscopic endonasal inspection in order to evaluate the real rate of cs invasion and analyze its correlation with the surgical outcome. MeTHoDs: consecutive patients, who have undergone endoscopic endonasal surgery for a pituitary adenoma with Knosp grade greater than 1, have been included in this study. The intra-operative cs invasion was assesses basing on surgical reports. The surgical outcome has been evaluated with Mri, endocrinological, visual and neurological evaluation have been performed 3 months after surgery and then annually. resulTs: The series included 402 patients. Male-female ratio was 1:1 and median age was 56 years (range 15-85). We observed that 43% of cases with Knosp grade greater than 1 presented no cs invasion on surgical inspection. Knosp grade 4 was the only one corresponding in all cases to a real cs invasion. radical tumor removal was achieved in 60%. while endocrinological remission was obtained in 37% of functioning adenomas. Better results were observed for lower Knosp grades. coNclusioNs: The endoscopic endonasal inspection is the most effective technique to detect cs invasion. indeed, it can provide a direct visualization of the medial wall, permitting the assessment of its invasion and the management of those cases with diffuse involvement. We confrm that the revision to the Knosp classifcation has improved its prognostic role.
AB - Background: cavernous sinus (cs) invasion is one of the most unfavorable features of pituitary adenomas. The most widely used classifcation was proposed by Knosp in 1993 and revised in 2015. The aim of this study is to extend our previous experience by comparing the preoperative neuroradiological assessment with the intra-operative endoscopic endonasal inspection in order to evaluate the real rate of cs invasion and analyze its correlation with the surgical outcome. MeTHoDs: consecutive patients, who have undergone endoscopic endonasal surgery for a pituitary adenoma with Knosp grade greater than 1, have been included in this study. The intra-operative cs invasion was assesses basing on surgical reports. The surgical outcome has been evaluated with Mri, endocrinological, visual and neurological evaluation have been performed 3 months after surgery and then annually. resulTs: The series included 402 patients. Male-female ratio was 1:1 and median age was 56 years (range 15-85). We observed that 43% of cases with Knosp grade greater than 1 presented no cs invasion on surgical inspection. Knosp grade 4 was the only one corresponding in all cases to a real cs invasion. radical tumor removal was achieved in 60%. while endocrinological remission was obtained in 37% of functioning adenomas. Better results were observed for lower Knosp grades. coNclusioNs: The endoscopic endonasal inspection is the most effective technique to detect cs invasion. indeed, it can provide a direct visualization of the medial wall, permitting the assessment of its invasion and the management of those cases with diffuse involvement. We confrm that the revision to the Knosp classifcation has improved its prognostic role.
KW - Cavernous sinus
KW - Magnetic resonance imaging
KW - Natural orifce endoscopic surgery
KW - Pituitary neoplasms
UR - http://www.scopus.com/inward/record.url?scp=84996848761&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84996848761&partnerID=8YFLogxK
M3 - Review article
C2 - 27280543
AN - SCOPUS:84996848761
VL - 60
SP - 485
EP - 494
JO - Journal of Neurosurgical Sciences
JF - Journal of Neurosurgical Sciences
SN - 0026-4881
IS - 4
ER -