Related Experiment Video
Updated: Mar 11, 2026
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
20.0K
Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp
Juyoung Hwang1, Ho Jun Seol1, Do-Hyun Nam1
1Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Brain Tumor Research and Treatment
|November 22, 2016
Summary
Surgical resection of non-functioning pituitary adenomas invading the cavernous sinus is challenging. Subtotal resection with radiation therapy offers a safe alternative for high-risk cavernous adenomas.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Non-functioning pituitary adenomas (NFPA) invading the cavernous sinus present significant surgical challenges.
- Gross total resection (GTR) is often difficult to achieve in these cases, potentially leading to higher recurrence rates.
- A new classification system for cavernous sinus invasion has been proposed to guide treatment strategies.
Purpose of the Study:
- To validate a new classification system for cavernous sinus invasion in NFPA.
- To identify limitations and considerations for treatment strategies in NFPA with cavernous sinus involvement.
Main Methods:
- A retrospective study of 275 patients with NFPA who underwent surgery between January 2000 and January 2012.
- Patients were followed for a median of 4 years.
- Tumor resection extent (GTR, NTR, STR) was correlated with the new Knosp classification.
Main Results:
- GTR was achieved in 66.9% of patients, near total resection (NTR) in 16.3%, and subtotal resection (STR) in 16.7%.
- Significant differences were observed between the extent of resection and the new Knosp classification (p<0.001).
- In the high-grade Knosp classification group, recurrence rates did not differ between GTR/NTR and STR with adjuvant radiation therapy (p=0.515).
Conclusions:
- The new Knosp classification system shows significant correlation with the extent of tumor resection.
- For NFPA with cavernous sinus invasion, particularly in high-grade cases, STR combined with adjuvant radiation therapy is a viable and safe treatment alternative when surgical complications are a high risk.
