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Updated: Mar 23, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
Alberto Torres1, Fernando Muñoz2, Jose Luis Sanmillan1
1Neurosurgical Department, Bellvitge University Hospital, Hospitalet de Llobregat, Universitat de Barcelona, Barcelona, Spain.
Introduction:
Pituitary adenomas may infiltrate the cavernous sinus, often through the cavernous sinus medial wall (CSMW). Standardization of CSMW resection has improved the safety and reproducibility of this maneuver and may increase the extent of resection. We evaluated surgical outcomes after CSMW resection in invasive pituitary adenomas, with special emphasis on growth hormone (GH)-secreting adenomas.
Methods:
We retrospectively reviewed patients with invasive pituitary adenomas who underwent CSMW resection at 2 high-volume neurosurgical centers between 2021 and 2023. Preoperative imaging, tumor invasiveness, hormonal secretion, extent of resection, biochemical remission, and complications were assessed. A surgical management algorithm for the CSMW is also presented.
Results:
A total of 193 pituitary adenomas were operated on during the study period. CSMW resection was performed in 63 patients (33%), including 28 nonfunctioning adenomas (44%) and 35 functioning adenomas (56%). The most frequent functioning subtype was GH-secreting adenoma (n = 20), followed by ACTH-secreting adenoma (n = 8) and prolactin-secreting adenoma (n = 4); 3 tumors showed GH/prolactin co-secretion. Cavernous sinus invasion was classified as group A (Knosp 0-3A) in 40 patients (64%), group B (Knosp 3B) in 11 (17%), and group C (Knosp 4) in 12 (19%). Gross total resection was achieved in 34 group A tumors (85%), 4 group B tumors (36%), and no group C tumors. In acromegaly, biochemical remission after surgery was achieved in 13 of 14 group A tumors (93%), 2 of 5 group B tumors (40%), and 0 of 1 group C tumors. Histologic invasion of the medial wall was confirmed in 55 of 63 specimens (87%) and in 32 of 40 group A tumors (80%). There were no deaths or internal carotid artery injuries. Two patients (3%) developed a new transient cranial nerve palsy, and 1 patient (1.6%) had a postoperative cerebrospinal fluid leak.
Conclusion:
Endoscopic endonasal CSMW resection is safe and technically feasible in experienced hands. In selected invasive pituitary adenomas, particularly functioning tumors with Knosp 0-3A invasion, it may improve extent of resection and biochemical remission.
