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Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery.
J Neurosurg Sci 2016; 60(4):485-94JN

Abstract

BACKGROUND

Cavernous sinus (CS) invasion is one of the most unfavorable features of pituitary adenomas. The most widely used classification was proposed by Knosp in 1993 and revised in 2015. The aim of this study is to extend our previous experience by comparing the pre-operative 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 confirm that the revision to the Knosp classification has improved its prognostic role.

Authors+Show Affiliations

Center of Pituitary and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy - matteo.zoli4@unibo.it.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27280543

Citation

Zoli, Matteo, et al. "Cavernous Sinus Invasion By Pituitary Adenomas: Role of Endoscopic Endonasal Surgery." Journal of Neurosurgical Sciences, vol. 60, no. 4, 2016, pp. 485-94.
Zoli M, Milanese L, Bonfatti R, et al. Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery. J Neurosurg Sci. 2016;60(4):485-94.
Zoli, M., Milanese, L., Bonfatti, R., Sturiale, C., Pasquini, E., Frank, G., & Mazzatenta, D. (2016). Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery. Journal of Neurosurgical Sciences, 60(4), pp. 485-94.
Zoli M, et al. Cavernous Sinus Invasion By Pituitary Adenomas: Role of Endoscopic Endonasal Surgery. J Neurosurg Sci. 2016;60(4):485-94. PubMed PMID: 27280543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cavernous sinus invasion by pituitary adenomas: 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, Y1 - 2016/06/09/ PY - 2016/6/10/entrez PY - 2016/6/10/pubmed PY - 2017/4/12/medline SP - 485 EP - 94 JF - Journal of neurosurgical sciences JO - J Neurosurg Sci VL - 60 IS - 4 N2 - BACKGROUND: Cavernous sinus (CS) invasion is one of the most unfavorable features of pituitary adenomas. The most widely used classification was proposed by Knosp in 1993 and revised in 2015. The aim of this study is to extend our previous experience by comparing the pre-operative 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 confirm that the revision to the Knosp classification has improved its prognostic role. SN - 1827-1855 UR - https://www.unboundmedicine.com/medline/citation/27280543/Cavernous_sinus_invasion_by_pituitary_adenomas:_role_of_endoscopic_endonasal_surgery_ L2 - http://www.minervamedica.it/index2.t?show=R38Y2016N04A0485 DB - PRIME DP - Unbound Medicine ER -