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Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery.
World Neurosurg 2016; 96:36-46WN

Abstract

BACKGROUND

Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach.

METHODS

We searched the MEDLINE database (1993-2015) to identify studies on radiologic criteria for CSI and endonasal surgery. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the studies included were reviewed for CSI criteria, gross total resection (GTR), endocrine remission, cranial nerve deficits, carotid injury, and other complications.

RESULTS

The prevalence of CSI was 43% radiographically compared with 18% intraoperatively (P < 0.001). The radiologic criteria of inferolateral venous compartment obliteration and Knosp 3-4 had the highest correlation with intraoperative CSI and the lowest correlation with GTR. Microscopy had significantly overestimated intraoperative CSI compared with endoscopy (P < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3-4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI.

CONCLUSIONS

Knosp 3-4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.

Authors+Show Affiliations

Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, Menoufia University, Shebeen El Kom, Egypt.Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neuroscience, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA. Electronic address: schwarh@med.cornell.edu.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27591098

Citation

Dhandapani, Sivashanmugam, et al. "Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery." World Neurosurgery, vol. 96, 2016, pp. 36-46.
Dhandapani S, Singh H, Negm HM, et al. Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery. World Neurosurg. 2016;96:36-46.
Dhandapani, S., Singh, H., Negm, H. M., Cohen, S., Anand, V. K., & Schwartz, T. H. (2016). Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery. World Neurosurgery, 96, pp. 36-46. doi:10.1016/j.wneu.2016.08.088.
Dhandapani S, et al. Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery. World Neurosurg. 2016;96:36-46. PubMed PMID: 27591098.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery. AU - Dhandapani,Sivashanmugam, AU - Singh,Harminder, AU - Negm,Hazem M, AU - Cohen,Salomon, AU - Anand,Vijay K, AU - Schwartz,Theodore H, Y1 - 2016/08/30/ PY - 2016/07/18/received PY - 2016/08/19/revised PY - 2016/08/20/accepted PY - 2016/9/4/pubmed PY - 2017/10/3/medline PY - 2016/9/4/entrez KW - Cavernous sinus invasion KW - Complications KW - Endonasal endoscopy KW - GTR KW - Pituitary adenoma KW - Radiological criteria KW - Remission KW - Systematic review SP - 36 EP - 46 JF - World neurosurgery JO - World Neurosurg VL - 96 N2 - BACKGROUND: Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach. METHODS: We searched the MEDLINE database (1993-2015) to identify studies on radiologic criteria for CSI and endonasal surgery. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the studies included were reviewed for CSI criteria, gross total resection (GTR), endocrine remission, cranial nerve deficits, carotid injury, and other complications. RESULTS: The prevalence of CSI was 43% radiographically compared with 18% intraoperatively (P < 0.001). The radiologic criteria of inferolateral venous compartment obliteration and Knosp 3-4 had the highest correlation with intraoperative CSI and the lowest correlation with GTR. Microscopy had significantly overestimated intraoperative CSI compared with endoscopy (P < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3-4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI. CONCLUSIONS: Knosp 3-4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27591098/Cavernous_Sinus_Invasion_in_Pituitary_Adenomas:_Systematic_Review_and_Pooled_Data_Meta_Analysis_of_Radiologic_Criteria_and_Comparison_of_Endoscopic_and_Microscopic_Surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(16)30771-9 DB - PRIME DP - Unbound Medicine ER -