Surgical Treatment of Cavernous Sinus Lesion in Patients with Nonfunctioning Pituitary Adenomas via the Endoscopic Endonasal Approach

Objective The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA). Design Retrospective study. Setting Keio University Hospital. Participants Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis. Main Outcome Measures Clinical presentation, extent of resection, and surgical complications. Results Gross total and near total resection of CS tumors was achieved in 12/30 (40%) cases of Knosp grade 4 NFPA. The average resection rate of CS lesions in these 30 patients was 73.5%; 77.3% in primary cases and 70.1% in recurrent cases that did not vary significantly. Preoperative visual disturbance and oculomotor nerve palsy improved in 12/19 (63.1%) and ⅗ (60%) cases, respectively. Complications associated with CS via the EEA were postoperative cerebrospinal leakage (1/30, 3.3%), meningitis (1/30, 3.3%), and transient cranial nerve palsy (2/30, 6.7%). These complications except a case of mild transient abducens nerve palsy occurred in recurrent cases with subdural lesions. Conclusions Although the optimal management of CS lesions in NFPA is controversial, debulking via the EEA is an effective and safe option that improves neurological symptoms and enables effective adjuvant radiotherapy. Recurrent cases with subdural invasion are technically challenging, even using the EEA, and special care is required to avoid complications.

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Predictors of Improved Abducens Nerve Palsy following Endoscopic Endonasal Approach to Skull Base Lesions

10.1055/s-0039-1679619 ◽

2019 ◽

Author(s):

Michael Mcdowell ◽

Rachel Whelan ◽

Ezequiel Goldschmidt ◽

Andrew Venteicher ◽

Carl Snyderman ◽

...

Keyword(s):

Skull Base ◽

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Skull Base Lesions

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Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery

Journal of Neurosurgery ◽

10.3171/2017.2.jns162214 ◽

2018 ◽

Vol 129 (2) ◽

pp. 430-441 ◽

Cited By ~ 13

Author(s):

Juan C. Fernandez-Miranda ◽

Nathan T. Zwagerman ◽

Kumar Abhinav ◽

Stefan Lieber ◽

Eric W. Wang ◽

...

Keyword(s):

Cavernous Sinus ◽

Cranial Nerves ◽

Spatial Relationship ◽

Abducens Nerve ◽

Human Head ◽

Residual Tumor ◽

Surgical Anatomy ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

OBJECTIVETumors with cavernous sinus (CS) invasion represent a neurosurgical challenge. Increasing application of the endoscopic endonasal approach (EEA) requires a thorough understanding of the CS anatomy from an endonasal perspective. In this study, the authors aimed to develop a surgical anatomy–based classification of the CS and establish its utility for preoperative surgical planning and intraoperative guidance in adenoma surgery.METHODSTwenty-five colored silicon–injected human head specimens were used for endonasal and transcranial dissections of the CS. Pre- and postoperative MRI studies of 98 patients with pituitary adenoma with intraoperatively confirmed CS invasion were analyzed.RESULTSFour CS compartments are described based on their spatial relationship with the cavernous ICA: superior, posterior, inferior, and lateral. Each compartment has distinct boundaries and dural and neurovascular relationships: the superior compartment relates to the interclinoidal ligament and oculomotor nerve, the posterior compartment bears the gulfar segment of the abducens nerve and inferior hypophyseal artery, the inferior compartment contains the sympathetic nerve and distal cavernous abducens nerve, and the lateral compartment includes all cavernous cranial nerves and the inferolateral arterial trunk. Twenty-nine patients had a single compartment invaded, and 69 had multiple compartments involved. The most commonly invaded compartment was the superior (79 patients), followed by the posterior (n = 64), inferior (n = 45), and lateral (n = 23) compartments. Residual tumor rates by compartment were 79% in lateral, 17% in posterior, 14% in superior, and 11% in inferior.CONCLUSIONSThe anatomy-based classification presented here complements current imaging-based classifications and may help to identify involved compartments both preoperatively and intraoperatively.

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Endoscopic Endonasal Approach for Pituitary Adenomas: A Series of 560 Patients

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1314045 ◽

2012 ◽

Vol 73 (S 02) ◽

Author(s):

A. Paluzzi ◽

P. Gardner ◽

J. Fernandez-Miranda ◽

M. Koutourousiou ◽

M. Tormenti ◽

...

Keyword(s):

Pituitary Adenomas ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Endoscopic Endonasal Management of Nonfunctioning Pituitary Adenomas with Cavernous Sinus Invasion: Our Experience

Otolaryngology ◽

10.1177/0194599813495815a48 ◽

2013 ◽

Vol 149 (2_suppl) ◽

pp. P48-P48

Author(s):

Fabio Ferreli ◽

Mario Turri-Zanoni ◽

Stefania Gallo ◽

Maurizio Bignami ◽

Giustino Tomei ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Adenomas ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Nonfunctioning Pituitary Adenomas

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Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension

10.1055/s-0041-1725507 ◽

2021 ◽

Author(s):

Tural Rahimli

Keyword(s):

Pituitary Adenoma ◽

Cavernous Sinus ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma ◽

Cavernous Sinus Invasion

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Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000008049 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Haibo Zhu ◽

Chuzhong Li ◽

Songbai Gui ◽

Xinsheng Wang ◽

Xuyi Zong ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Tumors ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion

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Endoscopic endonasal approach to pituitary adenomas: Impact on adenohypophyseal function. Study of 231 cases

Neurocirugía ◽

10.1016/j.neucir.2021.07.004 ◽

2021 ◽

Author(s):

Marta Araujo-Castro ◽

Franklin Mariño-Sánchez ◽

Alfredo García Fernández ◽

Alberto Acitores Cancela ◽

Víctor Rodríguez Berrocal

Keyword(s):

Pituitary Adenomas ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Function Study

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Extended endoscopic endonasal approach for selected pituitary adenomas: early experience

Yearbook of Endocrinology ◽

10.1016/j.yend.2011.06.071 ◽

2011 ◽

Vol 2011 ◽

pp. 323-324

Author(s):

W.H. Ludlam

Keyword(s):

Pituitary Adenomas ◽

Early Experience ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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The Role of Endoscopic Endonasal Approach in the Treatment of Cavernous Sinus Meningioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1312072 ◽

2012 ◽

Vol 73 (S 01) ◽

Author(s):

Daniel Prevedello ◽

Ammar Shaikhouni ◽

Rodrigo Mafaldo ◽

Leo Filho ◽

Daniele de Lara ◽

...

Keyword(s):

Cavernous Sinus ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Cavernous Sinus Meningioma

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Chordoma of the Craniocervical Junction: Endoscopic Endonasal Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1697979 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S372-S374

Author(s):

Eduard H. Voormolen ◽

Pierre Olivier Champagne ◽

Sebastien Froelich

Keyword(s):

Craniocervical Junction ◽

University Hospital ◽

Neurological Deficits ◽

Preoperative Imaging ◽

Classical Type ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Postoperative Mri ◽

Lower Clivus

Objective This study was aimed to achieve gross-total removal of a chordoma of the craniocervical junction via an endonasal approach (Fig. 1). Design The present study is a case report. Setting The study was conducted at neurosurgical clinic of university hospital. Participant A 40-year-old male, with normal neurologic exam and no prior medical history, presented with a 2-year history of cervicalgia. On preoperative imaging, a midline lesion, with image characteristics of chordoma, was seen in the lower clivus and odontoid. It had limited lateral extension. Main Outcome Measures This study measures postoperative neurological deficits and postoperative tumor volume on magnetic resonance imaging (MRI). Results A binostril approach to the upper nasopharynx was performed using endoscope at 30- and 45-degree angles. Subsequently, a heart-shaped mucosal flap was made and the clivus was drilled to expose the lesion (Fig. 2). After initial debulking, the ring of C1 was slightly drilled to reach the tumor in and around the odontoid. Postoperative MRI showed that a gross-total resection was achieved. The patient had no neurologic deficits postoperatively. Pathologic examination revealed a chordoma of the classical type. Conclusion An endoscopic endonasal approach, utilizing the heart-shaped flap and angled endoscopes and instruments, can be considered for resection of select cases of craniocervical junction chordoma with limited lateral expansion.The link to the video can be found at: https://youtu.be/rwVoZJRBIEo.

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