Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly

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 CSM...

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Autores: Torres, Alberto, Muñoz, Fernando, Sanmillan, Jose Luis, Gabarros, Andreu
Tipo de documento: artigo
Data de publicação:2026
País:España
Recursos:Universidad de Oviedo (UNIOVI)
Repositório:Dipòsit Digital de la UB
OAI Identifier:oai:dnet:ubarcelona__::0b6754e22014d5cd2209f4e64ac79d2f
Acesso em linha:https://hdl.handle.net/2445/229702
Access Level:Acceso aberto
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spelling Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in AcromegalyTorres, AlbertoMuñoz, FernandoSanmillan, Jose LuisGabarros, AndreuINTRODUCTION: 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. square 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. square 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. square 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.Elsevier B.V.2026info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/2445/229702reponame:Dipòsit Digital de la UBinstname:Universidad de Oviedo (UNIOVI)InglésReproducció del document publicat a: https://doi.org/10.1016/j.wneu.2026.124929World Neurosurgery, 2026, vol. 209, p. 124929https://doi.org/10.1016/j.wneu.2026.124929http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:dnet:ubarcelona__::0b6754e22014d5cd2209f4e64ac79d2f2026-05-27T06:46:51Z
dc.title.none.fl_str_mv Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
title Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
spellingShingle Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
Torres, Alberto
title_short Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
title_full Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
title_fullStr Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
title_full_unstemmed Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
title_sort Cavernous Sinus Medial Wall Resection in Invasive Pituitary Adenomas: Outcome in Acromegaly
dc.creator.none.fl_str_mv Torres, Alberto
Muñoz, Fernando
Sanmillan, Jose Luis
Gabarros, Andreu
author Torres, Alberto
author_facet Torres, Alberto
Muñoz, Fernando
Sanmillan, Jose Luis
Gabarros, Andreu
author_role author
author2 Muñoz, Fernando
Sanmillan, Jose Luis
Gabarros, Andreu
author2_role author
author
author
description 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. square 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. square 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. square 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.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/229702
url https://hdl.handle.net/2445/229702
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.wneu.2026.124929
World Neurosurgery, 2026, vol. 209, p. 124929
https://doi.org/10.1016/j.wneu.2026.124929
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier B.V.
publisher.none.fl_str_mv Elsevier B.V.
dc.source.none.fl_str_mv reponame:Dipòsit Digital de la UB
instname:Universidad de Oviedo (UNIOVI)
instname_str Universidad de Oviedo (UNIOVI)
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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