First Experience of the Selective Medial Wall Resection of the Cavernous Sinus in Pituitary Adenoma Patients

Objective: The selective medial wall resection of the cavernous sinus invaded by pituitary tumor was described in the several papers as an effective surgical step to receive a remission in treatment of the functional adenomas. We present our first experience with this technique.

Method: A retrospective review including patient's age and gender, type of adenomas, pathology findings, complications and outcomes was performed.

Results: A total 10 patients were included in the study. There were two males and eight females. Patient's age was between 31 and 60 years (mean: 47.2). According to the functional status, there was one patient with gonadotropin (FSH and LH)–secreting tumor, two patients with adrenocorticotropic hormone (ACTH)–secreting tumor, and seven patients with growth hormone (GH)–secreting tumors. With regard to the Knosp classification, grade 0 were 2 patients, grade 1—4 patients, grade 2—2 patients, and grade 3—2 patients. Two patients had microadenoma and in 8 patients there were macroadenoma. Average tumor volume was 1.3 cm³. One patient with a GH-secreting and one patient with gonadotropin secreting adenoma were operated for the second time due to the tumor progression and absence of the disease control after initial surgery 4 and 8 years prior respectively. Other eight patients were primary. A great total resection was achieved in all cases. A follow-up range was between 3 and 22 months (mean: 12.8 months). The biochemical remission in patients with GH-secreting adenomas was observed in 6 (85.7%) cases in the period of 7 days to 4 months postoperatively. Both patients with ACTH-secreting tumor developed a biochemical remission on day 5 postoperatively. Patient with gonadotropin secreting adenoma developed a hypogonadotropic hypogonadism postoperatively. A total remission rate in series regarding the functional activity of adenomas was 90%. Tumor invasion of the medial wall of the cavernous sinus was confirmed histologically by pathologist in 7 (70%) cases and in the rest of 3 (30%) cases it was doubtful because of lack of spacemen or tight adherence of the tumor to the sinus wall. All three were with GH-secreting tumors. One patient developed a new VI-CN palsy which was transient and resolved 3 months postoperatively. One patient developed a permanent diabetes insipidus and required a replacement therapy. In one patient initial III-CN palsy resolved after surgery. There were no internal carotid artery injury and mortality rate was zero.

Conclusion: Resection of the medial wall of the cavernous sinus could be performed in a safe mode. According to our initial experience morbidity rate seems to be low and the remission rate in functional adenomas with this technique expected to be high. Further follow-up is required to determine a long-term effect of the surgery.

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Artikel online veröffentlicht:
01. Februar 2023