Impact of Transcavernous Extension of the Endonasal Endoscopic Approach on Posterior Pituitary Function for Resection of Pituitary Adenomas

Introduction: Resection of the medial wall of the cavernous sinus (MWCS)—i.e., “transcavernous approach”—is an endoscopic technique developed to improve resection of invasive pituitary adenomas. In spite of its difficulty and risks, it has been proven to increase remission rates in functional adenomas, although its influence in posterior pituitary function has yet to be elucidated.

Objective: The goal of this study is to assess whether resection of the MWCS has any effect on the incidence of postoperative diabetes insipidus (DI) in patients undergoing endoscopic endonasal surgery for pituitary adenoma.

Methods: We retrospectively reviewed a series of 290 consecutive patients who underwent endoscopic endonasal resection of pituitary adenomas. Patients were classified according to the occurrence of transcavernous extension of the approach (no transcavernous approach, unilateral transcavernous, or bilateral transcavernous approach), and the incidence of postoperative DI was compared between groups.

Results: In 140 patients (48.3%), transcavernous extension was not required. Of the remaining 150 cases, unilateral transcavernous extension was performed in 131 (45.2%), and bilateral extension in 19 (6.6%). Overall, 33.4% of patients experienced some form of postoperative DI, and in 6.2% it was permanent. The incidence of permanent DI was 5% for those without transcavernous extension, 7.6% for unilateral transcavernous extension, and 5.3% for bilateral transcavernous extension (p = 0.935), without significant differences between those who underwent MWCS resection and those who did not (p = 0.872), nor between those who underwent monolateral versus bilateral MWCS resection (p = 0.789).

Conclusion: In our study, the Transcavernous approach with MWCS resection does not appear to increase the risk of postoperative DI in patients undergoing endoscopic endonasal resection of pituitary adenomas.

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Artikel online veröffentlicht:
05. Februar 2024