Suction Nerve Stimulator Technique for Resection of Pituitary Adenomas Invading the Cavernous Sinus via Endoscopic Endonasal Approach

Introduction: The cavernous sinus is a complex anatomical region with a high density of neurovascular structures. Pituitary adenomas are known for their capability of invading the medial cavernous sinus wall causing cranial neuropathies and making surgical resection challenging. New post-operative cranial neuropathies after resection of pituitary adenomas have been reported to be as high as 5 to 8.7% in some series. Herein, we aim to present our experience using a suction nerve stimulator technique for resection of pituitary adenomas with invasion of the cavernous sinus.

Objective: To describe the feasibility and safety of a suction nerve stimulator technique for resection of pituitary adenomas invading the cavernous sinus.

Method: s We performed a retrospective chart review of all patients undergoing endoscopic endonasal approach for pituitary adenoma resection in a single academic institution by the senior author since the introduction of the suction nerve stimulator device. Fifty consecutive patients were identified from January 2020 to July 2023.

Results: We identified 50 patients (16 females and 34 males), mean age 59.5 (27–82), in whom the suction tip nerve stimulator was used to monitor cranial nerves III, IV and VI in the affected cavernous sinus. Twenty-three (46%) patients had invasion of the cavernous sinus, 21 (42%) on the right, and 6 (12%) patients had bilateral. Eight (16%) patients presented with diplopia. Six of them had a third cranial nerve palsy, 1 had sixth palsy, and 1 patient had third and sixth nerve palsies. Among the patients who presented with cranial nerve palsy, 7 (87.5%) had complete recovery of their palsy and only 1 (12.5%) had partial improvement. No patient developed new postoperative cranial nerve palsy.

Conclusions: Our retrospective review introduces the efficacy of the suction tip nerve stimulating technique for monitoring cranial nerves during the resection of pituitary adenomas within this region. Notably, in our cohort, most patients presenting with preoperative cranial nerve palsy experienced full recovery, and no new postoperative cranial neuropathies were reported. This suggests that the suction tip nerve stimulating technique is both a safe and valuable tool in the surgical management of pituitary adenomas with cavernous sinus invasion. Further validation in larger cohorts could establish it as a standard protocol, potentially minimizing post-surgical neurological complications.

 

MissingLinkText

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024