Artikel
Endoscopic transphenoidal approach for pituitary adenomas invading the cavernous sinus: our experience with 128 cases
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Autoren
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Savas Ceylan
- Pituitary Research Center, Kocaeli University and Department of Neurosurgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Burak Cabuk
- Pituitary Research Center, Kocaeli University and Department of Neurosurgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Batihan Uye
- Pituitary Research Center, Kocaeli University and Department of Neurosurgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Ihsan Anik
- Pituitary Research Center, Kocaeli University and Department of Neurosurgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Kenan Koc
- Pituitary Research Center, Kocaeli University and Department of Neurosurgery, School of Medicine, Kocaeli University, Kocaeli, Turkey
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The aim of this study was to present the results of 128 cases, who underwent pituitary surgery using an endoscopic transphenoidal approach to the cavernous sinus and to evaluate the efficacy of this approach.
Method: Seven hundred twenty-nine pituitary adenomas were operated on using the endoscopic transsphenoidal approach between 1997 (September) – 2013 (December) in the department of Neurosurgery, Kocaeli University, Turkey. A retrospective review of clinical outcomes of 128 cases (17,5% of pituitary adenomas) with cavernous sinus invasion was performed. During the operation we found that cavernous sinus invasion expands in two ways in pituitary adenomas, a “medial corridor” and a “lateral corridor”. We classified these lesions according to the surgical corridors as Type I (Medial Corridor Involvement), Type II (Lateral Corridor Involvement), Type III (Total Encasement – Involvement both Medial & Lateral Corridors).
Results: Nonfunctioning tumors were present in 49 patients (38%); among functioning adenomas, 43 patients (34%) had growth hormone-secreting adenomas, 28 patients (22%) had prolactinomas, and 8 (6%) patients had adrenocorticotropic hormone-secreting adenomas. Considering the invasion classification, there were 59 cases of isolated medial corridor involvement (Type I), 15 with isolated lateral corridor involvement (Type II) and 54 with total involvement (Type III).Total tumor removal was performed in 79 cases (63%) and subtotal tumor removal was achieved in 49 (37%) of the 128 cases. According to 2010 criteria, random GH level less than 1 ng/ml, GH<0.4 ng/ml under oral glucose tolerance test and normal IGF-I levels were achieved in 13 patients (30%) with GH adenomas, remission criteria were defined in 4 patients with ACTH adenoma (50%). Prolactinomas were operated mostly for decompression; remission was accomplished in 32%.
Conclusions: Pituitary adenomas invading the cavernous sinus can be removed totally. Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure of the cavernous sinus. Resection and remission rates will increase with further development of endoscopic techniques and experience.
