Background

Parasellar dural invasion can be associated with treatment failure after excision of functioning pituitary adenomas. Because the medial wall of the cavernous sinus is a common site of microscopic disease, we hypothesize that its resection may lead to improvement in biochemical remission and recurrence rates. We aim to describe our technique in the resection of the medial wall of the cavernous sinus using binasal endoscopic transsphenoidal surgery (BETS); and compare tumor control and biochemical remission rates against a matched cohort.

Methods

Patients with functioning pituitary adenomas who underwent resection of the medial cavernous wall in addition to tumor excision via BETS were compared to a cohort matched for tumor type, size, and Knosp grade. Biochemical remission rates, tumor control at follow-up, and complication rates were assessed.

Results

Sixteen patients underwent resection of the medial wall of the cavernous sinus. Of 14 cases with wall specimens deemed adequate for histopathologic analysis, 43% had microscopic evidence of tumor. Two of three patients with Knosp grade 0 scores had microscopic tumor invasion of the medial wall. The mean blood loss in the cohort was 175 mL (comparable to control, p = 0.895), with no operative complications noted. Gross total excision was achieved in 81% of cases in the treatment cohort. At a median follow-up of 11 months, no statistical difference was noted in the biochemical remission and oncologic control rates between groups.

Conclusion

Resection of the medial wall of the cavernous sinus is safe and technically feasible using BETS when performed by experienced surgeons. The Knosp classification may not be reliable for microscopic tumor invasion. The effect of this technique on clinical outcomes remains to be determined by larger cohorts with matched controls and long-term follow-up.

中文翻译：

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功能性垂体腺瘤海绵窦内壁切除术：匹配队列研究的技术说明和结果

背景

功能性垂体腺瘤切除后，鞍旁硬膜浸润可能与治疗失败有关。由于海绵窦内壁是显微镜下病变的常见部位，我们假设将其切除可能会导致生化缓解和复发率的提高。我们的目标是描述我们使用双鼻内窥镜经蝶窦手术 (BETS) 切除海绵窦内壁的技术；并将肿瘤控制和生化缓解率与匹配的队列进行比较。

方法

除了通过 BETS 切除肿瘤外，还接受了海绵体内壁切除术的功能性垂体腺瘤患者与肿瘤类型、大小和 Knop 分级匹配的队列进行了比较。评估生化缓解率、随访时的肿瘤控制和并发症发生率。

结果

16 名患者接受了海绵窦内壁切除术。在 14 例壁标本被认为足以进行组织病理学分析的病例中，43% 有肿瘤的显微镜证据。具有 Knosp 0 级评分的三名患者中有两名患有内壁的微观肿瘤浸润。队列中的平均失血量为 175 mL（与对照组相比，p = 0.895），未发现手术并发症。在治疗队列中，81% 的病例实现了总切除。在中位随访 11 个月时，组间生化缓解和肿瘤控制率无统计学差异。

结论

当由经验丰富的外科医生执行时，使用 BETS 切除海绵窦内壁是安全且技术上可行的。Knosp 分类对于微观肿瘤侵袭可能不可靠。这项技术对临床结果的影响仍有待于具有匹配对照和长期随访的更大队列来确定。