Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results

Cavernous sinus (CS) invasion is found in 15–20% of pituitary adenomas; it represents a poor prognosis factor and a surgical challenge even in experienced pituitary centers. We present our experience and technical note description for surgical management of pituitary adenomas with CS invasion in acr...

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Bibliographic Details
Published in:Neurocirugía (Asturias, Spain) Spain), 2021-07, Vol.32 (4), p.170-177
Main Authors: Gómez-Amador, Juan Luis, Martínez-Anda, Jaime Jesús, Guerrero-Suarez, Pablo David, Rosales-Amaya, Arturo Miguel, Delgado-Arce, Julio Cesar, Guerrero-López, David Antonio
Format: Article
Language:eng ; spa
Subjects:
Acromegalia
Acromegaly
Adenoma hipofisiario
Cavernous sinus
Cirugía endoscópica
Endoscopic surgery
Pituitary adenoma
Seno cavernoso
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Summary:Cavernous sinus (CS) invasion is found in 15–20% of pituitary adenomas; it represents a poor prognosis factor and a surgical challenge even in experienced pituitary centers. We present our experience and technical note description for surgical management of pituitary adenomas with CS invasion in acromegaly by the transsellar lateral approach with an endoscopic endonasal transsphenoidal route. prospective case series of patients who underwent endoscopic endonasal surgery for Growing Hormone (GH) producing adenomas with CS invasion treated at the Neurosurgery departments of National Institute of Neurology and Neurosurgery in Mexico City, and of Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces between January 2014 and March 2019. Thirty-two of 94 patients with diagnosis of pituitary adenoma treated at our institutions (34%) had acromegaly; thirteen of patients with acromegaly diagnosis met the inclusion criteria for CS invasion. Postoperative images reported gross total resection in 10 patients (76.9%). Mean follow-up time was 28.3 months. Remission criteria were achieved in nine patients (69.2%), with one of these patients (11.1%) having recurrence during follow up. All patients with no biochemical remission had improvement in GH and IGF profiles. Three patients without remission underwent radiosurgery (14Gy), and one patient had remission after the procedure. We consider this to be a safe and efficient approach for tumors invading CS, when surgical team have good experience in endoscopy of the skull base and reconstruction techniques, appropriate instruments are available, and tumor has soft consistency. Se encuentra invasión al seno cavernoso en el 15-20% de los adenomas hipofisiarios, y representa un factor de mal pronóstico, así como un reto quirúrgico en algunas series. En el presente trabajo describimos y evaluamos nuestra experiencia con una técnica quirúrgica para el manejo de adenomas hipofisiarios con invasión al seno cavernoso en pacientes con acromegalia a través de un abordaje transelar lateral por la vía endonasal endoscópica. Serie de casos prospectiva de pacientes tratados con cirugía endonasal endoscópica para pacientes con diagnóstico de acromegalia y adenomas hipofisiarios con invasión al seno cavernoso tratados en los Departamentos de Neurocirugía del Instituto Nacional de Neurología y Neurocirugía en la Ciudad de México y en el Centro Médico Toluca del Instituto de Seguridad Social del Estado de Méx
ISSN:1130-1473
2529-8496
DOI:10.1016/j.neucir.2020.05.003