Cavernous Sinus: endonasal endoscopic approach for pituitary tumors

Abstract

Objective: To show the experience of the Hospital de Puerto Montt on endonasal endoscopic approach (EEA) to the cavernous sinus(CS) Methods: A patient series with pituitary tumors who required surgical approach to the cavernous sinus between 2017 and2018 at the Hospital de Puerto Montt, Chile. Results: Thirteen patients, between 30 and 60-year-old, 9 women and 4 men. All thecases presented pituitary tumors, four were functioning adenomas. Imagenological evaluation was made using the Knosp scale. Inall cases the chosen approach was transpterygoid. There were no vascular complications, neither cranial nerves nor cerebrospinalfluid leaks. Resection was complete in 6/13 patients and clinical remission in 3 of 5 functioning cases. Discussion: Tumor extensionto the cavernous sinus is a situation that usually limits the intent of resection of a pituitary tumor, and also orient complimentarytreatment. Knowledge of the anatomy of the sellar and cavernous regions allow surgical approaches with less complications and highergrade of resection. Conclusion: The endonasal endoscopic approach to the cavernous sinus is possible in some patients. Staging ofthe disease, resectability and indication of complementary therapies must be performed after careful multidisciplinary evaluation.