Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques

Bao, Xinjie; Deng, Kan; Liu, Xiaohai; Feng, Ming; Chen, Clark C.; Lian, Wei; Xing, Bing; Yao, Yong; Wang, Renzhi

doi:10.1007/s11102-015-0675-0

Cited by 33 publications

(20 citation statements)

References 44 publications

(63 reference statements)

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“…However, the reported rates of GTR of pituitary macroadenomas with CSI vary tremendously among different groups and range from 0% to 92.3%. 2,3,9,10,19,24 This variability may be partly due to the differing levels of experience among operating surgeons. 11 In our study, the GTR rate decreased with higher Knosp grade, regardless of whether the Knosp grades were derived from VIBE or CISS images.…”

Section: Discussionmentioning

confidence: 99%

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Lang

Silva

Dai

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Preoperatively determining the extent of parasellar invasion of pituitary macroadenomas is useful for surgical planning and patient counseling. Here, the authors compared constructive interference in steady state (CISS), a T2-weighted gradient-echo MRI sequence, to volume-interpolated breath-hold examination (VIBE), a T1-weighted gradient-echo MRI sequence, for evaluation of cavernous sinus invasion (CSI) by pituitary macroadenomas. METHODS VIBE and CISS images of 98 patients with pituitary macroadenoma were retrospectively analyzed and graded using the modified Knosp classification. The Knosp grades were correlated to surgical findings of CSI, which were determined intraoperatively using 0° and 30° endoscopes. The predictive accuracies for CSI according to the Knosp grades derived from the CISS and VIBE images were compared using receiver operating characteristic (ROC) curves. Postoperative MRI was used to evaluate the gross-total resection (GTR) rates. RESULTS The CSI rate by pituitary macroadenomas was 27.6% (27 of 98 cases). Of 196 assessments (left and right sides of 98 macroadenomas), 45 (23.0%) had different Knosp grades when scored using VIBE versus CISS images. For the VIBE images, 0% of Knosp grade 0, 4.5% of grade 1, 23.8% of grade 2, 42.1% of grade 3A, 100% of grade 3B, and 83.3% of grade 4 macroadenomas were found to have CSI intraoperatively. For the CISS images, 0% of Knosp grade 0, 2.1% of grade 1, 31.3% of grade 2, 56.3% of grade 3A, 100% of grade 3B, and 100% of grade 4 macroadenomas were found to have CSI intraoperatively. Two pituitary macroadenomas were classified as grade 4 on VIBE sequences but grades 3A and 2 on CISS sequences; CSI was not observed intraoperatively in both cases. The GTR rate was 64.3% and 60.0% for high-grade (3A, 3B, and 4) macroadenomas classified using VIBE and CISS sequences, respectively. The areas under the ROC curves were 0.94 and 0.97 for VIBE- and CISS-derived Knosp grades (p = 0.007), respectively. CONCLUSIONS Knosp grades determined using CISS sequence images are better correlated with intraoperative CSI than those determined using VIBE sequence images. CISS sequences may be valuable for the preoperative assessment of pituitary macroadenomas.

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Section: Discussionmentioning

confidence: 99%

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Lang

Silva

Dai

et al. 2019

Journal of Neurosurgery

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“…Nevertheless, most nonfunctioning PAs extending into the cavernous sinus are neither aggressive nor invasive, and cavernous sinus extension of PAs may be caused by weakness of the medial wall of the cavernous sinus (16). In our case series, total resection through extended transsphenoidal surgery was achieved for a substantial number of invasive Pas, with no recurrence after a long followup time (Figure 1) (17). Overall, a more accurate definition and objective diagnostic criteria are needed.…”

Section: Definition Of Refractory Pamentioning

confidence: 83%

Diagnosis and treatment of refractory pituitary adenomas: a narrative review

Liu¹,

Dai²,

Feng³

et al. 2021

Gland Surg

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“…In most reports, the extent of tumor removal in cases of pituitary adenoma invasion of the CS has been discussed in relation to the Knosp grade. 20,[28][29][30][31][32][33][34][35][36][37][38][39] However, a recent systematic review revealed that intraoperative CS invasion as judged during endoscopic surgery was different to the preoperative radiographic estimation of Knosp grade. 18 Hence, it may not be appropriate to discuss the removal rate of CS invasion in pituitary tumor cases with an estimated Knosp grade.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Cavernous Sinus Lesion in Patients with Nonfunctioning Pituitary Adenomas via the Endoscopic Endonasal Approach

et al. 2018

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The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA). Retrospective study. Keio University Hospital. Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis. Clinical presentation, extent of resection, and surgical complications. Gross total and near total resection of CS tumors was achieved in 12/30 (40%) cases of Knosp grade 4 NFPA. The average resection rate of CS lesions in these 30 patients was 73.5%; 77.3% in primary cases and 70.1% in recurrent cases that did not vary significantly. Preoperative visual disturbance and oculomotor nerve palsy improved in 12/19 (63.1%) and ⅗ (60%) cases, respectively. Complications associated with CS via the EEA were postoperative cerebrospinal leakage (1/30, 3.3%), meningitis (1/30, 3.3%), and transient cranial nerve palsy (2/30, 6.7%). These complications except a case of mild transient abducens nerve palsy occurred in recurrent cases with subdural lesions. Although the optimal management of CS lesions in NFPA is controversial, debulking via the EEA is an effective and safe option that improves neurological symptoms and enables effective adjuvant radiotherapy. Recurrent cases with subdural invasion are technically challenging, even using the EEA, and special care is required to avoid complications.

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Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques

Cited by 33 publications

References 44 publications

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Superiority of constructive interference in steady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas

Diagnosis and treatment of refractory pituitary adenomas: a narrative review

Surgical Treatment of Cavernous Sinus Lesion in Patients with Nonfunctioning Pituitary Adenomas via the Endoscopic Endonasal Approach

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