Endoscopic Endonasal Surgery for Tumors of the Cavernous Sinus: a Series of 234 Patients.

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Endoscopic Endonasal Surgery for Tumors of the Cavernous Sinus: a Series of 234 Patients.

World Neurosurg. 2017 Apr 24;:

Authors: Koutourousiou M, Vaz Guimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA

Abstract
BACKGROUND: Cavernous sinus (CS) tumors are often considered inoperable. We present our experience with endoscopic endonasal surgery (EES) and compare the outcomes for different tumor.
METHODS: EES (medial or lateral approach) was used in 234 patients with CS tumors. The cohort included 175 (75%) pituitary adenomas and 59 (25%) non-adenomatous lesions.
RESULTS: Presenting symptoms were significantly different between the two groups, with cranial neuropathies occurring mainly in non-adenomas (p<.0001). The overall gross total tumor resection rate from the CS was 37.3% (37.1% in adenomas, 38.1% in non-adenomas). In total, preexisting cranial nerve (CN) dysfunction improved in 56.4% of the patients. After treatment completion (including radiation of residual tumor), 83.3% of acromegalic patients, 50% of prolactinomas and 33.3% of Cushing's disease were in remission. Visual loss improved in 86.8% of adenomas and in 70.8% of non-adenomas. Intracavernous CN palsies improved in 77.3% of adenomas and 42.4% of non-adenomas. New permanent CN palsies occurred in 7 non-adenomas which is significantly higher than in adenomas (p=0.007). The CSF leak rate was 6.3% for adenomas and 11.9% for non-adenomas. Four patients suffered an internal carotid artery injury with no neurological sequelae in three cases and one death (0.4%).
CONCLUSION: EES provides an easily accessible midline corridor to the CS with equivalent or superior results to transcranial approaches in the management of select tumors. Symptomatology due to CS invasion is more likely to improve in pituitary adenomas and the rate of surgical complications is higher in non-adenomas. Using a team approach, the overall mortality due to vascular injury is low.

PMID: 28450229 [PubMed - as supplied by publisher]

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