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. 2024 Jun 19;166(1):273.
doi: 10.1007/s00701-024-06168-x.

Endoscopic transcavernous approach for functional pituitary adenomas

Daniele Starnoni  1   2   3 , Roy T Daniel  4   5   6 , Mahmoud Messerer  4   5   6
Affiliations

Endoscopic transcavernous approach for functional pituitary adenomas

Daniele Starnoni et al. Acta Neurochir (Wien). .

Abstract

Background: Invasion of the CS is one of the limiting factors for total resection for PitNet tumors with cure rates less than 30%. Extended approaches may be considered in selective and well-studied cases of secreting adenomas.

Method: We describe the key steps of the endoscopic transcavernous approach for functional pituitary adenomas with a video illustration. The surgical anatomy is described along with the advantages and limitations of this approach.

Conclusion: A detailed knowledge of CS anatomy and familiarity with this surgical approach acquired in the laboratory is essential. Proper instrumentation is critical to decrease the risks of vascular injury.

Keywords: Cavernous sinus; Endoscopic approach; PitNet; Pituitary adenomas.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Case involving a 62-year-old patient with abnormal IGF levels (745 µg/L) and acromegalic features. (A and B) Pre-operative Gd-enhanced T1W sagittal and coronal MR images showing a pituitary macroadenoma invading the inferior (green arrow), medial, superior (orange arrow) and posterior (red arrow) compartments of the right cavernous sinus. Pituitary gland (red star) is slightly displaced to the left side
Fig. 2
Fig. 2
(A) Intraoperative view showing the wide exposure of the anterior wall of the cavernous sinus that is prominent due to the lesion. (B) Schematic representation of the sequence of dural cuts for opening the anterior wall of the cavernous sinus. The anterior wall is opened at the lowest and medial aspect of the anterior wall where the carotid bends posteriorly to form the posterior genu. It is, subsequently, largely opened in a superior direction parallel to the medial wall of the CS and lateral direction. (C) intraoperative view showing the compartments of the CS after complete tumor resection. (D) Schematic representation of the inferior (IPL) and superior (SPL) parasellar ligaments and the carotid-clinoid ligament (CCL)
Fig. 3
Fig. 3
Post-operative T1W coronal MR image showing the placement of autologous fat in the resection lodge covering the carotid artery
See this image and copyright information in PMC

References

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