Extended Endoscopic Endonasal Transsphenoidal Approach to Resect the Pituitary Adenomas Invading the Cavernous Sinus

Objective: To retrospectively evaluate the effectiveness of the extended endoscopic endonasal removal of pituitary adenomas (PAs) invading the cavernous sinus. Methods: Between September 2003 and December 2010 at the Wuxi Second Hospital Affiliated Nanjing Medical University, 32 consecutive patients underwent “pure” extended endoscopic endonasal transsphenoidal surgery for PAs invading the cavernous sinus. The clinical outcomes of the patients were evaluated, including symptoms, the extent of the tumor, the amount of tumor removed, and any complications. Results: Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging, and clinical evaluation, was total in 21 out of 32 PA patients, subtotal in 8 patients, and partial in 3 patients. Two patients suffered from cerebrospinal fluid leak postoperatively, and underwent repeated operation for skull base reconstruction. There were no cases of meningitis. Conclusions: Extended endoscopic endonasal transsphenoidal surgery for PAs invading the cavernous sinus is a safe and effective alternative procedure after proper training. Moreover, the technique is less invasive, more effective, and requires less time than traditionally utilized procedure.