2025 Proffered Presentations
S008: SELECTIVE RESECTION OF THE MEDIAL WALL OF THE CAVERNOUS SINUS: A PROSPECTIVE STUDY
Dan Zimelewicz Oberman, MD, MSc1; Emiliano Sanchez-Garavito, MD1; Carlos Perez-Vega, MD1; Angela Donaldson2; Osarenoma Olomu, MD2; Stephen Graepel, MD3; Mark Edgar, MD4; Alfredo Quinones Hinojosa, MD1; Kaisorn Chaichana, MD1; Susan L. Samson, MD, PhD5; João Paulo Almeida, MD, PhD1; 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; 2Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida, USA.; 3Department of Neurosurgery, Mayo Clinic, Minnesota, Rochester, MN, USA; 4Department of Pathology, Mayo Clinic, Minnesota, Rochester, MN, USA; 5Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
Purpose: Pituitary adenomas, although histologically benign, can significantly impact patients' quality of life and increase mortality due to hormone hypersecretion. Invasion of the medial wall of the cavernous sinus (MWCS) by these tumors complicates surgical outcomes, reducing biochemical remission rates and increasing recurrence. This study aims to share our institutional experience with the selective resection of the MWCS in endoscopic pituitary surgery.
Methods: This prospective study included patients diagnosed with functional and non-functional pituitary adenomas who underwent endoscopic endonasal surgery. Inclusion criteria encompassed confirmed pituitary adenomas, selective MWCS resection, and a minimum of 3 months of follow-up. Patient demographics, tumor characteristics, surgical outcomes, and postoperative complications were analyzed using descriptive statistics.
Results: Twenty-seven cases met the inclusion criteria, with a median patient age of 50 years. Functional adenomas constituted 77.7% of cases, and macroadenomas 88.8%. Tumor invasion of the MWCS was confirmed in 77.7% of cases. The mean maximum tumor diameter was 18.44 ± 13.45 mm. Initial biochemical remission was achieved in 88.8% of cases. Complications included pulmonary embolism, epistaxis, and cerebrospinal fluid leak requiring reoperation, with no fatalities or major neurovascular injuries reported.
Conclusion: Resection of the MWCS is a promising strategy for improving surgical outcomes in pituitary adenomas with potential invasion into this area. The procedure demonstrates a balance of efficacy and safety, contributing positively to disease control and remission rates. Further research with larger cohorts and extended follow-up is required to validate these findings and assess long-term outcomes.