[Pituitary adenomas invading the cavernous sinus. Transcranial transcavernous approach]. / Adenomas hipofisarios con invasiòn intracavernosa. Resultados del abordaje trancraneal al seno cavernoso.

UNLABELLED: Pituitary adenomas represent a significant proportion (+o-13%) of all intracranial tumors. Surgical treatment is as rule performed by transsphenoidal approach. However, a small but not insignificant subgroup of pituitary adenomas (5 to 7%) invade the lateral parasellar structures and the cavernous sinus in particular, and poses obvious problems to the therapeutic strategy, since transsphenoidal removal of these adenomas is usually incomplete. OBJECTIVE: To evaluate the results of transcranial removal of a consecutive series of pituitary adenomas invading the cavernous sinus. MATERIAL AND METHOD: A retrospective study of 9 patients harbouring pituitary adenomas invading the cavernous sinus who had been submitted to transcranial surgery was conducted. These patients were operated on in the time span June 1999 - December 2003, in the Nuova Clinica Latina (now NCL- Neurological Centere of Latium), Rome Italy, and the Hospital "Hermanos Ameijeiras", La Habana, Cuba, using a fronto-orbitozigomatic (FOZ) craniotomy, anterior clinoidectomy and a limited dissection of the cavernous sinus through the antero-medial triangle. RESULTS: Total macroscopical removal was achieved in 8 cases, partial in 1, who showed improvement or normalization of the hormonal levels and of the preoperative symptoms. Transitory complications occurred in 6 patients, one of them showed a permanet neurological deficit (paresis of the III cranail nerve). CONCLUSIONS: Transcranial transcavernous approach is an effective technique for attempting total removal of intracavernous pituitary adenomas. It allows to achieve remission of symptoms and hormonal control in the medium-long term. However complications are relatively frequent, and permanent sequelae are not negligible.

Adenomas hipofisarios con invasiòn intracavernosa. Resultados del abordaje transcraneal al seno cavernoso / Pituitary adenomas invading the cavernous sinus. Transcranial transcavernous approach

Los adenomas hipofisarios representan el 13% delos tumores intracraneales. Generalmente el abordaje transesfenoidal es suficiente para su manejo, pero de un 5 a un 7% de los mismos se comporta de forma invasiva. El tratamiento de este subgrupo ha sido tradicionalmente incompleto (exéresis transesfenoidal parcial + radioterapia) y conduce a una elevada tasa de recidivas. Objetivos. Evaluar los resultados obtenidos con el abordaje transcavernoso en los adenomas hipofisarios con extensión intracavernosa. Material y método. Se realiza un estudio retrospectivo de 9 pacientes, cuya lesión fue abordada a travésdel triángulo antero medial mediante craneotomía fronto-órbito-zigomática en la Nuova Clinica Latina de Roma y el Hospital Hermanos Ameijeiras de Ciudad dela Habana entre Junio del 1999 y Junio del 2003.Resultados. En 8 casos se logró la exégesis total microscópicamente y parcial en 1. Con mejoría y/o normalización de los niveles hormonales y de la sintomatología preoperatoria. Se observaron complicaciones transitorias en 6 pacientes y la secuela más importante fue la paresia del III nervio craneal. Conclusiones. La exéresis transcavernosa es una técnica eficaz cuando se pretende resecar radicalmente la lesión, lograr remisión de los síntomas y conseguir descenso hormonal en el caso de los productores, aunque las complicaciones y secuelas pueden ser importantes

Pituitary adenomas represent a significant proportion (+o-13%) of all intracranial tumors. Surgical treatment is as rule performed by transsphenoidal approach. However, a small but not insignificant subgroup of pituitary adenomas (5 to 7%) invade the lateral parasellar structures and the cavernous sinus in particular, and poses obvious problems to the therapeutic strategy, since transsphenoidal removal of the seadenomas is usually incomplete. Objective. To evaluate the results of transcranial removal of a consecutive series of pituitary adenomas invading the cavernous sinus. Material and method. A retrospective study of 9patients harbouring pituitary adenomas invading the cavernous sinus who had been submitted to transcranial surgery was conducted. These patients were operated on in the time span June 1999 - December 2003, in the Nuova Clinica Latina (now NCL- Neurological Centere of Latium), Rome Italy, and the Hospital "HermanosAmeijeiras", La Habana, Cuba, using a fronto-orbitozigomatic(FOZ) craniotomy, anterior clinoidectomy and a limited dissection of the cavernous sinus through the antero-medial triangle. Results. Total macroscopical removal was achieved in 8 cases, partial in 1, who showed improvement or normalization of the hormonal levels and of the preoperative symptoms. Transitory complications occurred in6 patients, one of them showed a permanent neurological deficit (paresis of the III cranail nerve).Conclusions. Transcranial transcavernous approach is an effective technique for attempting total removal of intracavernous pituitary adenomas. It allows to achieve remission of symptoms and hormonal control in the medium-long term. However complications are relatively frequent, and permanent sequelae are not negligible