[Comparative assessment of the results of different surgical treatments in patients with pituitary adenomas infiltrating the cavernous sinus].
Benign pituitary tumors or adenomas are highly common, occasionally inclined to infiltrate the adjacent structures, the cavernous sinus in particular. Despite the fact that drug and radiation therapy are at present widely used treatments, surgical procedures remain highly topical. Different modifications of two basic surgical methods (transcranial intradural and transsphenoidal) that fail to completely remove a tumor from the cavernous sinus in most cases are mostly frequently used as before. Attempts to improve surgical procedures and introduction of current technologies have led to the emergence of an extradural method for tumor removal from the cavernous sinus and to the introduction of endoscopic monitoring during transsphenoidal operations. A strategy of two-stage removal of pituitary tumors has simultaneously been developed. The paper presents the results of surgical treatment of 297 patients with pituitary adenomas growing into the cavernous sinus, by using currently available procedures: transsphenoidal, transcranial intradural, and intra-extradural, and two-stage ones. The findings have confirmed that transsphenoidal removal of pituitary adenomas is the safest method. However, this method has a number of limitations in cases with tumor being grown into the cavernous sinus especially when there is a medial displacement of the intracavernous segment of the internal carotid artery. Moreover, secondary tumor nodes that may be removed by transcranial intradural access are a contraindication to its use. With this, attempts to remove a tumor from the cavernous sinus fail to ensure the desired completeness of removal from the cavernous sinus. The application of an intra-extradural access is the most adequate procedure for tumor removal from the cavernous sinus. The two-stage removal is the most adequate procedure in cases of simultaneously significant spread of a tumor intracranially and into the structures of the base of the skull.
Kadashev
B A
BA
Kutin
M A
MA
Kalinin
P L
PL
Trunin
Iu K
IuK
Alekseev
S N
SN
Shkarubo
A N
AN
D000203:Activities of Daily Living; D000236:Adenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002426:Cavernous Sinus / Q000473:pathology* / Q000601:surgery; D004700:Endocrine System Diseases / Q000209:etiology; D005128:Eye Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010911:Pituitary Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000401:mortality / Q000601:surgery*