title: A new endoscopic surgical classification and invasion criteria for pituitary adenomas involving the cavernous sinus.
abstract: OBJECTIVE
  There are two major problems for the pituitary adenomas invading the Cavernous Sinus (CS); differentiation of extension and invasion and inability to demonstrate the medial wall via preoperative imaging methods. Two important corridors are defined in endoscopic cavernous sinus approaches; the lateral and medial corridor.
  
  
  METHODS
  A retrospective analysis was performed in 400 endoscopic transphenoidal approaches and 360 pituitary adenomas underwent endoscopic transphenoidal surgery in our department between September 1997 and December 2010. 48 patients affected by the tumours involving the cavernous sinus were included in this study.
  
  
  RESULTS
  We performed an intraoperative evaluation of cavernous sinus invasion considering visualization of the medial wall defect, intracavernous ICA segments, minor tumour extensions through small focal pit holes of the medial wall of CS or confirming carotid segments of CS by micro-doppler. Cavernous sinus involvement was classified into three types according to the medial and lateral corridor extension of the tumor as 25 isolated medial corridor involvement (Type I), 5 isolated lateral corridor involvement (Type II) and 18 total involvement (Type III).
  
  
  CONCLUSIONS
  Our classification depends on fully surgical endoscopic approach supported by neuroimaging techniques and anatomical studies and shows a good predictive value for all cavernous sinus involvement.
authors.affiliation: Kocaeli University, Faculty of Medicine, Department of Neurosurgery and Pituitary Research Centre, Kocaeli, Turkey. ssceylan@yahoo.com
authors.forename: Savas
authors.initials: S
authors.lastname: Ceylan
authors.forename: Ihsan
authors.initials: I
authors.lastname: Anik
authors.forename: Kenan
authors.initials: K
authors.lastname: Koc
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000145:classification*; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000473:pathology / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D019635:Neurosurgical Procedures / Q000145:classification*; D010911:Pituitary Neoplasms / Q000145:classification* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery; D055815:Young Adult