title: Endoscopic endonasal transsellar approach for laterally extended pituitary adenomas: volumetric analysis of cavernous sinus invasion.
abstract: OBJECTIVE
  The authors conducted a statistical analysis of surgical results of the endoscopic endonasal transsellar approach to provide quantitative indices for selection of the approach in the treatment of laterally extended pituitary adenomas.
  
  
  METHODS
  Surgical results of 25 patients with laterally extended pituitary adenomas of Knosp grade 3 or 4 were retrospectively analyzed. The removal rate was evaluated by the volumetric change of the lateral tumor compartment.
  
  
  RESULTS
  The transsellar approach was used exclusively in all cases. Gross total removal of the lateral tumor compartment was achieved in 14 (56.0%). Factors affecting the tumor removal through the transsellar approach were lateral tumor volume (p = 0.006), maximal distance to the cavernous sinus outer wall (p = 0.004) and history of previous surgery (p = 0.017). The cut-off values for the lateral tumor volume and maximal distance to the cavernous sinus outer wall predicting the gross total removal were 0.479 ml and 8.1 mm, respectively. The surgical complications of the transsellar approach included each case of anterior lobe function insufficiency and liquorrhea.
  
  
  CONCLUSIONS
  The transsellar approach is adequate for removal of lateral tumor compartment in the majority of cases with laterally extended pituitary adenomas. The tumor compartments dorsal and ventral to the horizontal portion of the intracavernous carotid artery are amenable to the removal. But for removal of the tumor compartment lateral to the carotid siphon requires additional use of the parasellar approach.
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan, mtani@med.kobe-u.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Kohkichi
authors.initials: K
authors.lastname: Hosoda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Akutsu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D057605:Natural Orifice Endoscopic Surgery; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden