The Emerging Role of Endoscopic Endonasal Transcavernous Surgery in the Management of Non-Functioning Pituitary Adenomas with Cavernous Sinus Invasion

Introduction: Transcavernous surgery for resection of non-functioning pituitary adenomas (NFPAs) with cavernous sinus (CS) invasion is often not performed due to concern that the risk of neurovascular injury outweighs the risk posed by tumor progression or adjuvant radiosurgery. However, advances in endoscopic endonasal surgery (EES) techniques for safe and effective CS exploration have shown great promise to increase remission rates and reduce the likelihood of additional therapies without increasing morbidity for functional adenomas. To better understand the emerging role of first-line transcavernous surgery for resection of NFPAs with CS invasion, we examined surgical outcomes in patients with recurrent or newly diagnosed NFPAs treated with contemporary EES techniques. Methods: Surgical outcomes were retrospectively analyzed for 190 consecutive patients (102 males, median 58 years) with NFPAs who underwent EES. Multivariable logistic regression with adjustment for tumor diameter, Knosp grade and presence of CS invasion was used to compare outcomes between newly diagnosed ( n = 161) and recurrent adenomas ( n = 29). Results: While there were similar proportions of macroadenomas (100% versus 99%, p = 1.00), recurrent adenomas had more CS invasion (76% versus 32%, P=