2026 Poster Presentations
P046: MEDIAL WALL RESECTION OF THE CAVERNOUS SINUS IN THE ENDOSCOPIC ENDONASAL SKULL BASE SURGERY
Bakhtiyar Pashaev1; Arseniy Pichugin2; Nail Shajakhmetov1; Gulnar Vagapova3; Farida Nasybullina4; Regina Ashimova1; 1Interregional Clinical Diagnostic Center; 2Kazan State Medical University; 3Kazan State Medical Academy; 4City Clinical Hospital No. 7 named after. M.N. Sadykova
Background: The selective medial wall resection of the cavernous sinus invaded by pituitary tumor is anatomically based and well described in the recent papers. Nowadays this technique becomes highly demanded especially in pituitary surgery.
Objective: To assay efficacy of the resection of the middle wall of the cavernous sinus in surgical treatment of the patients with pituitary and non-pituitary skull base tumors via endoscopic endonasal approaches.
Method: A retrospective review of the consecutive series of patients with pituitary and non-pituitary skull base tumors treated with endoscopic endonasal approaches between 2020 and 2025 was conducted. Patient’s age and gender, type of tumors, pathology findings, extend of resection (EOR), complications and outcomes were analyzed.
Results: A total 29 patients (9 males and 20 females) with a median age of 49,4 (range 19-72) were included in the study. Pathologies comprised pituitary adenomas (n=25), chordoma (n=2), chondrosarcoma (n=1) and SNUC (n=1).
According to the functional status a pituitary adenomas group included Gonadotropin (FSH&LH) - secreting tumor (n=1), Adrenocorticotropic hormone (ACTH) –secreting tumor (n=2), Growth hormone (GH)-secreting tumors (n=13), Prolactin (PRL)-secreting tumor (n=1), non-functioning adenomas (n=8). In pituitary adenomas group with regard to the Knosp classification tumors corresponds to: grade-0 (n=3), grade-1 (n=9), grade-2 (n=6), grade-3 (n=3), and grade-4 (n=4). With regard to the tumor size a pituitary adenoma group included microadenomas (n=6), macroadenomas (n=18) and giant (n=1). Non-pituitary tumors were large (n=2), and giant (n=2). Four patients were operated for the second time due to the tumor progression or absence of the disease control after initial surgery 4, 5 and 8 years prior. Other 21 patients were primary. A great total resection(GTR) was achieved in 22(76%), subtotal resection in 4(14%), and partial resection in 3(10%) cases. A follow-up range was between 3 and 59 months (mean 26,7 months). The biochemical remission in patients with acromegaly was observed in 11(84%) cases in the period of 7 days to 6 months postoperatively. Patients with Cushing disease developed a biochemical remission on the day 5 postoperatively. Patient with gonadotropin secreting adenoma developed a hypogonadotropic hypogonadism postoperatively. Prolactin-level came to the base-line postoperatively in one patient with prolactinoma. A total remission rate in series regarding the functional activity of adenomas was 88%. Tumor invasion of the medial wall of the cavernous sinus was confirmed histologically by pathologist in 86%(n=25) of cases and in the rest 14%(n=4) of cases it was doubtful because of lack of spacemen or tight adherence of the tumor to the sinus wall. Postoperative improvement included vision (n=6) and recovery of CN III (n=3) and CN VI (n=2) palsies. Postoperatively complications were noted: transient VI-CN palsy(n=2), CSF-leak (n=1), transient diabetes insipidus (n=1). Average intraoperative blood-loss was 250ml (range 100-700). There were no internal carotid artery injury and mortality rate was zero.
Conclusion: Resection of the medial wall of the cavernous sinus is a useful and safe technique mostly applicable in pituitary surgery. In case of non-pituitary tumor this technique provides higher resection rate with low risk of complications.