Invasion of the Cavernous Sinus Medial Wall by Pituitary Adenomas: Intraoperative Evaluation and the Clinical Efficacy of the Cavernous Sinus Medial Wall Resection in the Treatment of Somatotroph Adenomas

Background: Pituitary adenomas are common benign intracranial tumors. This study aimed to explore the relevant factors influencing the cavernous sinus medial wall invasion by Pituitary adenomas based on intraoperative evaluation. Meanwhile, the authors introduced a safe technique for the resection of the medial wall of the cavernous sinus and conducted a preliminary evaluation of the efficacy of this technique. Methods: The clinical data of 108 patients with pituitary adenomas who underwent surgery at our institution were collected. Binary logistic regression analysis was utilized to identify independent predictors of medial wall invasion. Furthermore, the authors performed medial wall resection on 12 cases of somatotroph adenomas with medial wall invasion to initially assess the surgical efficacy of this technique for somatotroph adenomas. Results: Multivariate Logistic regression analysis showed that tumor Knosp grade and somatotroph adenomas were independent predictors of medial wall invasion ( P <0.05). For somatotroph adenomas, medial wall resection resulted in a high biochemical remission rate (83%), and all patients were free of recurrence at the last follow-up. Conclusion: Higher knosp grade and somatotroph adenomas will increase the risk of medial wall invasion of the cavernous sinus. Relying solely on the Knosp grade system to evaluate tumor invasion of the medial wall without differentiating between tumor subtypes is inaccurate. Invasion of the medial wall may be a cause of low biochemical remission rates and recurrence after surgery for somatotroph adenomas. The technique of medial wall resection is safe and effective, and holds significant importance in the treatment of somatotroph adenomas.