Abstract:
Pituitary adenomas are the most common hypothalamic-pituitary tumors, accounting for 10% of intracranial
neoplasms. Although benign, they can infiltrate the dura mater and destroy the skull base. Extension into the
cavernous sinus occurs in 10-15% of cases, and their removal is a difficult task. Analysis of postoperative
dynamics generated by surgical approaches (endoscopic transsphenoidal, extended lateral, microscopic, extraintradural) in the treatment of invasive cavernous sinus tumors. For this comparative analysis, a systematic
review of the specialized literature was performed with specific references to the published findings by
Sharipov O., Kitano M., Cappabianca P. and Kutin M.A., Snyderman C.H., Gardner P. The selection criteria
included clinical trials and relevant specialized journals published between 2000 and 2025. Visual disturbances
were common pre-op (standard EETSA: 74.2%, Microscopic Transsphenoidal: 51.4%), with notable
improvements post-op (standard EETSA: 61.3%, Microscopic Transsphenoidal: 65.1%). Post-op worsening
was higher in the Extra-Intradural (28.6%) and Microscopic Transphenoidal (10.1%) approaches.
Hypothalamic/endocrine disturbances predominated pre-op in the Extra-Intradural group (78.6%).
Improvements varied, but worsening was higher in the Extra-Intradural (28.6%). Post-op diabetes insipidus
was most common in the Extra-Intradural approach (35.7%), compared to the other approaches (2.9% -
10.07%). Meningitis and seizures were rare. Endoscopic approaches favor good visual recovery and a low
incidence of major complications with more radical resection. The Extra-Intradural approach, effective for
complex cases, involves higher risks of worsening neurological deficits and postoperative complications.
