Comparative characteristics of postoperative dynamics in the treatment of pituitary adenomas with cavernous sinus invasion

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.