• Atsushi Ishida, Hideki Shiramizu, Haruko Yoshimoto, Masataka Kato, Naoko Inoshita, Nobuhiro Miki, Masami Ono, and Shozo Yamada.
• Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
• Neurosurgery. 2022 Nov 1; 91 (5): 775781775-781.

BackgroundThe purpose of transsphenoidal surgery (TSS) for a functioning pituitary tumor (FPT) is to achieve endocrinological remission. The biggest challenge is aggressive tumor resection invading the cavernous sinus (CS).ObjectiveTo evaluate the effects of the medial wall of CS (MWCS) resection during FPT surgery.MethodsConsecutive FPTs were reviewed for CS invasion (CSI) between April 2018 and December 2021. We operated on more than 250 FPTs, including 134 somatotroph tumors, 70 corticotroph tumors, 35 lactotroph tumors, and 9 thyrotroph tumors.ResultsThe patients were classified into 3 groups based on the relationship between the tumor and the CS: group A (no clear wall invasion), in which MWCS was not removed because of no tumorous direct contact with MWCS (N = 92) and group B (possible wall invasion), where MWCS was removed because we were not confident of MWCS invasion (N = 102). Among these 102 patients, histological tumor invasion was confirmed in 45 of 79 patients (57%) for whom histology findings were available. Tumors invading the CS clearly during surgery were classified into the "clear CS invasion" (group C: N = 55) group. The overall complete remission rate in group B was 94%, which was as high as that in group A (87%). Moreover, we clarified that microscopic invasion of MWCS could not always be predicted from Knosp grading.ConclusionMWCS invasion occurred in 57% of cases confirmed histologically where it was unclear during surgery, and its resection can improve the overall complete remission rate in FPT cases.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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