Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery

Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature t...

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Bibliographic Details
Published in:World neurosurgery 2016-12, Vol.96, p.36-46
Main Authors: Dhandapani, Sivashanmugam, Singh, Harminder, Negm, Hazem M., Cohen, Salomon, Anand, Vijay K., Schwartz, Theodore H.
Format: Article
Language:English
Subjects:
Adenoma - diagnostic imaging
Adenoma - pathology
Adenoma - surgery
Cavernous Sinus - diagnostic imaging
Cavernous Sinus - pathology
Cavernous Sinus - surgery
Cavernous sinus invasion
Complications
Endonasal endoscopy
GTR
Humans
Microsurgery
Natural Orifice Endoscopic Surgery
Neoplasm Invasiveness
Neuroendoscopy
Neurosurgical Procedures
Nose
Pituitary adenoma
Pituitary Neoplasms - diagnostic imaging
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Radiological criteria
Remission
Systematic review
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Summary:Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach. We searched the MEDLINE database (1993–2015) to identify studies on radiologic criteria for CSI and endonasal surgery. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the studies included were reviewed for CSI criteria, gross total resection (GTR), endocrine remission, cranial nerve deficits, carotid injury, and other complications. The prevalence of CSI was 43% radiographically compared with 18% intraoperatively (P < 0.001). The radiologic criteria of inferolateral venous compartment obliteration and Knosp 3–4 had the highest correlation with intraoperative CSI and the lowest correlation with GTR. Microscopy had significantly overestimated intraoperative CSI compared with endoscopy (P 
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2016.08.088