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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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| Published in: | World neurosurgery 2016-12, Vol.96, p.36-46 |
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| creator | Dhandapani, Sivashanmugam Singh, Harminder Negm, Hazem M. Cohen, Salomon Anand, Vijay K. Schwartz, Theodore H. |
| description | 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 |
| doi_str_mv | 10.1016/j.wneu.2016.08.088 |
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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 < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3–4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI.
Knosp 3–4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2016.08.088</identifier><identifier>PMID: 27591098</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>World neurosurgery, 2016-12, Vol.96, p.36-46</ispartof><rights>2016</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-51b0b40ef18045e17f54df5d38b9b7def4e16cafd2acae155bc810f535b23bfa3</citedby><cites>FETCH-LOGICAL-c422t-51b0b40ef18045e17f54df5d38b9b7def4e16cafd2acae155bc810f535b23bfa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27591098$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhandapani, Sivashanmugam</creatorcontrib><creatorcontrib>Singh, Harminder</creatorcontrib><creatorcontrib>Negm, Hazem M.</creatorcontrib><creatorcontrib>Cohen, Salomon</creatorcontrib><creatorcontrib>Anand, Vijay K.</creatorcontrib><creatorcontrib>Schwartz, Theodore H.</creatorcontrib><title>Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>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 < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3–4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI.
Knosp 3–4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.</description><subject>Adenoma - diagnostic imaging</subject><subject>Adenoma - pathology</subject><subject>Adenoma - surgery</subject><subject>Cavernous Sinus - diagnostic imaging</subject><subject>Cavernous Sinus - pathology</subject><subject>Cavernous Sinus - surgery</subject><subject>Cavernous sinus invasion</subject><subject>Complications</subject><subject>Endonasal endoscopy</subject><subject>GTR</subject><subject>Humans</subject><subject>Microsurgery</subject><subject>Natural Orifice Endoscopic Surgery</subject><subject>Neoplasm Invasiveness</subject><subject>Neuroendoscopy</subject><subject>Neurosurgical Procedures</subject><subject>Nose</subject><subject>Pituitary adenoma</subject><subject>Pituitary Neoplasms - diagnostic imaging</subject><subject>Pituitary Neoplasms - pathology</subject><subject>Pituitary Neoplasms - surgery</subject><subject>Radiological criteria</subject><subject>Remission</subject><subject>Systematic review</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9UcFu3CAURFWrJkrzAz1UHHvxFmxj46qXlZM2kRI1yrZnhOERsbJhC3ij_ab-ZHE3yTHoCR5iZoAZhD5SsqKENl-2q0cH86rM_YrwXPwNOqW85QVvm-7tS8_ICTqPcUvyqGjN2-o9Oilb1lHS8VP0t5d7CM7PEW-sy_O128tovcPW4TubZptkOOC1BucnGb_izSEmmGSyCt_D3sIjlk7jO-9H0PhCJolvIcli7eR4iDZib_C91NaP_iFT-mATBCv_k3o_7WSwMV-WUZdO-6j8LqOWw1urwvN-M4cHCIcP6J2RY4Tzp_UM_f5--au_Km5-_rju1zeFqssyFYwOZKgJGMpJzYC2htXaMF3xoRtaDaYG2ihpdCmVBMrYoDglhlVsKKvByOoMfT7q7oL_M0NMYrJRwThKB9koQXldN6ShXZeh5RG6PDYGMGIX7JQdE5SIJSexFUtOYslJEJ6LZ9KnJ_15mEC_UJ5TyYBvRwDkX2aPg4jKglOgbQCVhPb2Nf1_AImobQ</recordid><startdate>201612</startdate><enddate>201612</enddate><creator>Dhandapani, Sivashanmugam</creator><creator>Singh, Harminder</creator><creator>Negm, Hazem M.</creator><creator>Cohen, Salomon</creator><creator>Anand, Vijay K.</creator><creator>Schwartz, Theodore H.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201612</creationdate><title>Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery</title><author>Dhandapani, Sivashanmugam ; Singh, Harminder ; Negm, Hazem M. ; Cohen, Salomon ; Anand, Vijay K. ; Schwartz, Theodore H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-51b0b40ef18045e17f54df5d38b9b7def4e16cafd2acae155bc810f535b23bfa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adenoma - diagnostic imaging</topic><topic>Adenoma - pathology</topic><topic>Adenoma - surgery</topic><topic>Cavernous Sinus - diagnostic imaging</topic><topic>Cavernous Sinus - pathology</topic><topic>Cavernous Sinus - surgery</topic><topic>Cavernous sinus invasion</topic><topic>Complications</topic><topic>Endonasal endoscopy</topic><topic>GTR</topic><topic>Humans</topic><topic>Microsurgery</topic><topic>Natural Orifice Endoscopic Surgery</topic><topic>Neoplasm Invasiveness</topic><topic>Neuroendoscopy</topic><topic>Neurosurgical Procedures</topic><topic>Nose</topic><topic>Pituitary adenoma</topic><topic>Pituitary Neoplasms - diagnostic imaging</topic><topic>Pituitary Neoplasms - pathology</topic><topic>Pituitary Neoplasms - surgery</topic><topic>Radiological criteria</topic><topic>Remission</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhandapani, Sivashanmugam</creatorcontrib><creatorcontrib>Singh, Harminder</creatorcontrib><creatorcontrib>Negm, Hazem M.</creatorcontrib><creatorcontrib>Cohen, Salomon</creatorcontrib><creatorcontrib>Anand, Vijay K.</creatorcontrib><creatorcontrib>Schwartz, Theodore H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhandapani, Sivashanmugam</au><au>Singh, Harminder</au><au>Negm, Hazem M.</au><au>Cohen, Salomon</au><au>Anand, Vijay K.</au><au>Schwartz, Theodore H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2016-12</date><risdate>2016</risdate><volume>96</volume><spage>36</spage><epage>46</epage><pages>36-46</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>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 < 0.001) for each Knosp grade. Endoscopy had significantly higher GTR than did microscopy particularly for Knosp 3–4 (47% vs. 21%; P = 0.001). Carotid injury and cranial nerve deficits occurred in 0.9% and 5%, respectively, with endoscopy. Among endoscopic series with CSI, GTR% showed significant correlation with number of patients in the series (P ≤ 0.01) but no correlation with complications, indicating the relative safety of endonasal endoscopy in experienced hands for removing tumors with CSI.
Knosp 3–4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27591098</pmid><doi>10.1016/j.wneu.2016.08.088</doi><tpages>11</tpages></addata></record> |
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| 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 |
| title | Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery |
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