378 Surgical Resection of Growth Hormone Secreting Pituitary Adenomas With Cavernous Sinus Invasion: Impact of Medial Wall and Compartment Resection on Acromegaly Remission

Le résumé fourni par la source

INTRODUCTION: Growth hormone secreting pituitary adenomas causing acromegaly demonstrate increased propensity for cavernous sinus (CS) invasion. Remission after surgical resection has ranged from 34-73%, with decreased remission observed among adenomas with CS invasion (25-41%). Greater understanding of CS anatomy and microsurgical techniques required for exploration have made the resection of lesions invading the CS routine and safe. METHODS: Data from 100 consecutive growth hormone secreting pituitary adenomas causing acromegaly, undergoing surgical resection with intent to cure, and with CS exploration and tumor resection when indicated were collected from 2018-2024. Biochemical remission was compared across adenomas with and without CS invasion. RESULTS: CS invasion was identified intra-operatively in 80% of cases. Gross total resection was similar across adenomas with and without CS invasion (78% versus 90%, p = 0.3). Moreover, biochemical remission after surgery was similar across cases with and without CS invasion (81% versus 85%, p = 1.0). Biochemical remission on immediate post-operative growth hormone levels demonstrated an 89% positive predictive value for long-term remission. With the addition of adjuvant medication and/or radiation therapy for cases not achieving remission after surgery alone, remission was obtained in 96% of adenomas with CS invasion. On multivariate analysis, gross total resection (OR 118, p < 0.001) was identified as a predictor of remission, while clival invasion (OR 0.1, p = 0.03) and prior surgical intervention (OR 0.07, p = 0.02) were associated with failure to achieve remission after surgery alone. Complications including cranial nerve palsies, diplopia, carotid injuries, and post-operative endocrinopathies were not different across cases with and without CS invasion. CONCLUSIONS: Growth hormone secreting pituitary adenomas present with a high degree of CS invasion. Resection of tumor invading the medial wall of the CS and CS compartments is associated with improved acromegaly remission without increased complications.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.