Aksonov R. Endoscopic endonasal surgery for pituitary adenomas with invasive infra- and parasellar spread

This dissertation is devoted to topical issue of pituitary adenoma surgery with infra- parasellar extension, identifying anatomical landmarks in changed anatomy during endoscopic endonasal transsphenoidal surgery. A retrospective analysis of 71 patients who underwent surgery from 2005 till 2017 aged from 18 till 74 ( average 48,2 ± 13,9) years were enrolled in study. Depending on pituitary adenomas extension into the sphenoid sinus patients were divided into 4 groups: Grade 0 - volume of the sphenoid sinus does not changed - 6 (8,4%), Grade 1 – size decreases till 12-10 mm - 9 (12,7%), Grade 2 - size decreases till 9-6 mm - 22 (31%), Grade 3 - size decreases less 5 mm - 34 (47,9%). Cavernous sinus invasion Knosp 3 and 4 was observed in 33 (40,2%) and 24 (29,3%) respectively. Visual disturbances were observed in 50 (70,4%) cases and oculomotor disorders identified in 5 (7%) cases preoperatively. Total resection was achieved in 41 (57,7%) cases, subtotal resection in 20 (28,16%) cases, partial resection - in 10 (14,08%) cases. Despite sphenoid sinus extension rate of total resection was still hight and achieved in G0 - 66,7%, G1 - 44,4% cases, G2 - 63,6% cases, G3 - 55,6% cases (χ2 = 4,72 df = 6, p = 0,579). Extended endoscopic endonasal transpterygoid approach was used mostly for pituitary adenomas with Кносп 4 extension. 51,7% (n = 15).