Journal of neurosurgery最新文献

{"title":"The carotidoclinoidal ligament in endoscopic endonasal transcavernous surgery: anatomical variations, operative techniques, and case series.","authors":"Jonathan Rychen, Yuanzhi Xu, Ludovico Agostini, Felipe Constanzo, Muhammad Reza Arifianto, Alix Bex, Limin Xiao, Vera Vigo, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.3171/2025.3.JNS242768","DOIUrl":"10.3171/2025.3.JNS242768","url":null,"abstract":"<p><strong>Objective: </strong>The carotidoclinoidal ligament (CCL) spans from the medial wall of the cavernous sinus (MWCS) to the internal carotid artery (ICA) and anterior clinoid process. In endoscopic endonasal transcavernous surgery, safe transection of the CCL requires not only knowledge of its typical anatomy, but also an understanding of its possible variations. The aim of this study was to analyze the anatomical variations of the CCL and the patterns of CCL invasion by pituitary adenomas (PAs).</p><p><strong>Methods: </strong>This investigation comprised an anatomical and a clinical study. Endonasal dissections of 20 specimens (40 sides) were performed to investigate CCL variations. A retrospective analysis of 145 patients with PA invading the CS (160 CS sides) was conducted to report the incidence and patterns of CCL invasion.</p><p><strong>Results: </strong>The CCL was present in all investigated sides (n = 40). In the coronal plane, 1 CCL branch was found in 20 sides (50.0%) and ≥ 2 CCL branches were found in 20 sides (50.0%). The main CCL branch was defined as the medial continuation of the proximal dural ring, marking the transition from the cavernous to the paraclinoidal ICA segment. When additional accessory CCL branches were present, they attached to the paraclinoidal ICA (n = 17, 53.1%), the horizontal cavernous ICA segment (n = 10, 31.3%), and/or the anterior genu of the cavernous ICA (n = 5, 15.6%). The CCL most commonly attached to the upper (n = 29, 72.5%) and middle third (n = 26, 65.0%) of the MWCS. In the axial plane, the CCL was found to be a fenestrated membrane in 29 sides (72.5%) and an intact membrane in 11 sides (27.5%). All CCLs attached to at least the anterior third of the MWCS. Additionally, some CCLs attached to the middle third (n = 23, 57.5%) and/or the posterior third (n = 17, 42.5%). The CCL was connected to the inferior parasellar ligament in 14 sides (35.0%). Among all PAs invading the CS, the CCL was invaded in 36 cases (22.5%). Two patterns of CCL invasion were identified: 1) tumor adherent to and infiltrating the CCL fibers (n = 30, 83.3%), and 2) CCL thickened due to tumor growth within and along the fibers (n = 6, 16.7%).</p><p><strong>Conclusions: </strong>This study represents a comprehensive analysis of the anatomical variations and patterns of invasion of the CCL, which is particularly relevant for the safe and effective resection of PA invading the CS.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"916-927"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital procedural volume is inversely linearly associated with complications in endoscopic endonasal transsphenoidal resection of pituitary tumors.","authors":"Jane S Han, Alexandra N Demetriou, Jonathan Dallas, Gloria Bae, Li Ding, William J Mack, Frank J Attenello, Gabriel Zada","doi":"10.3171/2025.3.JNS242018","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242018","url":null,"abstract":"<p><strong>Objective: </strong>Prior studies have shown that high-volume centers have improved outcomes in patients undergoing transsphenoidal resection for pituitary tumors. However, those investigations have not examined this association specifically for the endoscopic approach and are limited by characterizing the volume outcome association using arbitrary dichotomous volume cutoffs. The objective of the current study was to delineate the continuous volume-outcome relationship adjusted for risk factors in patients with benign pituitary tumors undergoing endoscopic endonasal transsphenoidal surgery (ETSS) and systemically identify volume cutoffs after which there is no significant increase in complication risk.</p><p><strong>Methods: </strong>In this retrospective analysis, the Nationwide Readmissions Database (NRD) was queried for patients with benign pituitary tumors who underwent ETSS from 2016 to 2018. ICD-10 coding was used for cohort selection. Patient and hospital characteristics were extracted from standard NRD-collected variables. The association of institutional procedural volume and outcomes (major complications, sellar tumor-specific complications, and discharge disposition) were evaluated using multivariable analysis.</p><p><strong>Results: </strong>A total of 14,947 patients (median age 56 years) with benign pituitary tumors who underwent ETSS were identified. Most patients received treatment at institutions with at least 13 cases per year (top 75th percentile). The multivariable analysis of volume as a continuous variable demonstrated that risk of major complications (e.g., sepsis) decreased at a steady rate (OR 0.984, 95% CI 0.977-0.992; p < 0.0001) per 1 procedure increase at institutions with a procedural volume of 1-57 cases per year. From 58 cases per year, there was no longer a decrease in risk (OR 1.001, 95% CI 0.996-1.006; p = 0.68). The risk of sellar tumor-specific complications (e.g., endocrinopathies and cranial nerve palsies) decreased throughout the entire volume range (OR 0.997, 95% CI 0.996-0.998; p < 0.0001). Furthermore, there was no linear response in discharge disposition, but the highest quartile was associated with the least likelihood of nonroutine discharge.</p><p><strong>Conclusions: </strong>A multivariable analysis with institutional case volume as a continuous variable exhibited a linear association with risk of major and sellar tumor-specific complications specific to this patient population. Future studies are needed to further characterize the factors that contribute to this additive relationship.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of treatment response and overall survival in patients with breast cancer brain metastases treated with stereotactic radiosurgery: a prospective study using the NeuroPoint Alliance SRS Registry.","authors":"Konstantinos Katsos, Giorgos Michalopoulos, Anthony L D'Ambrosio, William S Cobb, Inga S Grills, James McInerney, Randy L Jensen, Eric Chang, David W Andrews, Nader Pouratian, Robert Timmerman, Albert Attia, Aaron C Spalding, Kevin Walter, Mohamad Bydon, Anthony L Asher, Jason P Sheehan","doi":"10.3171/2025.3.JNS241471","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241471","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate mortality and progression outcomes in patients undergoing stereotactic radiosurgery (SRS) for breast cancer brain metastases and to identify associated risk factors using a national quality registry.</p><p><strong>Methods: </strong>The NeuroPoint Alliance (NPA) SRS Registry was employed for this study, which conducted prospective enrollment of patients undergoing SRS at 16 participating centers from 2017 to 2024. Outcomes of interest included the post-SRS EQ-5D score change, overall survival, local progression, out-of-field progression, and overall intracranial progression. For all time-to-event analyses, Kaplan-Meier curves and multivariable Cox regressions with hazard ratios were used.</p><p><strong>Results: </strong>A total of 138 patients (127 female, mean age 59.8 years) were identified; 46.4% had a single lesion, 42.0% had 2-4 lesions, and 11.6% had ≥ 5 lesions, while 87.0% had a Karnofsky Performance Status (KPS) score between 80 and 100. The median overall survival was 17.9 months, and independent predictors of all-cause mortality included a KPS score ≤ 90 (HR 6.73) and diabetes mellitus (HR 3.35). The median time to local progression was 19.8 months. More than 5 lesions at baseline (HR 9.03) and a marginal dose ≤ 17.6 Gy (HR 8.00) were predictive of local recurrence. The median was not reached for out-of-field progression, and predictors included ≥ 2 lesions at the time of SRS (HR 3.20) and a marginal dose ≤ 17.6 Gy (HR 4.61). At the final follow-up assessment, 17.1% of patients experienced no change according to the EQ-5D, while 34.3% had improvement, 11.4% had mixed results, and 37.1% had worsened health. In the multivariable linear regression model, pre-SRS resection (r = 1.92) and baseline EQ-5D score (r = 1.29) were statistically significant predictors of quality of life at the final follow-up assessment.</p><p><strong>Conclusions: </strong>Using real-world data from the NPA SRS Registry, this study demonstrated comparable outcomes in patients who underwent SRS for breast cancer brain metastases compared with those of previous literature. The number of lesions at the time of SRS and the marginal dose were independent risk factors for local recurrence, out-of-field progression, and overall intracranial progression. Pre-SRS resection and baseline EQ-5D score were independent predictors of quality of life following SRS.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumboperitoneal shunt placement under local anesthesia: a technical note from an experience with more than 200 cases.","authors":"Yasuaki Inoue, Ryo Oike, Takashi Iimori, Satoshi Ihara, Riku Ishimaru, Junia Yamashita, Shunsuke Hatakenaka","doi":"10.3171/2025.3.JNS242345","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242345","url":null,"abstract":"<p><p>The purpose of this technical note was to report that lumboperitoneal shunt (LPS) placement under local anesthesia can be a promising alternative for treating idiopathic normal pressure hydrocephalus (iNPH), particularly in elderly patients who might be reluctant to undergo surgery under general anesthesia. The authors present their experience with 202 cases of LPS placement performed for iNPH under local anesthesia between March 2022 and September 2024. The median operative time was 35 minutes, and the median operating room time was 71 minutes. Procedure-related complications were observed in 6 cases (3.0%), with no major complications specifically associated with local anesthesia. No cases required interruption of surgery due to pain, anxiety, or lack of patient cooperation, indicating that the procedure was well tolerated. This experience suggests that LPS placement under local anesthesia can be a safe and efficient option, even in patients with mild cognitive impairment, providing a viable alternative for those at higher risk of complications from general anesthesia. The authors believe that this technique offers a valuable addition to the surgical options for iNPH, and further study could help standardize this approach for wider clinical use.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of non-English language preference with tumor characteristics and postoperative outcomes following pituitary neuroendocrine tumor resection:\u2028a retrospective review of 1143 cases.","authors":"Daniel Quintana, Rithvik Ramesh, Wesley Shoap, Robert C Osorio, Christian Jimenez, Philip V Theodosopoulos, Sandeep Kunwar, José Gurrola, Ivan H El-Sayed, Manish K Aghi, Ezequiel Goldschmidt","doi":"10.3171/2025.3.JNS241308","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241308","url":null,"abstract":"<p><strong>Objective: </strong>Non-English language preference (NELP) poses a barrier to healthcare access and may contribute to delays in seeking care, understanding treatment plans, and communicating health concerns. This study assesses the relationship between NELP and the clinical characteristics and outcomes of patients with pituitary neuroendocrine tumors (PitNETs) at a high-volume tertiary center.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1143 adult patients who underwent PitNET surgery between 2012 and 2019 at a single institution. Clinical and radiological variables were recorded for NELP patients and compared to patients with English language preference (ELP). Multivariable logistic and negative binomial regression analyses were used to assess associations between NELP, tumor characteristics, and postoperative outcomes, adjusting for confounders.</p><p><strong>Results: </strong>Of the 1143 patients, 14.0% had NELP, with Spanish being the predominant language. NELP patients had larger tumor diameters (median [IQR] 2.0 [1.5-2.8] cm vs 1.5 [0.9-2.2] cm, p < 0.001) and higher rates of government insurance (78.2% vs 44.8%, p < 0.001), diagnosis during emergency department presentation (21.3% vs 7.5%, p < 0.001), cavernous sinus invasion (50.6% vs 30.7%, p < 0.001), and tumor apoplexy (8.8% vs 3.9%, p = 0.011), but they were less likely to present with preoperative endocrine disease (23.1% vs 41.6%, p < 0.001), and had shorter times to surgery (median [IQR] 79 [34.0-248.5] days vs 113 [53.0-430.8] days, p = 0.002) compared to ELP patients. NELP patients also had longer length of stay (LOS) (median [IQR] 2.00 [1.00-4.00] days vs 1.00 [1.00-2.00] days, p = 0.005) and higher lumbar drain placement rate (16.3% vs 8.1%, p = 0.002). In multivariable models, NELP was significantly associated with higher incidence rates of cavernous sinus invasion (OR 1.91, 95% CI 1.31-2.78, p < 0.001) and macroadenoma (OR 4.64, 95% CI 1.95-11.06, p < 0.001), prolonged LOS (incidence rate ratio 1.35, 95% CI 1.10-1.67, p = 0.004), and a lower rate of preoperative endocrine dysfunction (OR 0.56, 95% CI 0.35-0.92, p = 0.02), after adjustment for confounders. There were no significant differences in apoplexy at presentation, 30-day readmission rates, or lumbar drain use.</p><p><strong>Conclusions: </strong>NELP remained an independent risk factor for complex tumor presentation and extended hospital stay after controlling for sociodemographic factors. Understanding how NELP interacts with other health disparities in neurosurgical care can guide strategies to better support this patient population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Cerebellar necrosectomy: do we have enough evidence to support it?","authors":"Benjamin Thomas, Omprakash Damodaran, Behzad Eftekhar","doi":"10.3171/2025.3.JNS25349","DOIUrl":"10.3171/2025.3.JNS25349","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1163-1164"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of brainstem cavernous malformation resection, without and with use of a flexible omnidirectional carbon dioxide laser: a single-surgeon series of 277 surgical procedures.","authors":"Andrew J Gauden, Jason L Choi, Ingrid Luo, Summer S Han, Gary K Steinberg","doi":"10.3171/2025.3.JNS242848","DOIUrl":"10.3171/2025.3.JNS242848","url":null,"abstract":"<p><strong>Objective: </strong>Brainstem cavernous malformations (BCMs) are low-flow vascular lesions of the central nervous system that pose significant surgical challenges due to their deep location and proximity to eloquent structures. Resection is associated with significant morbidity, and published literature is sparse. This single-institutional, single-surgeon study aimed to delineate factors affecting outcomes in the resection of BCMs and to assess the efficacy of the omnidirectional CO2 laser for lesion resection.</p><p><strong>Methods: </strong>A retrospective review of all BCMs treated between 1990 and 2022 at Stanford Hospital and Clinics and Lucile Packard Children's Hospital by the senior author was conducted. Data from medical records and direct patient contact data, including presenting symptoms, presence of acute hemorrhage status, time from hemorrhage to surgery, radiological features, surgical approach used, and preoperative and postoperative neurological status, were recorded. The primary outcome assessed included the modified Rankin Scale (mRS) score at baseline and on follow-up. Comparisons were performed between resections with and without the use of the CO2 laser. Further analysis was performed to eliminate \"learning curve\" bias, and the last 75 patients in both treatment groups were compared.</p><p><strong>Results: </strong>In total, 277 surgical procedures for BCMs were identified in 254 patients treated from March 1990 to December 2022, and of these 236 (85%) surgical procedures in 215 patients had ≥ 3 months follow-up or mortality within 3 months postsurgery. Of these, 120/236 underwent conventional surgery and 116/236 underwent CO2 laser-assisted resection. Complete resection of the cavernous malformation was achieved in 96.4% of cases. Recurrent BCM was observed in 3/254 (1.2%) of patients, and 70 of 236 cases (30%) had immediate worsening of neurological status, with an average mRS increase of 0.47 points. The CO2 laser-assisted surgery group showed statistically significant long-term mRS score improvement compared to the conventional surgery group (28 [23%] of conventional and 45 [39%] of laser-assisted cases showed improvement; average mRS change +0.125 and -0.241, respectively, p = 0.02). Assessment of the last 75 patients in both groups showed a similar positive relationship between CO2 laser-assisted resection and long-term mRS outcomes (-0.475, 95% CI -0.881 to -0.07, p = 0.02).</p><p><strong>Conclusions: </strong>BCM remains among the most challenging pathologies for the cerebrovascular neurosurgeon. This series demonstrates that good surgical outcomes are achievable when resection is performed in a high-volume center by an experienced surgeon. Furthermore, this study suggests improved outcomes using the CO2 laser.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"952-959"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cranial surgery and mortality among patients with firearm-related traumatic brain injury resulting in subdural hematoma.","authors":"Kathleen R Ran, Jiaqi Liu, Vikas N Vattipally, Richard Cook, Sruthi Ranganathan, Jacob Jo, Jowah Gorbachev, John R Williams, Jordina Rincon-Torroella, Elliott R Haut, Jose I Suarez, Judy Huang, Chetan Bettegowda, James P Byrne, Tej D Azad","doi":"10.3171/2025.3.JNS242450","DOIUrl":"10.3171/2025.3.JNS242450","url":null,"abstract":"<p><strong>Objective: </strong>Firearm-related penetrating traumatic brain injury (pTBI) is highly morbid and causes heterogeneous intracranial injury patterns. As guidelines and practices evolve, tailored analysis of more homogeneous pTBI cohorts is needed to inform surgical management. Therefore, the aim of this study was to test the association between cranial surgery and survival among patients with pTBI resulting in subdural hematoma (SDH).</p><p><strong>Methods: </strong>Patients with firearm-related pTBI and resultant SDH were retrospectively identified using the American College of Surgeons Trauma Quality Program dataset (2017-2019). The study exposure of interest was cranial surgery, and the primary outcome was in-hospital mortality. Adjusted hierarchical regression models were specified to test the association between cranial surgery and in-hospital mortality. To further increase the homogeneity of the presenting injury pattern, a subgroup analysis was performed in patients with SDH and midline shift (MLS) > 5 mm.</p><p><strong>Results: </strong>A total of 1894 patients (84% male; median age 31 years) with firearm-related pTBI and SDH were included. The hierarchical logistic regression analysis demonstrated that cranial surgery was independently associated with lower odds of in-hospital mortality (OR 0.49, 95% CI 0.34-0.71; p < 0.001), even after risk adjustment for injury characteristics and placement of an external ventricular drain or intracranial pressure monitor. In a subgroup of 535 patients who presented with SDH and MLS > 5 mm, cranial surgery had a greater protective effect against in-hospital mortality (OR 0.40, 95% CI 0.24-0.67; p < 0.001).</p><p><strong>Conclusions: </strong>Cranial surgery was independently associated with lower in-hospital mortality among patients with firearm-related pTBI and SDH, and its protective effect was greater among patients with significant MLS. Further investigations of long-term functional outcomes are needed.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1009-1015"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Redefining risk and treatment paradigms in mild carotid stenosis.","authors":"Jin Xiao, Zhiyu Lv","doi":"10.3171/2025.3.JNS25771","DOIUrl":"10.3171/2025.3.JNS25771","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1160-1161"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of invasion of the medial wall of the cavernous sinus by pituitary adenomas.","authors":"Felipe Constanzo, Jonathan Rychen, Christine K Lee, Johannes Hugo Decker, Nancy Fischbein, Thomas Johnstone, Vladimir Ljubimov, Vera Vigo, Juan C Fernandez-Miranda","doi":"10.3171/2025.3.JNS242823","DOIUrl":"10.3171/2025.3.JNS242823","url":null,"abstract":"<p><strong>Objective: </strong>With their growing experience in endoscopic transcavernous approaches, the authors have observed that pituitary adenomas have distinct patterns of invasion into the medial wall of the cavernous sinus (MWCS). In this study, they aimed to describe the different patterns of MWCS invasion and their relevance for pituitary surgery.</p><p><strong>Methods: </strong>Based on a review of 144 patients with 159 cavernous sinus (CS) explorations, the authors described three patterns of MWCS invasion: focal invasion, wall thickening, and wall destruction. Demographics, previous surgery, size, hormonal status, consistency, CS compartment invasion, invasion of the carotico-clinoid ligament (CCL), carotid adherence, gross-total resection (GTR) of intracavernous tumor, endocrinological remission (ER), and complications (vascular injury, cranial nerve palsy, CSF leakage, and hematoma) were evaluated.</p><p><strong>Results: </strong>The most frequent pattern of MWCS invasion was wall destruction (47.2%), followed by wall thickening (28.9%) and focal invasion (23.9%). All cases of focal invasion were contained within the wall, whereas 59% of the wall-thickening and 100% of the wall destruction cases had intracavernous tumor (p < 0.001). Overall, GTR was achieved in 87.4% of cases and ER was achieved in 80.6% with surgery alone. Focal invasion was most associated with functioning adenomas (92%) and low Knosp grade (95%). Invasion of the CCL, adherence of the MWCS to the carotid artery, and fibrous consistency were found in 15%-20% of cases. GTR was achieved in all cases and ER in 93% with no complications associated with MWCS resection. Wall thickening was also found predominantly in functioning adenomas (83%) with low Knosp grade (72%), and often in recurrent cases (46%). Carotid adhesion was significantly more frequent (61%), as was CCL invasion (44%) and fibrous consistency (46%). GTR was achieved in 98% and ER in 82%, with transient postoperative diplopia in 7% of cases, all with intracavernous tumor. Wall destruction occurred almost exclusively in macroadenomas (96%) with high Knosp grades (59%) and no hormonal secretion (55%). Invasion of the CCL, fibrous consistency, and carotid adherence were found in less than one-third of the cases. GTR was achieved in 75% and ER in 65%, with postoperative diplopia in 11% of cases.</p><p><strong>Conclusions: </strong>Pituitary adenomas may invade the MWCS in three distinct patterns, each with particular tumor characteristics and a differential degree of technical difficulty and clinical outcomes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"895-906"},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}