Surgical outcome of endonasal transsphenoidal approach for pituitary macroadenoma involving cavernous sinus

Background: Pituitary macroadenomas with cavernous sinus (CS) invasion pose significant surgical challenges due to anatomical complexity and high risk of complications. The endonasal transsphenoidal approach (ETSA) is a minimally invasive technique that offers direct access to the sellar and parasellar regions. Objective: This study evaluates the surgical outcomes of ETSA for pituitary macroadenomas with cavernous sinus invasion based on a cohort of 36 patients. Methods: A retrospective review of 36 patients who underwent ETSA for pituitary macroadenomas with radiological evidence of CS invasion (Knosp grades 2–4) was conducted. Surgical outcomes were assessed in terms of gross total resection (GTR) rates, hormonal remission, and postoperative complications. Results: GTR was achieved in 61% of patients, with higher rates in Knosp grade 2 tumours (80%). Hormonal remission occurred in 67% of patients with functioning adenomas. Complications included cerebrospinal fluid (CSF) leaks (6%), transient cranial nerve deficits (8%), and diabetes insipidus (5%). No mortality was reported. Table: Clinical Characteristics of Patients Undergoing ETSA for Pituitary Macroadenomas. Conclusion: The ETSA is a safe and effective approach for managing pituitary macroadenomas involving the CS, particularly for lower-grade tumours. Advanced intraoperative tools and multidisciplinary care improve outcomes.