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Recurrence and biochemical remission rates vary widely among different histological subtypes of pituitary adenoma. In this prospective study, we evaluated 107 consecutive primary pituitary adenomas operated on by a single neurosurgeon including 28 corticotroph, 27 gonadotroph, 24 somatotroph, 17 lactotroph, 5 null-cell and 6 plurihormonal. In each case, we performed direct endoscopic intraoperative inspection of the medial wall of the cavernous sinus, which was surgically removed when invasion was visualized. This was performed irrespective of tumor functional status. Medial wall resection was performed in 47% of pituitary adenomas, and 39/50 walls confirmed pathologic evidence of invasion, rendering a positive predictive value of intraoperative evaluation of medial wall invasion of 78%. We show for the first-time dramatic disparities in the frequency of medial wall invasion among pathological subtypes. Somatotroph tumors invaded the medial wall much more often than other adenoma subtypes, 81% intraoperatively and 69% histologically, followed by plurihormonal tumors (40%) and gonadotroph cell tumors (33%), both with intraoperative positive predictive value of 100%. The least likely to invade were corticotroph adenomas, at a rate of 32% intraoperatively and 21% histologically, and null-cell adenomas at 0%. Removal of the cavernous sinus medial wall was not associated with permanent cranial nerve morbidity nor carotid artery injury, although 4 patients (all Knosp 3-4) experienced transient diplopia. Medial wall resection in acromegaly resulted in the highest potential for biochemical remission ever reported, with an average postoperative day 1 GH levels of 0.96 ug/L and surgical remission rates of 92% based on normalization of IGF-1 levels after surgery (mean = 15.56 months; range 3-30 months). Our findings suggest that tumor invasion of the medial wall of the cavernous sinus may explain the relatively low biochemical remission rates currently seen for acromegaly and illustrate the relevance of advanced intradural surgical approaches for successful and durable outcomes in endonasal pituitary surgery for functional adenomas., (© 2022. The Author(s).)

This article, published in the Journal of Neurological Surgery, explores the patency of the cavernous sinus (CS) after medial wall resection. The study included 66 patients who underwent endoscopic endonasal approach (EEA) surgeries to resect CS-invading tumors. The results showed that CS patency was achieved in 85% of patients within the first 12 months and 92% by 18 months. Bilateral resection of the CS medial wall and resection for the removal of meningiomas were associated with increased rates of nonpatency. However, the study found that patency versus nonpatency did not have any significant difference in postoperative adverse events or effects. [Extracted from the article]

This article, titled "Outcomes of the Middle Turbinate Swing Technique during the Expanded Endonasal Approach (EEA): A Tertiary Center Experience," explores the use of the middle turbinate (MT) swing technique in skull base surgery. The MT swing technique involves detaching the posterior and lateral attachments of the middle turbinate to allow it to swing laterally into the maxillary sinus, providing better access to the skull base. The study analyzed surgeries performed between January 2021 and August 2023, finding that the MT swing technique did not compromise skull base exposure or tumor resection and had low rates of complications. The authors suggest that further research is needed to investigate the long-term benefits of preserving the middle turbinate during skull base surgery. [Extracted from the article]