Extended transsphenoidal approach for XXXX invading the cavernous sinus using multiple complementary techniques.

@entity1 @entity129 @entity2013 @entity5 @entity260 @entity977
PURPOSE: Transsphenoidal surgery is the treatment of choice for most @entity977 ( @entity977 ), except @entity2013 . Difficulties achieving radical resection with this method are encountered in @entity1 with PAs invading the cavernous sinus (CS), due to the inability of the standard transsphenoidal approach to expose all @entity5 adequately. This study analyzed methods to resect PAs invading the CS and factors influencing the degree of @entity5 resection and occurrence of complications. METHODS: Outcomes were retrospectively analyzed in 52 @entity1 with @entity977 invading the CS who underwent surgery via the extended transsphenoidal approach utilizing multiple techniques, including microscopy, endoscopy, neuronavigation, and intraoperative Doppler ultrasonography. RESULTS: Gross-total resection (GTR) was achieved in 33 @entity1 (63.5  %). GTR rate was significantly higher in @entity1 with Knosp Grade 3 than Knosp Grade 4 (92.3 vs. 53.8  %) and in @entity1 undergoing initial surgery than reoperation (77.1 vs. 35.3  %). One @entity1 (2.9  %) undergoing initial surgery experienced transient @entity129 , without other @entity260 . @entity260 were significantly higher after reoperation. Firm @entity5 consistency was significantly more frequent in @entity1 undergoing reoperation than initial surgery (52.9 vs. 8.6  %). CONCLUSION: Extended transsphenoidal surgery incorporating multiple complementary techniques was highly effective for PAs invading the CS. @entity260 rates were relatively low, especially for @entity1 undergoing initial surgery and those with Knosp Grade 3 @entity5 . Total resection of PAs invading the CS remains challenging, especially in @entity1 undergoing reoperation or having firm @entity5 .
