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Vol. 18. Issue 4.
Pages 294-300 (January 2007)
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Vol. 18. Issue 4.
Pages 294-300 (January 2007)
Adenomas hipofisarios con invasiòn intracavernosa. Resultados del abordaje transcraneal al seno cavernoso
Pituitary adenomas invading the cavernous sinus. Transcranial transcavernous approach
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A. Spallone
Neurological Centre of Latium. Roma. Italia
J.L. Gonzàlez-Gonzàlez*, F. Mostes de Oca*, R. Verdial-Vidal**
* Servicio de Neurocirugía Hospital Hermanos Ameijeiras. La Habana. Cuba
** Servicio de Neurocirugía Hospital Universitario General Calixto García. La Habana. Cuba
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Resumen

Los adenomas hipofisarios representan el 13% de los tumores intracraneales. Generalmente el abordaje transesfenoidal es suficiente para su manejo, pero de un 5 a un 7% de los mismos se comporta de forma invasiva. El tratamiento de este subgrupo ha sido tradicionalmente incompleto (exéresis transesfenoidal parcial + radioterapia) y conduce a una elevada tasa de recidivas.

Objetivos

Evaluar los resultados obtenidos con el abordaje transcavernoso en los adenomas hipofisarios con extensión intracavernosa.

Material y método

Se realiza un estudio retrospectivo de 9 pacientes, cuya lesión fue abordada a través del triángulo antero medial mediante craneotomía fronto-órbito-zigomática en la Nuova Clinica Latina de Roma y el Hospital Hermanos Ameijeiras de Ciudad de la Habana entre Junio del 1999 y Junio del 2003.

Resultados

En 8 casos se logró la exégesis total microscópicamente y parcial en 1. Con mejoría y/o normalización de los niveles hormonales y de la sintomatología preoperatoria. Se observaron complicaciones transitorias en 6 pacientes y la secuela más importante fue la paresia del III nervio craneal.

Conclusiones

La exéresis transcavernosa es una técnica eficaz cuando se pretende resecar radicalmente la lesión, lograr remisión de los síntomas y conseguir descenso hormonal en el caso de los productores, aunque las complicaciones y secuelas pueden ser importantes.

Palabras clave:
Adenomas invasivos
Seno cavernoso
Aborde transcraneal
Craneotomía fronto-órbitozigomática (FOZ)
Triángulo antero medial
Summary

Pituitary adenomas represent a significant proportion (+o-13%) of all intracranial tumors. Surgical treatment is as rule performed by transsphenoidal approach. However, a small but not insignificant subgroup of pituitary adenomas (5 to 7%) invade the lateral parasellar structures and the cavernous sinus in particular, and poses obvious problems to the therapeutic strategy, since transsphenoidal removal of these adenomas is usually incomplete.

Objective

To evaluate the results of transcranial removal of a consecutive series of pituitary adenomas invading the cavernous sinus.

Material and method

A retrospective study of 9 patients harbouring pituitary adenomas invading the cavernous sinus who had been submitted to transcranial surgery was conducted. These patients were operated on in the time span June 1999 - December 2003, in the Nuova Clinica Latina (now NCL- Neurological Centere of Latium), Rome Italy, and the Hospital “Hermanos Ameijeiras”, La Habana, Cuba, using a fronto-orbitozigomatic (FOZ) craniotomy, anterior clinoidectomy and a limited dissection of the cavernous sinus through the antero-medial triangle.

Results

Total macroscopical removal was achieved in 8 cases, partial in 1, who showed improvement or normalization of the hormonal levels and of the preoperative symptoms. Transitory complications occurred in 6 patients, one of them showed a permanet neurological deficit (paresis of the III cranail nerve).

Conclusions

Transcranial transcavernous approach is an effective technique for attempting total removal of intracavernous pituitary adenomas. It allows to achieve remission of symptoms and hormonal control in the medium-long term. However complications are relatively frequent, and permanent sequelae are not negligible.

Key words:
Invasive adenomas
Cavernous sinus
Transcranial approach
FOZ craniotomy
Antero-medial triangle

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