Endoscopic resection of knosp grade 0-2 growth hormone-secreting pituitary adenomas with routine medial cavernous sinus wall excision.

Abstract

Endoscopic surgical resection is gold standard treatment for growth hormone-secreting pituitary adenomas (GH-PA). However, biochemical remission rates are only approximately 40-60% after adenoma resection. Emerging evidence suggests that invasion of the medial cavernous sinus wall may contribute to persistent disease, even in low Knosp grade GH-PAs. This single-center study evaluated clinical and biochemical outcome of GH-PA resection with medial cavernous sinus wall excision-an approach that has demonstrated promising results internationally. We compared these data with two historical cohorts from our own institution operated microscopically and endoscopically respectively. Fourteen patients had endoscopic GH-PA resection with medial cavernous sinus wall excision (ERA + MCS) at Odense University Hospital during 2023 to 2025. All procedures were performed by a specialized skull base surgical team. Patient outcomes were assessed based on radiologic and biochemical remission at 3 and 6 months and perioperative complications were evaluated. The historical cohorts comprised of 29 patients operated microscopically with adenoma resection (MRA) and 16 patients operated endoscopically with adenoma resection without excision of the medial cavernous sinus wall (ERA-MCS). In all three cohorts the surgeries were primary. Endoscopic GH-PA resection with medial cavernous sinus wall excision resulted in complete 6 months biochemical and 3 months radiological remission in 86% of primary GH-secreting adenoma (Knosp grade 0-2). No intraoperative complications were observed, and early postoperative complications were minimal, with transient syndrome of inappropriate antidiuretic hormone secretion occurring in two patients (14%). Remission rates in the historic cohorts, were 31% (MRA) and 38% (ERA-MCS), respectively. Our data confirms that endoscopic resection of GH-PAs with routine medial cavernous sinus wall excision is a safe and effective surgical approach yielding high remission rates.