Endoscopic endonasal resection of the cavernous sinus medial wall for functioning pituitary adenomas: A propensity score-matched retrospective cohort study

Functioning pituitary adenomas (FPAs) account for 63% to 85% of pituitary adenomas. Although endoscopic endonasal surgery targets biochemical remission and reduced recurrence, cavernous sinus medial wall (CSMW) invasion often leads to incomplete resection and persistent disease. This retrospective study evaluated the clinical value of combining tumor excision with CSMW resection in patients with FPAs. We compared 60 patients who underwent tumor excision plus CSMW resection with contemporaneous controls who underwent tumor excision alone. Propensity scores based on age, sex, body mass index, Knosp grade, hormone subtype, and tumor size/volume were used for 1:1 nearest-neighbor matching, yielding 60 pairs. In the matched cohort, the CSMW resection group achieved higher sustained biochemical cure (≥6 months) (85.0% vs 61.7%) and clinical symptom relief (83.3% vs 56.7%), and a higher magnetic resonance imaging-defined gross total resection rate (95.0% vs 81.7%), with a lower recurrence rate (3.3% vs 15.0%) (all P < .05). After multivariable adjustment (age, sex, body mass index, and Knosp grade), CSMW resection remained independently associated with sustained biochemical cure (odds ratio [OR] = 4.77, 95% confidence interval [CI] 1.83–12.43), symptom relief (OR = 4.68, 95% CI 1.79–12.21), and gross total resection (OR = 4.55, 95% CI 1.04–19.95), and with reduced recurrence (OR = 0.16, 95% CI 0.03–0.78). Postoperative cerebrospinal fluid leakage and intracranial infection were less frequent with CSMW resection (both 3.3% vs 18.3%; OR = 0.13, 95% CI 0.03–0.54), whereas length of stay and other sinonasal complications did not differ materially. Tumor excision combined with CSMW resection may improve key clinical outcomes in FPAs and warrants consideration in appropriately selected patients.