Management of Pituitary Adenomas Invading the Cavernous Sinus

Cavernous sinuses are complex dural venous sinuses that house important neurovascular structures, which often preclude full surgical access for tumor resection. Neuroimaging and anatomic grading scales have corroborated that more invasive tumors are less likely to undergo gross total resection and biochemical remission. Endoscopic approaches are increasingly favored over microsurgical techniques. Direct transcavernous approaches have yielded even greater degrees of resection. Radiosurgery is a powerful adjuvant therapy for residual, recurrent, and/or inaccessible cavernous sinus disease that provides excellent tumor control rates and favorable risk-benefit ratios for the achievement of biochemical remission with minimal endocrine morbidity.