{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:28:18Z","timestamp":1772724498641,"version":"3.50.1"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The carotidoclinoidal ligament (CCL) spans from the medial wall of the cavernous sinus (MWCS) to the internal carotid artery (ICA) and anterior clinoid process. In endoscopic endonasal transcavernous surgery, safe transection of the CCL requires not only knowledge of its typical anatomy, but also an understanding of its possible variations. The aim of this study was to analyze the anatomical variations of the CCL and the patterns of CCL invasion by pituitary adenomas (PAs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This investigation comprised an anatomical and a clinical study. Endonasal dissections of 20 specimens (40 sides) were performed to investigate CCL variations. A retrospective analysis of 145 patients with PA invading the CS (160 CS sides) was conducted to report the incidence and patterns of CCL invasion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The CCL was present in all investigated sides (n = 40). In the coronal plane, 1 CCL branch was found in 20 sides (50.0%) and \u2265 2 CCL branches were found in 20 sides (50.0%). The main CCL branch was defined as the medial continuation of the proximal dural ring, marking the transition from the cavernous to the paraclinoidal ICA segment. When additional accessory CCL branches were present, they attached to the paraclinoidal ICA (n = 17, 53.1%), the horizontal cavernous ICA segment (n = 10, 31.3%), and\/or the anterior genu of the cavernous ICA (n = 5, 15.6%). The CCL most commonly attached to the upper (n = 29, 72.5%) and middle third (n = 26, 65.0%) of the MWCS. In the axial plane, the CCL was found to be a fenestrated membrane in 29 sides (72.5%) and an intact membrane in 11 sides (27.5%). All CCLs attached to at least the anterior third of the MWCS. Additionally, some CCLs attached to the middle third (n = 23, 57.5%) and\/or the posterior third (n = 17, 42.5%). The CCL was connected to the inferior parasellar ligament in 14 sides (35.0%).<\/jats:p>\n                    <jats:p>Among all PAs invading the CS, the CCL was invaded in 36 cases (22.5%). Two patterns of CCL invasion were identified: 1) tumor adherent to and infiltrating the CCL fibers (n = 30, 83.3%), and 2) CCL thickened due to tumor growth within and along the fibers (n = 6, 16.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study represents a comprehensive analysis of the anatomical variations and patterns of invasion of the CCL, which is particularly relevant for the safe and effective resection of PA invading the CS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.jns242768","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T22:46:01Z","timestamp":1751064361000},"page":"916-927","source":"Crossref","is-referenced-by-count":0,"title":["The carotidoclinoidal ligament in endoscopic endonasal transcavernous surgery: anatomical variations, operative techniques, and case series"],"prefix":"10.3171","volume":"143","author":[{"given":"Jonathan","family":"Rychen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanzhi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludovico","family":"Agostini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe","family":"Constanzo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Reza","family":"Arifianto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alix","family":"Bex","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limin","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Vigo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[{"name":"The Neurosurgical Atlas, Carmel, Indiana;"},{"name":"Department of Neurological Surgery, Keck School of Medicine, University of South California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","article-title":"Gray\u2019s Anatomy","author":"Williams PLWR","year":"1989","unstructured":"Williams PLWR, Dyson M, Bannister L. Gray\u2019s Anatomy. 37th ed. Churchill Livingstone; 1989."},{"issue":"3-4","key":"b2","series-title":"Surg Radiol Anat","first-page":"241","article-title":"The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery","volume":"25","author":"Ozdo\u011fmu\u015f O","year":"2003","unstructured":"Ozdo\u011fmu\u015f O, Saka E, Tulay C, G\u00fcrdal E, Uz\u00fcn I, Cavdar S. The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery. Surg Radiol Anat. 2003;25(3-4):241\u2013246."},{"issue":"6","key":"b3","series-title":"Sao Paulo Med J","first-page":"351","article-title":"Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery","volume":"125","author":"Das S","year":"2007","unstructured":"Das S, Suri R, Kapur V. Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery. Sao Paulo Med J. 2007;125(6):351\u2013353."},{"issue":"2 Suppl Operative","key":"b4","series-title":"Neurosurgery. Dec","first-page":"ons233","article-title":"Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note","volume":"71","author":"Fernandez-Miranda JC","year":"2012","unstructured":"Fernandez-Miranda JC, Tormenti M, Latorre F,  Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note. Neurosurgery. Dec 2012;71(2 Suppl Operative):ons233\u2013ons239."},{"issue":"2 Suppl Operative","key":"b5","series-title":"Neurosurgery. Dec","first-page":"ons117","article-title":"The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships","volume":"73","author":"Peris-Celda M","year":"2013","unstructured":"Peris-Celda M, Kucukyuruk B, Monroy-Sosa A,  The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships. Neurosurgery. Dec 2013;73(2 Suppl Operative):ons117\u2013ons131."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"122","article-title":"The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and\/or resection","volume":"131","author":"Truong HQ","year":"2019","unstructured":"Truong HQ, Lieber S, Najera E, Alves-Belo JT, Gardner PA, Fernandez-Miranda JC. The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and\/or resection. J Neurosurg. 2019;131(1):122\u2013130."},{"issue":"5","key":"b7","series-title":"J Neurosurg","first-page":"1418","article-title":"Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery","volume":"137","author":"Xu Y","year":"2022","unstructured":"Xu Y, Nunez MA, Mohyeldin A,  Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery. J Neurosurg. 2022;137(5):1418\u20131430."},{"issue":"11","key":"b8","series-title":"Acta Neurochir (Wien)","first-page":"3431","article-title":"The \"candy wrapper\" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus","volume":"165","author":"Serioli S","year":"2023","unstructured":"Serioli S, Plou P, Leonel LCPC,  The \"candy wrapper\" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus. 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Resection of corticotroph microadenomas invading the medial wall of the cavernous sinus in two cases of a primary and recurrent case of Cushing\u2019s disease. Neurosurg Focus Video. 2023;9(1):V2."},{"issue":"1","key":"b16","series-title":"Neurosurg Focus Video","first-page":"V4","article-title":"Endoscopic ultrasound guided resection of a Cushing\u2019s adenoma invading the medial cavernous sinus wall using the \"interdural peeling\" technique","volume":"9","author":"Finger G","year":"2023","unstructured":"Finger G, Wu KC, Gosal JS,  Endoscopic ultrasound guided resection of a Cushing\u2019s adenoma invading the medial cavernous sinus wall using the \"interdural peeling\" technique. 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World Neurosurg. 2019;126:53\u201358."},{"issue":"4","key":"b18","series-title":"Pituitary","first-page":"340","article-title":"Efficacy and safety of cavernous sinus medial wall resection in pituitary adenoma surgery: a systematic review and a single-arm meta-analysis","volume":"26","author":"Pontes JPM","year":"2023","unstructured":"Pontes JPM, Udoma-Udofa OC, de Oliveira JS,  Efficacy and safety of cavernous sinus medial wall resection in pituitary adenoma surgery: a systematic review and a single-arm meta-analysis. 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Neurosurgery. 2022;91(5):775\u2013781."},{"key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"106306","article-title":"Resection of the medial wall of the cavernous sinus in functioning pituitary adenomas: technical note and outcomes in a matched-cohort study","volume":"200","author":"Omar AT II","year":"2021","unstructured":"Omar AT II, Munoz DG, Goguen J,  Resection of the medial wall of the cavernous sinus in functioning pituitary adenomas: technical note and outcomes in a matched-cohort study. Clin Neurol Neurosurg. 2021;200:106306."},{"issue":"3","key":"b21","series-title":"J Neurosurg","first-page":"505","article-title":"Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes","volume":"121","author":"Nishioka H","year":"2014","unstructured":"Nishioka H, Fukuhara N, Horiguchi K, Yamada S. Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes. J Neurosurg. 2014;121(3):505\u2013510."},{"issue":"1","key":"b22","series-title":"Oper Neurosurg (Hagerstown)","first-page":"72","article-title":"\"One-and-a-Half\" interdural transcavernous pituitary transposition\/rotation for protection of hypophyseal portal system in adult peripheral retroinfundibular craniopharyngioma","volume":"27","author":"Shen A","year":"2024","unstructured":"Shen A, Yu Y, Lyu L,  \"One-and-a-Half\" interdural transcavernous pituitary transposition\/rotation for protection of hypophyseal portal system in adult peripheral retroinfundibular craniopharyngioma. Oper Neurosurg (Hagerstown). 2024;27(1):72\u201385."},{"issue":"2","key":"b23","series-title":"Neurosurg Focus Video","first-page":"V9","article-title":"Endoscopic endonasal pituitary hemitransposition for resection of suprasellar and retrosellar dermoid cyst","volume":"2","author":"Almeida JP","year":"2020","unstructured":"Almeida JP, Tang D, Kshettry VR, Sindwani R, Recinos PF. Endoscopic endonasal pituitary hemitransposition for resection of suprasellar and retrosellar dermoid cyst. Neurosurg Focus Video. 2020;2(2):V9."},{"issue":"6","key":"b24","series-title":"J Neurosurg","first-page":"1892","article-title":"The side door and front door to the upper retroclival region: a comparative analysis of the open pretemporal and the endoscopic endonasal transcavernous approaches","volume":"133","author":"Labib MA","year":"2019","unstructured":"Labib MA, Borba Moreira L, Zhao X,  The side door and front door to the upper retroclival region: a comparative analysis of the open pretemporal and the endoscopic endonasal transcavernous approaches. J Neurosurg. 2019;133(6):1892\u20131904."},{"issue":"10","key":"b25","series-title":"Acta Neurochir (Wien)","first-page":"2123","article-title":"Transcavernous sinus pituitary gland transposition: how I do it","volume":"161","author":"C\u00e1rdenas Ruiz-Valdepe\u00f1as E","year":"2019","unstructured":"C\u00e1rdenas Ruiz-Valdepe\u00f1as E, Kaen A, Tirado Caballero J. Transcavernous sinus pituitary gland transposition: how I do it. Acta Neurochir (Wien). 2019;161(10):2123\u20132127."},{"key":"b26","article-title":"Knochenlehre, Vol. 1: Handbuch der systematischen Anatomie des Menschen","author":"Henle J","year":"1855","unstructured":"Henle J. Knochenlehre, Vol. 1: Handbuch der systematischen Anatomie des Menschen. Druck und Verlag von Friedrich Vieweg und Sohn; 1855."},{"key":"b1","article-title":"Gray\u2019s Anatomy","author":"Williams PLWR","year":"1989","unstructured":"Williams PLWR, Dyson M, Bannister L. Gray\u2019s Anatomy. 37th ed. Churchill Livingstone; 1989."},{"issue":"3-4","key":"b2","series-title":"Surg Radiol Anat","first-page":"241","article-title":"The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery","volume":"25","author":"Ozdo\u011fmu\u015f O","year":"2003","unstructured":"Ozdo\u011fmu\u015f O, Saka E, Tulay C, G\u00fcrdal E, Uz\u00fcn I, Cavdar S. The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery. Surg Radiol Anat. 2003;25(3-4):241\u2013246."},{"issue":"6","key":"b3","series-title":"Sao Paulo Med J","first-page":"351","article-title":"Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery","volume":"125","author":"Das S","year":"2007","unstructured":"Das S, Suri R, Kapur V. Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery. Sao Paulo Med J. 2007;125(6):351\u2013353."},{"issue":"2 Suppl Operative","key":"b4","series-title":"Neurosurgery. Dec","first-page":"ons233","article-title":"Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note","volume":"71","author":"Fernandez-Miranda JC","year":"2012","unstructured":"Fernandez-Miranda JC, Tormenti M, Latorre F,  Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note. Neurosurgery. Dec 2012;71(2 Suppl Operative):ons233\u2013ons239."},{"issue":"2 Suppl Operative","key":"b5","series-title":"Neurosurgery. Dec","first-page":"ons117","article-title":"The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships","volume":"73","author":"Peris-Celda M","year":"2013","unstructured":"Peris-Celda M, Kucukyuruk B, Monroy-Sosa A,  The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships. Neurosurgery. Dec 2013;73(2 Suppl Operative):ons117\u2013ons131."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"122","article-title":"The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and\/or resection","volume":"131","author":"Truong HQ","year":"2019","unstructured":"Truong HQ, Lieber S, Najera E, Alves-Belo JT, Gardner PA, Fernandez-Miranda JC. The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and\/or resection. J Neurosurg. 2019;131(1):122\u2013130."},{"issue":"5","key":"b7","series-title":"J Neurosurg","first-page":"1418","article-title":"Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery","volume":"137","author":"Xu Y","year":"2022","unstructured":"Xu Y, Nunez MA, Mohyeldin A,  Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery. J Neurosurg. 2022;137(5):1418\u20131430."},{"issue":"11","key":"b8","series-title":"Acta Neurochir (Wien)","first-page":"3431","article-title":"The \"candy wrapper\" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus","volume":"165","author":"Serioli S","year":"2023","unstructured":"Serioli S, Plou P, Leonel LCPC,  The \"candy wrapper\" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus. Acta Neurochir (Wien). 2023;165(11):3431\u20133444."},{"issue":"4 Suppl","key":"b9","series-title":"Neurosurgery","first-page":"S375","article-title":"The cavernous sinus, the cavernous venous plexus, and the carotid collar","volume":"51","author":"Rhoton AL Jr","year":"2002","unstructured":"Rhoton AL Jr. The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery. 2002;51(4 Suppl):S375\u2013S410."},{"issue":"1","key":"b10","series-title":"J Neurosurg","first-page":"131","article-title":"The medial wall of the cavernous sinus. Part 2: selective medial wall resection in 50 pituitary adenoma patients","volume":"131","author":"Cohen-Cohen S","year":"2018","unstructured":"Cohen-Cohen S, Gardner PA, Alves-Belo JT,  The medial wall of the cavernous sinus. Part 2: selective medial wall resection in 50 pituitary adenoma patients. J Neurosurg. 2018;131(1):131\u2013140."},{"issue":"3","key":"b11","series-title":"J Neurosurg","first-page":"777","article-title":"Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery","volume":"142","author":"Xu Y","year":"2024","unstructured":"Xu Y, Lee CK, Rychen J,  Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery. J Neurosurg. 2024;142(3):777\u2013787."},{"issue":"6","key":"b12","series-title":"J Neurosurg","first-page":"1766","article-title":"Pursuing perfect 2D and 3D photography in neuroanatomy: a new paradigm for staying up to date with digital technology","volume":"138","author":"Xu Y","year":"2022","unstructured":"Xu Y, Vigo V, Klein J,  Pursuing perfect 2D and 3D photography in neuroanatomy: a new paradigm for staying up to date with digital technology. J Neurosurg. 2022;138(6):1766\u20131772."},{"issue":"1","key":"b13","series-title":"Sci Rep","first-page":"9919","article-title":"Prospective intraoperative and histologic evaluation of cavernous sinus medial wall invasion by pituitary adenomas and its implications for acromegaly remission outcomes","volume":"12","author":"Mohyeldin A","year":"2022","unstructured":"Mohyeldin A, Katznelson LJ, Hoffman AR,  Prospective intraoperative and histologic evaluation of cavernous sinus medial wall invasion by pituitary adenomas and its implications for acromegaly remission outcomes. Sci Rep. 2022;12(1):9919."},{"key":"b14","series-title":"World Neurosurg","first-page":"199","article-title":"endoscopic extracapsular resection of an adrenocorticotropic hormone-secreting macroadenoma with selective resection of the medial cavernous sinus wall","volume":"144","author":"Borghei-Razavi H","year":"2020","unstructured":"Borghei-Razavi H, Muhsen BA, Joshi K, Woodard T, Kshettry VR. endoscopic extracapsular resection of an adrenocorticotropic hormone-secreting macroadenoma with selective resection of the medial cavernous sinus wall. World Neurosurg. 2020;144:199."},{"issue":"1","key":"b15","series-title":"Neurosurg Focus Video","first-page":"V2","article-title":"Resection of corticotroph microadenomas invading the medial wall of the cavernous sinus in two cases of a primary and recurrent case of Cushing\u2019s disease","volume":"9","author":"Mohyeldin A","year":"2023","unstructured":"Mohyeldin A, Nunez MA, Xu Y, Fernandez-Miranda JC. Resection of corticotroph microadenomas invading the medial wall of the cavernous sinus in two cases of a primary and recurrent case of Cushing\u2019s disease. Neurosurg Focus Video. 2023;9(1):V2."},{"issue":"1","key":"b16","series-title":"Neurosurg Focus Video","first-page":"V4","article-title":"Endoscopic ultrasound guided resection of a Cushing\u2019s adenoma invading the medial cavernous sinus wall using the \"interdural peeling\" technique","volume":"9","author":"Finger G","year":"2023","unstructured":"Finger G, Wu KC, Gosal JS,  Endoscopic ultrasound guided resection of a Cushing\u2019s adenoma invading the medial cavernous sinus wall using the \"interdural peeling\" technique. Neurosurg Focus Video. 2023;9(1):V4."},{"key":"b17","series-title":"World Neurosurg","first-page":"53","article-title":"Removal of the medial wall of the cavernous sinus for functional pituitary adenomas: a technical report and pathologic significance","volume":"126","author":"Nagata Y","year":"2019","unstructured":"Nagata Y, Takeuchi K, Yamamoto T,  Removal of the medial wall of the cavernous sinus for functional pituitary adenomas: a technical report and pathologic significance. World Neurosurg. 2019;126:53\u201358."},{"issue":"4","key":"b18","series-title":"Pituitary","first-page":"340","article-title":"Efficacy and safety of cavernous sinus medial wall resection in pituitary adenoma surgery: a systematic review and a single-arm meta-analysis","volume":"26","author":"Pontes JPM","year":"2023","unstructured":"Pontes JPM, Udoma-Udofa OC, de Oliveira JS,  Efficacy and safety of cavernous sinus medial wall resection in pituitary adenoma surgery: a systematic review and a single-arm meta-analysis. Pituitary. 2023;26(4):340\u2013351."},{"issue":"5","key":"b19","series-title":"Neurosurgery","first-page":"775","article-title":"Resection of the cavernous sinus medial wall improves remission rate in functioning pituitary tumors: retrospective analysis of 248 consecutive cases","volume":"91","author":"Ishida A","year":"2022","unstructured":"Ishida A, Shiramizu H, Yoshimoto H,  Resection of the cavernous sinus medial wall improves remission rate in functioning pituitary tumors: retrospective analysis of 248 consecutive cases. Neurosurgery. 2022;91(5):775\u2013781."},{"key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"106306","article-title":"Resection of the medial wall of the cavernous sinus in functioning pituitary adenomas: technical note and outcomes in a matched-cohort study","volume":"200","author":"Omar AT II","year":"2021","unstructured":"Omar AT II, Munoz DG, Goguen J,  Resection of the medial wall of the cavernous sinus in functioning pituitary adenomas: technical note and outcomes in a matched-cohort study. Clin Neurol Neurosurg. 2021;200:106306."},{"issue":"3","key":"b21","series-title":"J Neurosurg","first-page":"505","article-title":"Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes","volume":"121","author":"Nishioka H","year":"2014","unstructured":"Nishioka H, Fukuhara N, Horiguchi K, Yamada S. 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