{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:26Z","timestamp":1776096506526,"version":"3.50.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,4,13]]},"abstract":"\n BACKGROUND<\/jats:title>\n Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. Tumor invasion into the medial wall of the cavernous sinus (MWCS) has been observed, even in Knosp grades 0\u20132, and may lead to suboptimal surgical results if not additionally resected. Removal of the MWCS may enhance the surgical outcome and result in improved endocrine remission rates. The aim of this study was to evaluate the impact of additional MWCS resection during TSS for acromegaly on endocrine remission and complication rates. The authors prospectively collected the data of acromegaly patients at a large tertiary pituitary referral center. Between January 2023 and January 2025, patients treated with TSS and additional selective resection of the MWCS were included. Patient demographics, tumor characteristics, surgical outcome, and postoperative complications were reviewed.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n Twelve patients were included (9 primary TSS, 3 re-TSS). Tumor invasion of the MWCS was confirmed in 91.7%. The median follow-up was 19 months (range 3\u201327 months). After primary TSS, 8 of 9 patients (88.9%) were in endocrine remission. Following re-TSS, remission was observed in 33.3%. Ultimately, disease control was achieved in 11 of 12 patients (91.7%). No carotid injuries or permanent neurological deficits were observed.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Additional selective resection of the MWCS during TSS in acromegaly is a technique that can be safely executed, and it seems to enhance endocrine remission rates especially in primary TSS.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE2665<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case2665","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:34Z","timestamp":1776094054000},"source":"Crossref","is-referenced-by-count":0,"title":["Selective resection of the medial wall of the cavernous sinus in acromegaly: patient series"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6700-196X","authenticated-orcid":true,"given":"Rob A.","family":"Vergeer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R.","family":"Postma","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7178-009X","authenticated-orcid":true,"given":"Melanie M.","family":"van der Klauw","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid G. W.","family":"Korsten-Meijer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Feijen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4168-1207","authenticated-orcid":true,"given":"Wilfred F. A.","family":"den Dunnen","sequence":"additional","affiliation":[{"name":"Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-5680","authenticated-orcid":true,"given":"J. Marc C.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos M. A.","family":"Kuijlen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Groningen, University Medical Center Groningen"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Expert Rev Pharmacoecon Outcomes Res","first-page":"223","article-title":"Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly","volume":"9","author":"Biermasz","year":"2009","unstructured":"Biermasz NRRoelfsema FPereira AMRomijn JA.Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly. 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J Clin Endocrinol Metab. 2021;106(6):1783-1792. doi:10.1210\/clinem\/dgab069"},{"issue":"4","key":"bib4","series-title":"J Neurosurg","first-page":"803","article-title":"Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification","volume":"122","author":"Micko","year":"2015","unstructured":"Micko ASGW\u00f6hrer AWolfsberger SKnosp E.Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. 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Rhinology. 2006;44(1):2-7."},{"issue":"9","key":"bib22","series-title":"Tidsskr Nor Laegeforen","article-title":"Endoskopisk fireh\u00e5ndsteknikk ved hypofysesvulster","volume":"143","author":"Wiedmann","year":"2023","unstructured":"Wiedmann MOlesrud ILashkarivand AEndoskopisk fireh\u00e5ndsteknikk ved hypofysesvulster. Tidsskr Nor Laegeforen. 2023;143(9). doi:10.4045\/tidsskr.22.0693"},{"issue":"1","key":"bib23","series-title":"Neurosurg Rev","first-page":"259","article-title":"The application of nasoseptal \u201crescue\u201d flap technique in endoscopic transsphenoidal pituitary adenoma resection","volume":"43","author":"Zhang","year":"2020","unstructured":"Zhang CYang NMu LThe application of nasoseptal \u201crescue\u201d flap technique in endoscopic transsphenoidal pituitary adenoma resection. Neurosurg Rev. 2020;43(1):259-263. doi:10.1007\/s10143-018-1048-8"},{"issue":"3","key":"bib24","series-title":"J Neurosurg","first-page":"402","article-title":"The occurrence of dural invasion in pituitary adenomas","volume":"64","author":"Selman","year":"1986","unstructured":"Selman WRLaws ERJrScheithauer BWCarpenter SM.The occurrence of dural invasion in pituitary adenomas. J Neurosurg. 1986;64(3):402-407. doi:10.3171\/jns.1986.64.3.0402"},{"issue":"6","key":"bib25","series-title":"J Neurosurg","first-page":"1343","article-title":"Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery","volume":"97","author":"Dickerman","year":"2002","unstructured":"Dickerman RDOldfield EH.Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery. 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