Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos: Estudio prospectivo de una serie de 23 casos

Abstract

The Knosp classification alone cannot predict the behavior of these tumors. In our experience, despite tumor extension to the cavernous sinus, pituitary macroadenomas can be safely resected with low morbidity and mortality.

Anatomical-Radiological Aspects and Their Influence on the Results of Pituitary Adenomas Endoscopic Endonasal Surgery

“…So, although the volume is an important factor to consider in the surgical planning, the SIPAP extension and Knosp invasion grades could give more information about the possible extent of resection, which is described by many authors. 12,13,15,16,19,20,21,22 Knosp grade of invasion of the cavernous sinus is widely described as one of the most important factors to consider before pituitary adenoma surgery, being unfavorable as the grade goes higher. This invasion represents a negative prognostic factor, reducing the probability of success in surgical treatment, both in terms of complete tumor resection and hormonal remission in functioning tumors.…”

“…This invasion represents a negative prognostic factor, reducing the probability of success in surgical treatment, both in terms of complete tumor resection and hormonal remission in functioning tumors. 12,13 Dallapiaza et al found that tumors with Knosp grades 0 to 2 and volumes up to 10 cm 3 had more chance to get a gross total resection, being Knosp grade the only independent predictor in a multivariate analysis. 21 In our study, Knosp had a correlation with the extent of resection, but it didn't result as an independent predictor in the multivariate analysis.…”

“…There are numerous studies that describe the preoperative factors that predict the extent of resection, among which we find the degree of invasion of the cavernous sinus of Knosp. 11,12,13,14 However, there is little evidence about the preoperative variables that could predict the endocrinological outcome.…”