ОТСРОЧЕННАЯ ТРАНЗИТОРНАЯ ОФТАЛЬМОПЛЕГИЯ ПОСЛЕ ЭНДОСКОПИЧЕСКОЙ ХИРУРГИИ ОСНОВАНИЯ ЧЕРЕПА С ВОВЛЕЧЕНИЕМ КАВЕРНОЗНОГО СИНУСА: КЛИНИЧЕСКИЕ ХАРАКТЕРИСТИКИ И ФАКТОРЫ РИСКА

Abstract

Objective. Postoperative cranial nerve dysfunction remains a significant concern in endoscopic endonasal surgery for pituitary neuroendocrine tumors (PitNETs), also known as pituitary adenomas, that invade the cavernous sinus. However, the reported incidence, timing, and recovery patterns vary considerably across studies. The aim of this study was to characterize the clinical features, risk factors, and recovery patterns of postoperative ophthalmoplegia following cavernous sinus exploration.

Methods. We conducted a retrospective analysis of 127 consecutive patients who underwent endoscopic skull base surgery with cavernous sinus exploration between March 2020 and September 2024. The onset of ophthalmoplegia, involved cranial nerves, and prognosis were evaluated. Risk factors were assessed using multivariate logistic regression analysis, and recovery patterns were analyzed using Kaplan–Meier survival curves.

Results. The overall rate of gross total resection was 74.8% (96.9% for functioning adenomas), with biochemical remission in functioning pituitary neuroendocrine tumors reaching 96.9% at 3-month follow-up. New postoperative cranial nerve dysfunction occurred in 13.6% (17/125) of patients, presenting exclusively as ophthalmoplegia. The abducens nerve was most commonly affected (52.9%), followed by the oculomotor (41.2%) and trochlear nerves (11.8%). Early-onset ophthalmoplegia (≤3 days) was observed in 29.4% of cases, while delayed-onset (>3 days) occurred in 70.6% (mean onset time: 9 days).

Conclusions. Postoperative ophthalmoplegia following cavernous sinus exploration occurs more frequently than previously reported but follows a benign course with near-complete resolution. Distinct temporal patterns and associated risk factors suggest different pathophysiological mechanisms underlying early and delayed ophthalmoplegia, providing valuable insights for surgical decision-making and patient counseling.