SynthesisPituitary2021
Diagnostic value of Knosp grade and modified Knosp grade for cavernous sinus invasion in pituitary adenomas: a systematic review and meta-analysis.
Synthesis in Pituitary, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Disparities in indications and outcomes reporting for pediatric tethered cord surgery: The need for a standardized outcome assessment tool.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Pooled it
- Pooled it
- Radiomics and artificial intelligence in pituitary adenomas (PitNETs): from imaging biomarkers to clinical translation.Reviews in endocrine & metabolic disorders · 2026Review
- Pituitary adenoma imaging as a determinant of acromegaly diagnosis and outcomes.The Journal of clinical endocrinology and metabolism · 2026Review
- Article
- Radiolabeling molecular biomarkers of invasive pituitary adenomas: a narrative review.Pituitary · 2025Review
- Article
- Predictors of residual and recurrent pituitary neuroendocrine tumors: impact of medial cavernous sinus wall invasion and Trouillas grading.Neuroradiology · 2025Article
- Radiological and Immunohistochemical Characteristics of PitNETs in 79 Patients Undergoing Neurosurgery.Cancers · 2025Article
- Grading and staging for pituitary neuroendocrine tumors.Brain pathology (Zurich, Switzerland) · 2025Review
- Radiomics-based multiple machine learning approaches for investigating medial wall invasion of the cavernous sinus in pituitary adenomas.Frontiers in oncology · 2025Article
- Advancements in Molecular Diagnosis and Pharmacotherapeutic Strategies for Invasive Pituitary Adenomas.Immunity, inflammation and disease · 2024Review
- Anatomical-Radiological Aspects and Their Influence on the Results of Pituitary Adenomas Endoscopic Endonasal Surgery.Journal of neurological surgery. Part B, Skull base · 2024Article
- Multi-center application of a convolutional neural network for preoperative detection of cavernous sinus invasion in pituitary adenomas.Neuroradiology · 2024Article
- Regulation of long noncoding RNAs in the pathogenesis and clinical implications of pituitary adenomas.Immunity, inflammation and disease · 2023Review
- Radiomics model and clinical scale for the preoperative diagnosis of silent corticotroph adenomas.Journal of endocrinological investigation · 2023Article
- Machine Learning Models to Forecast Outcomes of Pituitary Surgery: A Systematic Review in Quality of Reporting and Current Evidence.Brain sciences · 2023Review
- A Convolutional Neural Network Model for Detecting Sellar Floor Destruction of Pituitary Adenoma on Magnetic Resonance Imaging Scans.Frontiers in neuroscience · 2022Article
- ST8SIA6-AS1 Promotes the Epithelial-to-Mesenchymal Transition and Angiogenesis of Pituitary Adenoma.Journal of oncology · 2022Article
- Microscopic Transsphenoidal Resection of Giant Pituitary Adenomas: Analysis of the Factors Limiting the Degree of Resection in 73 Cases.Frontiers in neurology · 2022Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveThis study aimed to examine the reliability of existing Knosp grade (KG) and modified KG for cavernous sinus invasion (CSI).
methodsA thorough search of literature from 1993 to 2020 in six databases was performed. Studies that reported the intraoperative confirmation of CSI using KG and/or modified KG were included. The pooled estimates were calculated by meta-analysis with a bivariate mixed-effect model and the assessment of heterogeneity with I
resultsThe final search yielded 12 eligible studies, which enrolled 3006 patients assessed with KG and 1315 patients assessed with modified KG. The results of the area under the receiver operating characteristic curve showed the good discriminative abilities of grades 2-4 (0.90), 3-4 (0.86) and 3B-4 (0.91) in predicting CSI. Grade 3A showed a remarkably lower CSI rate (44% versus 81%) and incomplete resection rate (26% versus 52%) than grade 3B. Grades 0 and 1 showed a low CSI rate. CSI and incomplete resection rates in grade 2 (30% and 21%, respectively) were close to those in grade 3A.
conclusionsModifying the KG improved its prognostic role in CSI and gross total resection. However, these grading systems cannot be used as the group standard for invasive and non-invasive pituitary adenomas (PAs) because of the weak reliability of the scale's middle grades (grades 2 and 3A). Authors of future PA studies should consider reporting KG as high (grades 3B and 4), medium (grades 2 and 3A) and low (grades 0 and 1) to optimise the application of the scale.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.