Using ATECO MRV and a novel grading system for quantifying sinovenous stenoses, the authors can identify IIH patients with sensitivity and specificity of 93%.

446Giant pituitary tumours (GPTs) are rare tumours of 30 mm or more, that have major extensions into the suprasellar and parasellar compartments. [1][2][3][4][5][6][7] Despite the major neurosurgical challenge that resecting GPTs presents, [8][9][10][11][12][13][14][15][16] both transsphenoidal and transcranial approaches have been used. 2,17,18 Transsphenoidal approaches offer a more direct route to the sellar components and can stay outside the arachnoid whenever possible. Transcranial approaches offer direct visualization of the suprasellar components but, because they must come from the subarachnoid position, visualizing the sellar contents can be difficult without drilling the planum sphenoidale or mobilizing the optic nerve.Surgical morbidity and mortality for these lesions can be high, although the safety of the surgery has progressively ABSTRACT: Objective: To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS). Methods: Seventy-two consecutive patients with GPTs (greater than 10 cm 3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications. Results: The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829). Conclusions: Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients. RÉSUMÉ: Résultats du traitement chirurgical des tumeurs géantes de l'hypophyse (TGH).Objectif : Le but de l'étude était d'évaluer les résultats de la chirurgie transsphénoïdale endoscopique binasale (CTEB), de la craniotomie et de la chirurgie transsphénoïdale par microscopie (CTM) chez des patients atteints de tumeurs géantes de l'hypophyse et de comparer les résultats obtenus suite à ces chirurgies. Méthode : Les dossiers de patients consécutifs atteints de TGH (volume supérieur à 10 cm3), qui ont été traités chirurgicalement soit par CTEB, crani...

There are multiple transvenous approaches for treatment of cavernous dural arteriovenous fistulae (DAVF). The choice of a specific route depends on the compartment of the cavernous sinus involved in the fistula and its venous drainage. We used two different facial vein approaches to treat patients with cavernous DAVF draining directly into the anterior compartment of the cavernous sinus and thence to the superior ophthalmic vein. Other transvenous routes to the sinus were not apparent. Embolization was targeted to the involved compartment with preservation of those not embolized. No major post-procedure ophthalmic venous engorgement occurred. We believe that ideal treatment of cavernous DAVF is targeted transvenous coil deposition, which necessitates detailed knowledge of the anatomy of the facial veins and cavernous sinus compartments.

BackgroundAlthough the relationship between acromegaly and depression has been ascribed to the effects of chronic disease, the role of growth hormone (GH), and insulin like growth factor-1 (IGF-1) is not clear.ObjectiveTo determine whether related hormones levels in acromegalics are correlated with depressive symptoms and whether these symptoms are ameliorated following surgery.Materials and MethodsA prospective cohort study was conducted on patients diagnosed with acromegaly (n = 15) or non-functioning pituitary adenomas (NFPA; n = 20, as controls) and undergoing first-time surgery, who completed the Center for Epidemiological Studies Depression (CES-D) questionnaire both pre-surgery and post-surgery. The primary outcome was the patient’s severity of depression symptomatology using the CES-D score; GH, IGF-1 levels, and tumor characteristics were also measured.ResultsHormone levels (GH and IGF-1) and depression scores in acromegaly patients showed significant reductions following surgery (p < 0.05). The average change in CES-D score was 5.73 ± 2.58 (mean ± SE). A moderate correlation was found between GH levels and CES-D scores (r = 0.52, p < 0.01). The depressed affect subscale accounted for the most improvement in CES-D scores postoperatively and correlated most highly with GH levels. We did not find similar declines in the matched cohort of NFPA patients.Conclusion and RelevanceSurgical resection of the pituitary tumor in acromegaly patients leads to reduction in GH levels that is correlated with reduction in CES-D scores. The results suggest a role for GH in depression and provide a stronger foundation on which to build the hypothesis that GH impacts affect. The study also suggests that hormones should be factored into the matrix that entails the neuro-biological underpinnings of depressive disorders. Future work could explore the mechanisms involved, further brain and neuropeptide interactions, and, novel potential therapeutic targets in depressive and other mental health disorders.