Are Nonfunctioning Pituitary Adenomas Extending into the Cavernous Sinus Aggressive and/or Invasive?

Yokoyama, Shunichi; Hirano, Hirofumi; Moroki, Koichi; Goto, Masamichi; Imamura, Shinichi; Kuratsu, Jun‐ichi

doi:10.1227/00006123-200110000-00014

Cited by 27 publications

(42 citation statements)

References 22 publications

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“…Of these, four (172 samples, 44.7% of all samples included in this review) referred to the medial wall of the CS as a loose fibrous structure [4,9], as its own pituitary capsule of fine collagen fibers [28], or as two layers composed of the lateral part of the pituitary capsule and the fibrous layer [21]. Ten studies (213 samples, 55.3% of all samples included in this review) Fig.…”

Section: Resultsmentioning

confidence: 99%

“…With regard to the methodology, in those studies that presented results confirming a fibrous tissue separating the pituitary fossa from the lateral sellar compartment, all of them utilized magnetic resonance imaging (MRI) [4,9,28] and/or histological staining methods (the Van Gieson [28], hematoxylin and eosin, and/or Masson's trichrome [4,9,21]). Of these studies, three included histological sections and cadaveric dissection under surgical microscope [4,9,21], while in one study, transphenoidal surgery was assessed by the Mann-Whitney U test in cases and controls beyond the histological section [28].…”

Section: Resultsmentioning

confidence: 99%

“…Of these studies, three included histological sections and cadaveric dissection under surgical microscope [4,9,21], while in one study, transphenoidal surgery was assessed by the Mann-Whitney U test in cases and controls beyond the histological section [28]. The second group, which identified the medial wall of the CS as comprised of a dural layer, did not utilize MRI in their methodology.…”

Section: Resultsmentioning

confidence: 99%

“…This hypothesis has been debated by Kehrli et al [9], Yokoyama et al [28], Dietemann et al [4], and Songtao et al [21], whose studies suggested the absence of this dural medial wall. According to Kehrli et al [9], a dural wall limiting the CS medially does not exist, but a perforated, fibrous tissue originating from the mesenchyma.…”

Section: Discussionmentioning

confidence: 99%

“…2). However, some recent reports suggest that there is not a medial dural wall-rather, there exists a loose fibrous tissue that separates the pituitary capsule [4,9], or merely its own capsule formed by fine collagen fibers that separate the gland [28].…”

Section: Introductionmentioning

confidence: 99%

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Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

et al. 2011

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The cavernous sinus (CS) has one of the most complex anatomical networks of the skull base and because of the diversity of its contents is involved in many pathological processes. Nevertheless, anatomical literature concerning the CS is still controversial, so a systematic literature review was performed to find out the microanatomy of the medial wall of the CS and its clinical importance on sellar pathologies. Experimental studies from English-language literature between 1996 and 2010 were identified in MEDLINE, LILACS, and Cochrane databases. After analysis, two tables were prepared exhibiting the major points of each article. Fourteen experimental studies were included in the tables. Four studies concluded that the medial wall of the CS is composed of a loose, fibrous structure, and the remaining ten presumed that the medial wall is formed by a dural layer that constitutes the lateral wall of the sella. The lack of definition standards and of methodological criteria led to variation in the results among different studies. Thus, this hindered results comparison, possibly explaining the different observations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

et al. 2011

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Matrix metalloproteinase-9, a potential biological marker in invasive pituitary adenomas

et al. 2007

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Cavernous sinus invasion might be a risk factor for apoplexy

et al. 2012

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The clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. We aimed to evaluate the frequency, symptoms, outcome and risk factors of clinical and subclinical pituitary apoplexy (PA) patients. In a retrospective analysis, charts of 547 pituitary adenoma patients from 2000 to December 2011 were reviewed. The patients were classified as clinical or subclinical PA. We compared the results with a control group without PA. Anterior pituitary hormones for endocrine dysfunction, histology, Ki-67 labeling index (LI), and p53 positivity of the tumor and pituitary imaging by magnetic resonance imaging were evaluated. Thirty-two patients (5.8%) were diagnosed as clinical and 81 patients (14.8%) as subclinical PA. Among PA patients, 85 patients (75.2%) had a macroadenoma, 8 patients (7.1%) had a microadenoma. The most frequent symptoms at presentation in PA patients were visual loss and headache. The patients with macroadenoma had a significantly increased risk for PA (p < 0.05). Hormone inactive tumors were significantly associated with the development of clinical PA (p = 0.05). Dopamine agonist use was significantly higher in subclinical PA patients (p = 0.001). Sex, Ki-67 LI, p53 positivity, diabetes mellitus, hypertension, somatostatin analogue and anticoagulant use did not predispose to PA whereas cavernous sinus invasion predisposed patients to PA (p < 0.01). The incidence of subclinical PA is higher than that of clinical PA. The development of PA is associated with macroadenomas. Clinically non-functioning tumors predispose to clinical PA. Cavernous sinus invasion of the tumor may be a sign of increased risk of bleeding.

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Are Nonfunctioning Pituitary Adenomas Extending into the Cavernous Sinus Aggressive and/or Invasive?

Cited by 27 publications

References 22 publications

Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

Matrix metalloproteinase-9, a potential biological marker in invasive pituitary adenomas

Cavernous sinus invasion might be a risk factor for apoplexy

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