Cavernous Sinus Invasion by Pituitary Adenoma: MR Imaging

Cottier, Jean-Philippe; Destrieux, Christophe; Brunereau, L.; Bertrand, Philippe; Moreau, Laurence; Jan, Michel; Herbreteau, Denis

doi:10.1148/radiology.215.2.r00ap18463

Cited by 235 publications

(172 citation statements)

References 8 publications

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“…We observed a significantly increased prevalence of invasion in macroadenomas (83.5% of the patients with invasive tumors).This higher prevalence of invasive tumors has also been observed by others [1][2][3]5 , although Scotti et al 4 have not noticed such difference. Knosp et al 1 have also noted that the grade of parasellar extension was directly related to the tumor's size.…”

Section: Discussionsupporting

confidence: 88%

“…CSI occurs more often unilaterally. In Scotti et al 4 and Cottier et al 2 series, invasion by PA occurred only unilaterally. In our series, unilateral invasion by PA was observed in 93.7% of the patients and bilateral invasion occurred in 3 patients (all with GH-secreting adenoma).…”

Section: Discussionmentioning

confidence: 91%

“…Cottier et al 2 also considered the presence of normal pituitary gland interposed between the tumor and the CS and intact CS medial venous compartment as seen on MRI as criteria for absence of CSI. Moreau et al 5 also observed that there was no actual tumor invasion when the lesion did not cross the medial intercarotid line.…”

Section: Discussionmentioning

confidence: 99%

“…Cottier et al 2 noted that besides the visualization of an intact CS superior venous compartment, the absence of size asymmetry between the 2 CS, absence of bulging of lateral wall of CS and grade 2 or less of parasellar extension were also good signs of absence of CSI. In the study of Moreau et al 5 , the signs highly suggestive of absence of invasion were lack of size asymmetry, lack of bulging of the lateral wall of the CS, visualization of at least two venous compartments and non-displaced ICA.…”

Section: Discussionmentioning

confidence: 99%

“…Experienced neurosurgeons can easily distinguish between normal and abnormal dural walls. Some authors [1][2][3][4][5][6] have tried to define imaging criteria for CSI using anatomical parameters, such as the intracavernous ICA and the CS venous compartments; they have also compared imaging and surgical findings.…”

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confidence: 99%

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Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

Vieira

Cukiert

Liberman

2004

Arq. Neuro-Psiquiatr.

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-This study used MRI to define preoperative imaging criteria for cavernous sinus invasion (CSI) by pituitary adenoma (PA). MR images of 103 patients with PA submitted to surgery (48 with CSI) were retrospectively reviewed. The following MR signs were studied and compared to intraoperative findings (the latter were considered the gold standard for CSI detection): presence of normal pituitary gland between the adenoma and CS, status of the CS venous compartments, CS size, CS lateral wall bulging, displacement of the intracavernous internal carotid artery (ICA) by adenoma, grade of parasellar extension (Knosp-Steiner classification) and percentage of intracavernous ICA encased by the tumor. Statistical analysis was performed using qui-square testing and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for each MR finding. The following signs have been found to represent accurate criteria for non-invasion of the CS: 1-normal pituitary gland interposed between the adenoma and the CS (PPV, 100%); 2-intact medial venous compartment (PPV, 100%); 3-percentage of encasement of the intracavernous ICA lower than 25% (NPV, 100%) and 4-medial intercarotid line not crossed by the tumor (NPV, 100%). Criteria for CSI were: 1-percentage of encasement of the intracavernous ICA higher than 45%; 2-occlusion of three or more CS venous compartments and 3-occlusion of the CS lateral venous compartment. The CS was very likely to be invaded if the inferior venous compartment was not detected (PPV. 92,8%), if the lateral intercarotid line was crossed (PPV. 96,1%) or if a bulging lateral dural wall of the CS was seen (PPV, 92,3%). The preoperative diagnosis of CSI by PA is extremely important since endocrinological remission is rarely obtained after microsurgery alone in patients with invasive tumors. The above mentioned MR imaging criteria may be useful in advising most of the patients preoperatively on the potential need for complimentary therapy after surgery.KEY WORDS: magnetic resonance imaging, pituitary adenoma, cavernous sinus, invasion, microneurosurgery.Ressonância magnética da invasão do seio cavernoso por adenomas hipofisários, critérios diagnósticos e achados cirúrgicos RESUMO -Este estudo utilizou exames de RM para definir critérios pré-operatórios de imagem para invasão do seio cavernoso (ISC) em adenomas hipofisários (AH). As imagens de RM de 103 pacientes com AH tratados cirurgicamente (48 com ISC) foram revisadas retrospectivamente. Os seguintes sinais de RM foram estudados e comparados aos achados intraoperatórios (considerados o padrão-ouro para invasão do seio cavernoso): presença de glândula hipofisária normal interposta entre o adenoma e o SC, situação dos compartimentos venosos do SC, tamanho do SC, abaulamento da parede lateral do SC, deslocamento da artéria caróti-da interna (ACI) intracavernosa pelo adenoma, grau de extensão paraselar (classificação de Knosp-Steiner) e porcentagem de envolvimento da ACI intracavernosa pelo tumor. A análise estatí...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

Vieira

Cukiert

Liberman

2004

Arq. Neuro-Psiquiatr.

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Pituitary Volume and Headache

Levy¹,

Jäger²,

Powell³

et al. 2004

Arch Neurol

144

124

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Medial portion of the cavernous sinus: Quantitative analysis of the medial wall

et al. 2005

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Pituitary tumors invade the cavernous sinus via the medial wall. Researchers have speculated that this wall is composed of dura and that substances secreted by tumors might damage this barrier. In contrast to the lateral wall, little is known about the structure of the medial wall of the cavernous sinus (MWCS). This study provides the first detailed quantitative (thickness) and qualitative (histological) assessment of the MWCS. Eighteen sellar-parasellar tissue blocks were obtained from adult human autopsies. Ten specimens were used for microsurgical dissection and macroscopic anatomical description. Eight specimens were used for histopathological study and for recording computer measurements of MWCS thickness. Each of these eight specimens was divided into three approximately equal-sized pieces, with cuts made in the coronal plane from posterior to anterior starting at the anterior level of the pituitary stalk. Wall thicknesses were compared in the three different regions (posterior, middle, anterior), and also on the left vs. the right sides. The investigations showed that the MWCS is a distinct dural layer that forms a barrier between the medial venous space of the cavernous sinus and the pituitary gland. The mean thickness of the 48 total (left and right) MWCS observed in the 24 sections examined was 0.195 +/- 0.066 mm (range = 0.080-0.387 mm). This wall is composed of loosely arranged collagen fibers that comprise a specific layer known as "meningeal dura." The posterior third of the MWCS was significantly thinner than the middle third (P = 0.0014) or anterior third (P = 0.0001). No macro- or microscopic defects were observed in any of the MWCS in the 18 specimens. The thinness of the posterior MWCS suggests that this is the most likely path for extension of pituitary tumors into the cavernous sinus.

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Cavernous Sinus Invasion by Pituitary Adenoma: MR Imaging

Abstract: The radiologic diagnosis of cavernous sinus invasion by pituitary adenoma remains difficult, but the above-mentioned criteria may be of assistance.

Cited by 235 publications

References 8 publications

Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

Pituitary Volume and Headache

Medial portion of the cavernous sinus: Quantitative analysis of the medial wall

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