Cavernous sinus invasion by pituitary adenomas

Ahmadi, Jamshid; North, CM; Segall, H D; Cs, Zee; Weiss, M H

doi:10.2214/ajr.146.2.257

Cited by 95 publications

(60 citation statements)

References 5 publications

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“…Surgical invasion describes the invasive nature of the tumour as recognised during operation, while histological invasion, although more frequent, can only be demonstrated by investigating the anatomical structures in the vicinity of the tumour. In up to 80% of the cases, dural invasion can be detected, when the basal dura is thoroughly investigated (26,27). In this series, the overall remission rate of non-invasive adenomas was 66.5% and dropped to 23.7% for invasive tumours.…”

Section: Discussionmentioning

confidence: 68%

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Nomikos

Buchfelder²,

Fahlbusch³

2005

eur j endocrinol

456

283

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Background and aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method: We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used.Results: The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions: These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.

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Section: Discussionmentioning

confidence: 68%

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Nomikos

Buchfelder²,

Fahlbusch³

2005

eur j endocrinol

456

283

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“…The presence of tumor lateral to the carotid artery in patients with pituitary adenomas has been considered the classic gold-standard for the pre-operative radiological diagnosis of cavernous sinus invasion 7 . It is present in the bigger tumors 8,9 .…”

Section: Discussionmentioning

confidence: 99%

Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

Cukiert

Andrioli

Goldman

et al. 1998

Arq. Neuro-Psiquiatr.

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-The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transesphenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients.KEY WORDS: pituitary tumors, magnetic resonance image, cavernous sinus invasion. Invasão de seio cavernoso por tumores pituitários: correlação neurorradiológica e clínico-cirúrgicaRESUMO -O critério imagenológico clássico para diagnóstico de invasão de seio cavernoso é a presença de tumor lateralmente à carótida em cortes coronais. Estudamos 17 pacientes com macroadenomas hipofisários com ressonância compátivel a invasão de seio cavernoso e que tiveram esta invasão confirmada cirurgicamente. Somente 8 destes pacientes possuíam tumor lateralmente à carótida (critério clássico). Treze pacientes possuíam tumor localizado entre as porções intracavernosas da carótida e em todos havia ruptura da captação anelar de contraste no seio cavernoso. Dez pacientes possuíam abertura dos folhetos posteriores do seio cavernoso. Todos os pacientes foram tratados por via transesfenoidal. Somente um caso obteve cura endocrinológica. Somente 3 pacientes portadores de algum destes sinais imagenológicos foram identificados em uma série de cerca de 250 casos e não possuíam invasão de seio cavernoso. Os critérios acima parecem adequadamente permitir prever a invasão do seio. Este diagnóstico é relevante já que a maioria dos pacientes com invasão de seio cavernoso acaba realizando terapia complementar. PALAVRAS-CHAVE: tumor hipofisário, ressonância magnética, seio cavernoso invasão.Cavernous sinus invasion by pituitary adenomas has been noted since the early days of pituitary surgery 1 . On the other hand, the pre-operative diagnosis of cavernous sinus invasion was rarely done before the introduction of CT scanning in the clinical practice and correctly performed only in the more obvious cases by means of CT 2 . The availability of high resolution MR imaging 3 has made it possible to study the sellar region in a detail not possible using CT scans 4 . Different criteria have

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“…Special attention has been drawn to the endosteum of the sellar floor, the rate of histological invasion into which has been reported to be as high as 46%-85%. 52,62 Overt parasellar invasion into cavernous sinus (CS) structures is found intraoperatively in 6%-10% 1,20 of cases and is the most important reason for incomplete resection and the decrease in cure rates from 78%-92% (in cases without parasellar invasion) to 20%-52%. 16,20,21,24,36,39,62,64 Because of the close relationship of the internal carotid arteries (ICAs), histological specimens of the medial wall are not routinely available, 54,65,77 so surgical observations 59 and/or radiological signs of invasion 14 are still the most important methods of detection.…”

mentioning

confidence: 99%

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

Micko¹,

Wöhrer

Wolfsberger³

et al. 2015

JNS

413

281

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abbreviatioNs CS = cavernous sinus; ER = endocrinological remission; GTR = gross-total resection; ICA = internal carotid artery. submitted May 22, 2014. accepted December 2, 2014. iNclude wheN citiNg Published online February 6, 2015; DOI: 10.3171/2014.12.JNS141083. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect An important prognostic factor for the surgical outcome and recurrence of a pituitary adenoma is its invasiveness into parasellar tissue, particularly into the space of the cavernous sinus (CS). The aims of this study were to reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. methods The authors investigated 137 pituitary macroadenomas classified radiologically at least on one side as Grade 1 or higher (parasellar extension) and correlated the surgical findings using an endoscopic technique, with special reference to the invasiveness of the tumor into the CS. In each case, postoperative MRI was performed to evaluate the gross-total resection (GTR) rate and the rate of endocrinological remission (ER) in functioning adenomas. results The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. coNclusioNs The proposed classification proved that with increasing grades, the likelihood of surgically observed invasion rises and the chance of GTR and ER decreases. The direct endoscopic view confirmed the low rate of invasion of Grade 1 adenomas but showed significantly lower rates of invasion in Grade 2 and 3 adenomas than those previousl...

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Cavernous sinus invasion by pituitary adenomas

Cited by 95 publications

References 5 publications

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

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