Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

Abstract

Despite all the improvement in transsphenoidal surgery, the anatomical knowledge has been a main issue stressed by most authors 1 . In the transsphenoidal approach for pituitary adenomas, detailed preoperative planning with information regarding the sphenoid sinus, tumoral involvement of adjacent structures (cavernous sinus, suprasellar region, carotid arteries) and intercarotid distance (ICD) is critical. Despite that, there is little literature regarding the ICD at the parassellar region of the intracranial carotid arteries at its cavernous segment and its modifications due to the sellar pathologies, specially non-functioning pituitary adenomas 2,3,4,5,6 .Although vascular injuries have become less frequent over the years, with reports ranging from 0-3.8% 7,8,9,10,11,12,13,14,15,16,17,18,19,20 , it is still considered one of the most important complications in the transsphenoidal approaches due to its potential hazardous effects and difficult management. Taking this into consideration, it is crucial that every surgeon knows exactly the carotid artery position and its relation to the lesion.This study has the aim to measure and analyze ICD in a series of patients with non-functioning pituitary adenomas with no previous treatment and correlate the data with measurements in controls with no endocrinological, sellar or parassellar disease. AbstrACtObjective: To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method: We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment -ICD1 and horizontal cavernous segment -ICD2) and compared to twenty paired controls. Results: There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion: The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.Keywords: Pituitary gland; pituitary disease; internal carotid artery; endoscopy; sella turcica. resumo Objetivo: Avaliar a distância intercarotídea (DIC) de pacientes com macroadenoma de hipófise e comparar com controles saudáveis. Método: Foram analisados retrospectivamente imagens de ressonância magnética com contraste de vinte pacientes consecutivos com diagnóstico de macroadenoma hipofisário não-funcionante, medidas as DIC em dois níveis diferentes (segmento petroso -DIC1 e segmento cavernoso horizontal -DIC2) e comparados com vinte controles pareados. Resultados: Não houve diferença estatisticamente significativa da DIC1 média entre os grupos e su...

Sellar Remodeling after Surgery for Nonfunctioning Pituitary Adenoma: Intercarotid Distance as a Predictor of Recurrence.

“…We have reiterated that ICD is a simple MRI measurement that is reliable within and between observers, despite the small distances involved. 4 Our study reaffirms that after transsphenoidal debulking of nonfunctioning pituitary adenoma the sella contracts medially; though the magnitude of this contraction varies substantially. It also demonstrates that abnormal cavernous-carotid anatomy does, to some degree, normalize following surgery.…”

“…ICD increases from infanthood to adulthood and shows a relatively large interindividual variation (12.8-23.9 mm). [2][3][4] Likewise, with pituitary adenoma in situ ICD variation is large 4,5 and can inform surgical candidacy and planning. The ratio of tumor diameter to preoperative ICD has also recently been used to predict extent of resection.…”

“…6 Giant pituitary adenomas show obvious widening of the sella. 4 Although tumor height and width appear to correlate with preoperative ICD, 7 to what extent sella widening occurs with smaller pituitary adenomas is less well defined, 4,7-10 as are the factors determining this process. Furthermore, it is difficult to confirm expansion is secondary to tumor as there is rarely a baseline historic scan that predates the tumor's presence.…”

“…Furthermore, it is difficult to confirm expansion is secondary to tumor as there is rarely a baseline historic scan that predates the tumor's presence. 3,4 Tumors displace or compress adjacent structures by exerting pressure on them. This pressure should be relieved by surgical decompression.…”

Sphenoid sinus mucosal thickening in patients with non‐functioning pituitary adenoma

“…Some authors have studied the ICD using different measuring techniques. [17][18][19][20][21][22] However, only a small number of investigations have focused on the differences in the ICD compared with healthy subjects in patients with sellar and parasellar pathologies. Ebner et al 23 reported that acromegalic patients (1.64 ± 0.40 cm) had narrower mean ICD compared with healthy subjects (1.90 ± 0.26 cm).…”