Tumors Invading the Cavernous Sinus That Cause Internal Carotid Artery Compression Are Rarely Pituitary Adenomas

Molitch, Mark E.; Cowen, Laura; Stadiem, Raymond; Uihlein, Alexander V.; Naidich, Michelle J.; Russell, Eric J.

doi:10.1210/endo-meetings.2011.part2.p5.p1-435

Cited by 2 publications

(2 citation statements)

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“…Pituitary adenomas can frequently encase the ICA, but they rarely cause arterial compression, especially when compared with other sellar and parasellar masses that invade the cavernous sinus. 1 Symptomatic carotid artery stenosis secondary to compression by a pituitary adenoma is most commonly the result of pituitary apoplexy, with a number of reports of this previously described in the literature. [2][3][4][5][6] The majority of these have resulted in unilateral ICA compression, with only a handful of the cases resulting in bilateral carotid artery compression.…”

Section: Discussion Observationsmentioning

confidence: 99%

Failed endovascular therapy for acute internal carotid artery occlusion from pituitary apoplexy: illustrative case

Elsehety¹,

Zeineddine²,

Barreto³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Large pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion. Here, the authors present a case of pituitary apoplexy causing acute bilateral ICA occlusion with resultant stroke. Our middle-aged patient presented with sudden vision loss and experienced rapid deterioration requiring intubation. Computed tomography (CT) angiography revealed a large pituitary mass causing severe stenosis of the bilateral ICAs. CT perfusion revealed a significant perfusion delay in the anterior circulation. The patient was taken for cerebral angiography, and balloon angioplasty was attempted with no improvement in arterial flow. Resection of the tumor was then performed, with successful restoration of blood flow. Despite restoration of luminal patency, the patient experienced bilateral ICA infarcts. OBSERVATIONS Pituitary apoplexy can present as an acute stroke due to flow-limiting carotid compression. Balloon angioplasty is ineffective for the treatment of this type of compression. Surgical removal of the tumor restores the flow and luminal caliber of the ICA. LESSONS Pituitary apoplexy can be a rare presentation of acute stroke and should be managed with immediate surgical decompression rather than attempted angioplasty in order to restore blood flow and prevent the development of cerebral ischemia.

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Section: Discussion Observationsmentioning

confidence: 99%

Failed endovascular therapy for acute internal carotid artery occlusion from pituitary apoplexy: illustrative case

Elsehety¹,

Zeineddine²,

Barreto³

et al. 2021

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

show abstract

“…Although the ICA passes through the cavernous sinus, the integrity of the arterial lumen is rarely compromised by invasive pituitary neoplasms [14]. Studies in adults have implicated meningiomas [15] and metastases [14] more likely to alter ICA structure than adenomas.…”

Section: Discussionmentioning

confidence: 99%