A paedriatic patient with meningioma arising from the cavernous sinus wall

1997 ◽  
Vol 139 (3) ◽  
pp. 259-260 ◽  
Author(s):  
J. Kuratsu ◽  
A. Okamura ◽  
T. Kamiryo ◽  
Y. Ushio
Keyword(s):  
Author(s):  
Y Meng ◽  
S Suppiah ◽  
L Gonen ◽  
G Klironomos ◽  
F Gentili ◽  
...  

Introduction: Surgical removal is the standard treatment for Cushing’s disease. Although endoscopic transsphenoidal surgical (ETS) approach has grown in popularity, its efficacy has not yet been established. Furthermore, achieving long-term remission remains challenging. Methods: We conducted a retrospective chart review of 39 consecutive patients who underwent ETS for Cushing’s disease at our institution between 2005 and 2014. Univariate analysis using Pearson’s χ2 test was carried out on variables of patient demographics, radiology, pathology, biochemical markers versus recurrence. Results: The mean age was 40, with 82% females. Average length of follow-up was 44.8 months. Based on serum cortisol level, 28 patients (71%) achieved mid to long-term remission after ETS. Of them, 25 experienced an immediate remission, and 3 achieved a delayed remission as long as 4 months postoperatively. MRI findings of (1) microadenomas or no detectable abnormality, (2) adjacency to the cavernous sinus wall were associated with significantly higher recurrence rate (p<0.05). Histologically, MIB-1 >5% was not a significant variable (p=0.55). Conclusion: We found ETS resection to be an effective and safe procedure for majority of the ACTH-secreting adenomas, with remission rates >70%. Additionally, patients with microadenomas, negative preoperative MR, and cavernous sinus adjacency were less likely to achieve remission.


2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Yasushi Kosuge ◽  
Hidetaka Onodera ◽  
Taigen Sase ◽  
Masashi Uchida ◽  
Hiroshi Takasuna ◽  
...  

2012 ◽  
Vol 116 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Russell R. Lonser ◽  
Alexander Ksendzovsky ◽  
Joshua J. Wind ◽  
Alexander O. Vortmeyer ◽  
Edward H. Oldfield

Object Dural invasion by adrenocorticotropic hormone (ACTH)-secreting adenomas is a significant risk factor for incomplete resection and recurrence in Cushing disease (CD). Since ACTH-producing adenomas are often the smallest of the various types of pituitary tumors at the time of resection, examining their invasion provides the best opportunity to identify the precise sites of early dural invasion by pituitary adenomas. To characterize the incidence and anatomical distribution of dural invasion by ACTH-secreting adenomas, the authors prospectively and systematically analyzed features of dural invasion in patients with CD. Methods The authors prospectively studied consecutive patients with CD undergoing the systematic removal of ACTH-secreting adenoma and histological analysis of the anterior sella dura as well as other sites of dural invasion that were evident at surgery. Clinical, imaging, histological, and operative findings were analyzed. Results Eighty-seven patients with CD (58 females and 29 males) were included in the study. Overall, dural invasion by an ACTH-positive adenoma was histologically confirmed in 30 patients (34%). Eighteen patients (60% of dural invasion cases, 21% of all patients) had evidence of cavernous sinus wall invasion (4 of these patients also had other contiguous sites of invasion), and 12 patients (40% of dural invasion cases) had invasion of the sella dura excluding the cavernous sinus wall. Eleven patients (13% all patients) had invasion of the routinely procured anterior sella dura specimen. Preoperative MR imaging revealed an adenoma in 64 patients (74%) but accurately predicted dural invasion in only 4 patients (22%) with cavernous sinus invasion and none of the patients with non–cavernous sinus invasion. Adenomas associated with dural invasion (mean ± SD, 10.9 ± 7.8 mm, range 2–37 mm) were significantly larger than those not associated with dural invasion (5.7 ± 2.1 mm, range 2.5–12 mm; p = 0.0006, Mann-Whitney test). Conclusions Dural invasion by ACTH-producing adenomas preferentially occurs laterally into the wall of the cavernous sinus. Preoperative MR imaging infrequently detects dural invasion, including cavernous sinus invasion. Invasion is directly associated with tumor size. To provide a biochemical cure and avoid recurrence after resection, identification and removal of invaded sella dura, including the medial cavernous sinus wall, are necessary.


Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1433-1435 ◽  
Author(s):  
Oren N. Gottfried ◽  
Scott W. Soleau ◽  
William T. Couldwell

Abstract OBJECTIVE AND IMPORTANCE We present a previously undescribed variant of the cavernous internal carotid artery (ICA) and review the literature concerning other variants of the cavernous ICA. CLINICAL PRESENTATION The patient, a 53-year-old woman with fibromuscular dysplasia and multiple intracranial aneurysms, underwent cerebral angiography in preparation for clipping of a terminal ICA bifurcation aneurysm that demonstrated a redundant loop of the cavernous ICA abutting the supraclinoid carotid artery. INTERVENTION The patient underwent a pterional craniotomy to approach a terminal ICA bifurcation aneurysm. During the procedure, an unexpected vascular anomaly was discovered. On further dissection, we confirmed that the vascular abnormality was a segment of the ICA that had herniated through the superomedial cavernous sinus wall. CONCLUSION This case demonstrates that the cavernous ICA may become dehiscent from the cavernous sinus wall and herniate into the suprasellar space. Knowledge and anticipation of anatomic variants of the cavernous carotid artery are essential to avoid inadvertent vascular injury during surgery.


2020 ◽  
Vol 144 ◽  
pp. 199
Author(s):  
Hamid Borghei-Razavi ◽  
Baha'eddin A. Muhsen ◽  
Krishna Joshi ◽  
Troy Woodard ◽  
Varun R. Kshettry

2010 ◽  
Vol 112 (1) ◽  
pp. 99-107 ◽  
Author(s):  
Savas Ceylan ◽  
Kenan Koc ◽  
Ihsan Anik

Object In this report, the authors describe their experience with surgical access to the cavernous sinus via a fully transnasal endoscopic approach in 20 cases. Clinical and endocrinological follow-up are discussed. Methods The authors used an endoscopic transsphenoidal approach in 192 patients with pituitary adenomas between September 1997 and January 2008, adding a cavernous sinus approach in 20 patients with invasive tumors during the last 5 years of this period. Parasellar extension of the tumor was measured according to the Knosp Scale. Radical tumor removal was achieved in 13 (65%) of 20 patients, and subtotal removal in 7 (35%). The authors used recently defined cavernous sinus approaches in the first 14 cases, including the paraseptal approach in 6, middle turbinectomy in 7, and contralateral middle turbinectomy in 1 case. Combined approaches rather than defined standard cavernous sinus approaches were used in 4 cases and an extended approach in 2. Results The tumors included nonsecretory adenomas in 5 cases (25%), growth hormone–secreting adenomas in 7 (35%), prolactin-secreting adenomas in 4 (20%), and adrenocorticotropic hormone–secreting adenomas in 4 cases (20%). Normal growth hormone and insulin-like growth factor 1 levels were achieved in 4 patients (57%) with growth hormone adenomas, and remission criteria were obtained in 3 patients with prolactinomas and 3 patients with adrenocorticotropic hormone–secreting adenomas. Conclusions Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure for cavernous sinus medial wall adenomas that enables removal of the adenoma from the medial cavernous sinus wall. Because of the necessity for multidisciplinary treatment to achieve satisfactory results, Gamma Knife surgery and medical therapy should be supplementary treatment options after endoscopic transsphenoidal surgery.


Author(s):  
Masayuki Miyoshi

In spite of various attempts, conclusive evidence to explain blood passage in the splenic red pulp does not seem to have been presented. Scanning electron microscope (SEM) observations on the rabbit spleen, originally performed by us, revealed that the sinus was lined by a perforated lattice composed of longitudinally extended rod cells and transverse cytoplasmic processes, and that perforations in the lattice were continuous to the spaces among the stellate reticulum cells of the cord. In the present study the observation was extended to the dog and rat spleens, in which the cord is more developed than in the rabbit in order to clarify the possible differences in the fine structure of the sinus wall. An attempt was also made to examine the development and distribution of macrophage in the blood passage of the red pulp.Spleens were washed and fixed by perfusion with Ringer solution and then with buffered glutaraldehyde. Small tissue cubes were dehydrated with acetone, dried in air and heated with gold. Observations were made by a JEOL SEM Type-3. One air dried tissue cube was cut into small pieces and post fixed with buffered OsO4 for examination under the transmission electron microscope (TEM).


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