Endoscopic Extracapsular Resection of an Adrenocorticotropic Hormone–Secreting Macroadenoma with Selective Resection of the Medial Cavernous Sinus Wall

2020 ◽  
Vol 144 ◽  
pp. 199
Author(s):  
Hamid Borghei-Razavi ◽  
Baha'eddin A. Muhsen ◽  
Krishna Joshi ◽  
Troy Woodard ◽  
Varun R. Kshettry
Keyword(s):  
Cavernous Sinus ◽  
Adrenocorticotropic Hormone ◽  
Sinus Wall ◽  
Extracapsular Resection

Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus

2010 ◽  
Vol 112 (1) ◽  
pp. 99-107 ◽  
Author(s):  
Savas Ceylan ◽  
Kenan Koc ◽  
Ihsan Anik
Keyword(s):  
Growth Hormone ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Adrenocorticotropic Hormone ◽  
Multidisciplinary Treatment ◽  
Transsphenoidal Approach ◽  
Endoscopic Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Sinus Wall

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.

scholarly journals Factors associated with recurrence after endoscopic transphenoidal surgery for Cushing’s disease

2015 ◽  
Vol 42 (S1) ◽  
pp. S41-S41
Author(s):  
Y Meng ◽  
S Suppiah ◽  
L Gonen ◽  
G Klironomos ◽  
F Gentili ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Univariate Analysis ◽  
Cushing's Disease ◽  
Serum Cortisol Level ◽  
Surgical Removal ◽  
Significant Variable ◽  
Safe Procedure ◽  
Sinus Wall

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.

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):  
Cavernous Sinus ◽  
Sinus Wall

scholarly journals Cavernous sinus sampling in patients with Cushing's disease

2015 ◽  
Vol 38 (2) ◽  
pp. E6 ◽  
Author(s):  
Till Burkhardt ◽  
Jörg Flitsch ◽  
Philine van Leyen ◽  
Nina Sauer ◽  
Jens Aberle ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Adrenocorticotropic Hormone ◽  
Correct Diagnosis ◽  
Cushing's Disease ◽  
High Dose ◽  
Consecutive Series ◽  
Test Results ◽  
High Dose Dexamethasone ◽  
Invasive Method

OBJECT Correct diagnosis and precise localization of adenomas in patients with Cushing's disease are essential for avoiding unsuccessful transsphenoidal pituitary exploration. In addition to the well-established inferior petrosal sinus sampling, preoperative cavernous sinus sampling (CSS) was introduced as a potentially improved way to predict adenoma lateralization. The authors present their results with CSS in a consecutive series of patients with Cushing's disease. METHODS During 1999–2014, transsphenoidal surgeries were consecutively performed in 510 patients with Cushing's disease. For most patients, suppression of cortisol in high-dose dexamethasone tests and stimulation of adrenocorticotropic hormone and cortisol after administration of corticotropin-releasing hormone were sufficient to prove the diagnosis of adrenocorticotropic hormone–dependent hypercortisolism. Of the 510 patients, 67 (13%) were referred to the department of neuroradiology for CSS according to the technique of Teramoto. The indications for CSS were unclear endocrine test results or negative MRI results. Data for all patients were retrospectively analyzed. RESULTS A central/peripheral gradient was found in 59 patients; lateralization to the left or right side was found in 51. For 8 patients with a central/peripheral gradient, no left/right gradient could be determined. For another 8 patients with equivocal test results, no central/peripheral gradient was found. No severe CSS-associated complications were encountered. Of the 51 patients who underwent transsphenoidal surgery, the predicted lateralization was proven correct for 42 (82%). CONCLUSIONS As MRI techniques have improved, the number of potential candidates for this invasive method has decreased in the past decade. However, because detecting minute adenomas remains problematic, CSS remains a useful diagnostic tool for patients with Cushing's disease.

scholarly journals Ruptured dermoid cyst of the lateral cavernous sinus wall with temporary symptoms: a case report

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Yasushi Kosuge ◽  
Hidetaka Onodera ◽  
Taigen Sase ◽  
Masashi Uchida ◽  
Hiroshi Takasuna ◽  
...  
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Cavernous Sinus ◽  
Sinus Wall

scholarly journals Prospective evaluation of the characteristics and incidence of adenoma-associated dural invasion in Cushing disease

2012 ◽  
Vol 116 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Russell R. Lonser ◽  
Alexander Ksendzovsky ◽  
Joshua J. Wind ◽  
Alexander O. Vortmeyer ◽  
Edward H. Oldfield
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
Significant Risk ◽  
Pituitary Tumors ◽  
Significant Risk Factor ◽  
Incomplete Resection ◽  
Cushing Disease ◽  
Cavernous Sinus Invasion ◽  
Sinus Wall ◽  
Acth Secreting

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.

Suprasellar Displacement of Intracavernous Internal Carotid Artery: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1433-1435 ◽  
Author(s):  
Oren N. Gottfried ◽  
Scott W. Soleau ◽  
William T. Couldwell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Vascular Anomaly ◽  
Vascular Abnormality ◽  
Bifurcation Aneurysm ◽  
Sinus Wall ◽  
Anatomic Variants ◽  
Cavernous Carotid Artery

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.

Adrenocorticotropin Production by a Mammary Carcinoma

1977 ◽  
Vol 35 ◽  
pp. 462-463
Author(s):  
K.S. McCarty ◽  
N.R. Wallace ◽  
W. Litaker ◽  
S. Wells ◽  
G. Eisenbarth
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Small Cell ◽  
Hormone Production ◽  
Carcinoma Of The Breast ◽  
Ectopic Acth ◽  
Ultrastructural Studies ◽  
Subcutaneous Metastases ◽  
Ectopic Acth Production ◽  
The Right ◽  
Pituitary Carcinomas

The production of adrenocorticotropic hormone by non-pituitary carcinomas has been documented in several tumors, most frequently small cell carcinoma of the lung, islet cell carcinomas of the pancreas, thymomas and carcinoids. Electron microscopy of these tumors reveals typical membrane-limited "neurosecretory" granules. Confirmation of the granules as adrenocorticotropin (ACTH) requires the use of OsO4 as a primary fixative to give the characteristic cored granule appearance in conjunction with immunohistochemical demonstration of the hormone peptide. Because of the rarity of ectopic ACTH production by mammary carcinomas and the absence of appropriate ultrastructural studies in the two examples of such ectopic hormone production in the literature of which we are aware (1,2), we present biochemical and ultrastructural data from a carcinoma of the breast with apparent ACTH production.The patient had her primary tumor in the right breast in 1969. The tumor recurred as visceral and subcutaneous metastases in 1976 and again in 1977.

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