High Incidence of Dural Tumor Infiltration in Endocrine Active Pituitary Tumors without MRI Evidence of Cavernous Sinus Invasion

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.

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Assessment of magnetic resonance imaging criteria for the diagnosis of cavernous sinus invasion by pituitary tumors

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.06.010 ◽

2021 ◽

Vol 90 ◽

pp. 262-267

Author(s):

Nicholas Chang ◽

Jessica W. Grayson ◽

João Mangussi-Gomes ◽

Sebastian Fung ◽

Raquel Alvarado ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cavernous Sinus ◽

Pituitary Tumors ◽

Resonance Imaging ◽

Cavernous Sinus Invasion

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

Journal of Neurosurgery ◽

10.3171/2011.8.jns11456 ◽

2012 ◽

Vol 116 (2) ◽

pp. 272-279 ◽

Cited By ~ 32

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.

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Cavernous Sinus Invasion and Tumor Proliferative Potential of Growth Hormone-Producing Pituitary Tumors

Endocrine Journal ◽

10.1507/endocrj.47.supplmarch_s77 ◽

2000 ◽

Vol 47 (SupplMarch) ◽

pp. S77-S79 ◽

Cited By ~ 7

Author(s):

TOSHIHIKO IUCHI ◽

NAOKATSU SAEKI ◽

YOSHIO UCHINO ◽

YOSHINORI HIGUCHI ◽

ICHIRO TATSUNO ◽

...

Keyword(s):

Growth Hormone ◽

Cavernous Sinus ◽

Pituitary Tumors ◽

Proliferative Potential ◽

Cavernous Sinus Invasion

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Petroclival meningiomas: surgical experience in 109 cases

Journal of Neurosurgery ◽

10.3171/jns.1996.84.1.0020 ◽

1996 ◽

Vol 84 (1) ◽

pp. 20-28 ◽

Cited By ~ 206

Author(s):

William T. Couldwell ◽

Takanori Fukushima ◽

Steven L. Giannotta ◽

Martin H. Weiss

Keyword(s):

Cavernous Sinus ◽

Surgical Approaches ◽

Surgical Removal ◽

Total Removal ◽

Content Type ◽

Cavernous Sinus Invasion ◽

Petroclival Meningiomas ◽

High Incidence ◽

Progression Of Disease

✓ The surgical removal of petroclival meningiomas has historically been associated with a high incidence of morbidity and mortality. The 109 consecutive patients included in the present retrospective study represent a combined series of tumors operated on by the four authors during a period from 1980 to 1992. The series is composed of 40 men and 69 women ranging in age from 25 to 75 years (mean 51 years). Surgical approaches to tumors in this series included simple retromastoid (60 cases), combined supra- and infratentorial petrosal (22), transtemporal (primary transsigmoid retrolabyrinthine, translabyrinthine, or transcochlear (12)), subtemporal (11), and frontotemporal transcavernous (eight). Gross-total removal was achieved in 75 patients (69%). Recurrence or progression of disease occurred in 14 patients (13%) over a 6.1-year mean follow-up period, and it was found within the cavernous sinus in 12 of these cases. Four recurrent cases demonstrated histological compatibility with malignant meningioma. Perioperative death occurred in four patients, and there were 56 significant complications in 35 other patients. Review of this series, with the attendant complications, has facilitated the authors' decision-making when considering the risk of gross-total removal in selected patients with asymptomatic cavernous sinus invasion or tumor adherent to the brainstem.

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Endoscopic Endonasal Surgical Results of Pituitary Tumors with Cavernous Sinus Invasion.

10.1210/endo-meetings.2010.part1.p6.p1-283 ◽

2010 ◽

pp. P1-283-P1-283

Author(s):

Marvin Bergsneider ◽

Marilene Wang ◽

Anthony Heaney

Keyword(s):

Cavernous Sinus ◽

Pituitary Tumors ◽

Surgical Results ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion

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Predictive Value of Cavernous Sinus Invasion on Extent of Resection Following Endoscopic Transsphenoidal Resection of Pituitary Macroadenomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336162 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Christopher Farrell ◽

Sonia Teufack ◽

Mary Petrone ◽

Rahul Sharma ◽

Tyler Kenning ◽

...

Keyword(s):

Cavernous Sinus ◽

Predictive Value ◽

Extent Of Resection ◽

Cavernous Sinus Invasion ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience

Cancers ◽

10.3390/cancers13030537 ◽

2021 ◽

Vol 13 (3) ◽

pp. 537

Author(s):

Felix Ehret ◽

Markus Kufeld ◽

Christoph Fürweger ◽

Alfred Haidenberger ◽

Paul Windisch ◽

...

Keyword(s):

Disease Control ◽

Effective Treatment ◽

Cavernous Sinus ◽

Treatment Options ◽

Cavernous Sinus Invasion ◽

Robotic Radiosurgery ◽

Patient Morbidity ◽

Biochemical Remission ◽

Patients Experience

Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.

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Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00336-x ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

K. El-Bahy ◽

Ashraf M. Ibrahim ◽

Ibrahim Abdelmohsen ◽

Hatem A. Sabry

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Visual Outcome ◽

Extent Of Resection ◽

Optic Canal ◽

Falciform Ligament ◽

Cavernous Sinus Invasion ◽

Anterior Clinoidectomy ◽

Microsurgical Techniques

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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