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

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

scholarly journals Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

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.

scholarly journals Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience

2015 ◽  
Vol 53 (4) ◽  
pp. 308-316
Author(s):  
F. Ferreli ◽  
M. Turri-Zanoni ◽  
F.R. Canevari ◽  
P. Battaglia ◽  
M. Bignami ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
Extent Of Resection ◽  
Tumor Control ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Visual Outcomes ◽  
Contrast Enhanced ◽  
Wait And See

Background: The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy. Methods: We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria. Results: EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal approach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred. Discussion: EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preserving or restoring visual function, and obtaining adequate long-term tumor control.

scholarly journals Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation

1998 ◽  
Vol 56 (1) ◽  
pp. 107-110 ◽  
Author(s):  
ARTHUR CUKIERT ◽  
MARIO ANDRIOLI ◽  
JAYME GOLDMAN ◽  
MARCIA NERY ◽  
LUIS SALGADO ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Gold Standard ◽  
Pituitary Tumors ◽  
Medial Wall ◽  
Cavernous Sinus Invasion ◽  
Mri Features ◽  
Pituitary Macroadenomas

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.

Transcavernous surgery; an effective treatment for pituitary macroadenomas

1995 ◽  
Vol 133 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Akira Matsuno ◽  
Tomio Sasaki ◽  
Nobuhito Saito ◽  
Toshihiro Mochizuki ◽  
Takamitsu Fujimaki ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Elevated Serum ◽  
Serum Levels ◽  
Pituitary Hormones ◽  
Cavernous Sinus Invasion ◽  
Stimulation Tests ◽  
Sufficient Degree ◽  
Pituitary Macroadenomas

Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K. Transcavernous surgery; an effective treatment for pituitary macroadenomas. Eur J Endocrinol 1995:133:156–65. ISSN 0804–4643 The endocrinological outcome in four patients with pituitary macroadenomas laterally invading the cavernous sinus, who were treated surgically by the transcranial transcavernous approach, was compared with that in four patients with macroadenomas that had been removed transsphenoidally. The decrease in the elevated serum levels of anterior pituitary hormones after transcavernous surgery ranged from 58.4% to 90.1%, whereas after transsphenoidal surgery it ranged from 0% to 46.1%. The responsiveness of pituitary hormones to stimulation tests was restored and maintained after transcranial transcavernous surgery. Transsphenoidal surgery achieved neither sufficient tumor reduction nor produced a satisfactory endocrinological remission. When cavernous sinus invasion is suspected by magnetic resonance imaging, even if it cannot be confirmed with certainty, transcranial transcavernous surgery is recommended. It is a useful surgical procedure for obtaining a sufficient degree of tumor extirpation and satisfactory endocrinological improvement in patients with macro-adenomas laterally invading the cavernous sinus, particularly somatotroph or corticotroph macro-adenomas. Postoperatively, mild cranial nerve paresis may occur, but this may resolve in 1–4 months. Akira Matsuno, Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426-3 Anegasaki, Ichihara City, Chiba 299-01, Japan

Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes

2014 ◽  
Vol 121 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Hiroshi Nishioka ◽  
Noriaki Fukuhara ◽  
Kentaro Horiguchi ◽  
Shozo Yamada
Keyword(s):  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Independent Predictor ◽  
Remission Rate ◽  
Unfavorable Outcome ◽  
Medial Wall ◽  
Significant Independent Predictor ◽  
Cavernous Sinus Invasion ◽  
Histological Verification ◽  
Transsphenoidal Resection

Object Cavernous sinus (CS) invasion is the most important preoperative predictor of remission in the surgical treatment of growth hormone–producing pituitary adenomas. The purpose of this study was to evaluate the effectiveness of an aggressive technique for removal of tumors invading the CS in patients with acromegaly. Methods The authors retrospectively reviewed the cases of 150 consecutive patients with acromegaly who underwent primary transsphenoidal surgery in 2010 and 2011. The authors reviewed preoperative Knosp grade, intraoperative findings, histology of the medial wall of the CS, and surgical outcome according to the current consensus criteria for acromegaly. Results Cavernous sinus invasion was identified in 55 patients (36.7%): definite CS involvement by the tumor was observed under direct vision in 41 patients (74.5%), while invasion was histologically verified in 39 patients (70.9%). Invasion increased in frequency with the higher Knosp grade but was observed in 14.4% (13 of 90) of Grade 0 and 1 tumors. Overall, the remission rate fulfilling stringent criteria was 84.7% (127 of 150). Although CS invasion was significantly associated with an unfavorable outcome (p < 0.0001), remission was achieved in 69.1% (38 of 55) of patients with invasion. No major complications occurred in this series. Conclusions Cavernous sinus invasion is the most significant, independent predictor of unfavorable outcome. Confirmation of invasion requires direct observation within the CS regardless of the microscope or endoscope used. Particularly in cases in which only the medial wall is involved, histological verification is always necessary to detect the occult invasion. Direct removal of the invading tumor, by sharp excision of the medial wall of the CS, is effective and safe and increases the chance of remission.

scholarly journals Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

2018 ◽  
Vol 128 (2) ◽  
pp. 422-428 ◽  
Author(s):  
Davis G. Taylor ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Cohort Study ◽  
Cavernous Sinus ◽  
Residual Tumor ◽  
Maximum Diameter ◽  
Preoperative Imaging ◽  
Cavernous Sinus Invasion ◽  
Normal Gland ◽  
Group A ◽  
Group B ◽  
Pituitary Macroadenomas

OBJECTIVEExtracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor’s anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors’ experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. In mid-2010, the authors began using a new surgical technique to identify and use this interface for the resection of larger macroadenomas, a technique that can be used with the microscope or the endoscope.METHODSThe authors performed a cohort study using prospectively collected preoperative imaging reports and operative details and retrospectively reviewed postoperative images and clinical follow-up of patients with a pituitary macroadenoma 20–40 mm in maximum diameter undergoing microscopic transsphenoidal resection. Since dissection of the tumor capsule only pertains to encapsulated tumor within the sella and not to tumor invading the cavernous sinus, assessment of tumor removal of noninvasive tumors emphasized the entire tumor, while that of invasive tumors emphasized the intrasellar component only. The incidence of residual tumor on postoperative imaging, new-onset endocrinopathy, and recovery of preoperative pituitary deficits was compared between patients who underwent surgery before (Group A) and after (Group B) implementation of the new technique.RESULTSThere were 34 consecutive patients in Group A and 74 consecutive patients in Group B. Tumors in 18 (53%) Group A and 40 (54%) Group B patients had no evidence of cavernous sinus invasion on MRI. Use of the posterior pseudocapsule technique reduced the incidence of intrasellar residual tumor on postoperative MRI for tumors without cavernous sinus invasion (39% [Group A] vs 10%, p < 0.05) and in all tumors regardless of invasion (50% vs 18%, p < 0.005). The incidence of new endocrinopathy was less likely (25% vs 12%, p = 0.098) and the recovery of prior deficits more likely (13% vs 27%, p = 0.199) among patients treated using the pseudocapsule approach, although the differences are not statistically significant.CONCLUSIONSUse of the posterior pseudocapsule dissection plane can enhance the resection of pituitary macroadenomas.

scholarly journals Association of Morbidity with Extent of Resection and Cavernous Sinus Invasion in Sphenoid Wing Meningiomas

Skull Base ◽  
2011 ◽  
Vol 21 (S 02) ◽  
pp. e5-e5
Author(s):  
Michael Ivan ◽  
Jason Cheng ◽  
Gurvinder Kaur ◽  
Michael Sughrue ◽  
Aaron Clark ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Extent Of Resection ◽  
Cavernous Sinus Invasion

Preoperative depiction of cavernous sinus invasion by pituitary macroadenoma using three-dimensional anisotropy contrast periodically rotated overlapping parallel lines with enhanced reconstruction imaging on a 3-tesla system

2008 ◽  
Vol 108 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Yuichiro Yoneoka ◽  
Naoto Watanabe ◽  
Hitoshi Matsuzawa ◽  
Itaru Tsumanuma ◽  
Satoshi Ueki ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Healthy Volunteers ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
3 Tesla ◽  
Mr Images ◽  
Cavernous Sinus Invasion ◽  
Parallel Lines ◽  
Pituitary Macroadenomas

Object Three-dimensional anisotropy contrast (3DAC) magnetic resonance (MR) imaging provides clear depiction of neuronal fibers. The aim of this study was to identify intracavernous cranial nerves in patients with pituitary macro-adenoma and in healthy volunteers by using 3DAC MR imaging on a 3-tesla system and to preoperatively predict cavernous sinus invasion by pituitary macroadenoma. Methods Thirty-three patients (cavernous sinuses in 66 sides) with pituitary macroadenomas and 25 healthy volunteers (50 sides) participated in this study. Coronal 3DAC MR images constructed from diffusion weighted images, acquired with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) sequences, and T2-weighted reverse images were obtained at the same anatomical locations using a 3-tesla MR imaging system. Attempts were made to identify the cranial nerves. Results The oculomotor and ophthalmic/maxillary nerves were preoperatively identified in all sides (66 sides in patients and 50 sides in healthy volunteers) on 3DAC MR images. In the 33 patients, cavernous sinus invasion was revealed in 10 (12 [18.2%] of 66 sides) by intraoperative endoscopic observation. Coronal 3DAC MR images revealed that the oculomotor nerves were half surrounded with adenoma in all 12 of these sides, and the ophthalmic/maxillary nerves were half encapsulated with tumor (sensitivity/specificity: 100%/100% and 83%/100%, respectively). Conclusions Preoperative evaluation of pituitary macroadenomas using 3DAC PROPELLER MR imaging on a 3-tesla system is likely to be a powerful noninvasive method of detecting cavernous sinus invasion, which can potentially dominate the therapeutic strategy for these lesions.

Sign in / Sign up

Export Citation Format

Share Document