Cluster Headache Secondary to Macroprolactinoma with Ipsilateral Cavernous Sinus Invasion

We present a 25 year-old man with episodic cluster headache that was refractory to all standard pharmacological prophylactic and abortive treatments. Because of the lack of response, an MRI brain was performed which showed a large pituitary tumour with ipsilateral cavernous sinus invasion. The serum prolactin was significantly elevated at 54,700 miU/L (50–400) confirming a macro-prolactinoma. Within a few days of cabergoline therapy the headache resolved. He continues to be headache free several years after starting the dopamine agonist. This case highlights the importance of imaging the pituitary fossa in patients with refractory cluster headache, It also raises the potential anatomical importance of the cavernous sinus in pituitary-associated headache.

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Forbes albright syndrome: galactorrhea–amenorrhea associated with a pituitary tumour: a case report

Journal of Diabetes Metabolic Disorders & Control ◽

10.15406/jdmdc.2021.8.00217 ◽

2021 ◽

Vol 8 (1) ◽

pp. 27-29

Author(s):

Rupak Chatterjee ◽

Prantiki Halder ◽

Sudeshna Mallik ◽

Bibhuti Saha

Keyword(s):

Case Report ◽

Prolactin Level ◽

Pituitary Tumour ◽

Serum Prolactin ◽

Loss Of Consciousness ◽

Pituitary Macroadenoma ◽

Serum Prolactin Level ◽

Mri Brain ◽

Menstrual Irregularities ◽

Albright Syndrome

Forbes Albright syndrome is a hyperprolactinemia syndrome characterised by galactorrhea and amenorrhea associated with a pituitary tumour. Here we report a case of 30 years female who was admitted with menstrual irregularities for 4 months, galatorrhea and headache with recurrent episodes of loss of consciousness for 3months. Her serum prolactin level was highly raised. MRI brain (plain plus contrast) showed enlarged pituitary gland- pituitary macroadenoma. She was diagnosed as a case of Forbes Albright Syndrome and was treated with Tablet Cabergoline. With the medication, size of her tumour markedly reduced and symptoms resolved as she was followed up after 3 months.

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Safety and efficacy of mini doppler in recurrent pituitary tumours

Romanian Neurosurgery ◽

10.33962/roneuro-2020-051 ◽

2020 ◽

pp. 336-342

Author(s):

Moshiur Rahman ◽

Ezequiel Garcia-Ballestas ◽

Luis Rafael Moscote-Salazar

Keyword(s):

Cavernous Sinus ◽

Surgical Excision ◽

Pituitary Surgery ◽

Pituitary Tumour ◽

Csf Leak ◽

Surgical Removal ◽

Pituitary Tumours ◽

Female Ratio ◽

Cavernous Sinus Invasion ◽

Number Of Patients

Background: Pituitary surgery is the most common surgery used to remove pituitary tumours. The use of mini doppler in surgical removal of an endonasal pituitary tumour has shown good short-term clinical outcomes and few complications in patients. Cavernous sinus invasion limits the surgical excision and still a challenge of gross total resection. Objective: The main objective of this study is to evaluate the outcome of surgical removal of an endonasal pituitary tumour using mini doppler. Method: A total of 12 patients were studied retrospectively from 2012 to 2018 in a single institution (Private hospital) in Dhaka, Bangladesh. The male and female ratio was 7:5. Results: 92% of cases of the total number of patients had satisfactory removal/ neurological improvement/hormonal improvement. Among 12 cases, 8 cases had transient diabetes insipidus and one patient had CSF leak. Conclusion: The intraoperative Doppler is a useful tool to localize the carotids, which provides safer resection of endonasal pituitary tumours. Thus, it is very safe and effective for laterosellar resection of recurrent pituitary tumours and for cavernous sinus invasions.

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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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SPHENOPALATINE GALGLION BLOCK FOR THE TREATMENT OF EPISODIC CLUSTER HEADACHE IN PREGNANCY: A CASE REPORT

10.26226/morressier.5ab3c880a874c60026559690 ◽

2018 ◽

Author(s):

Costanza Barcellona

Keyword(s):

Case Report ◽

Cluster Headache ◽

Episodic Cluster Headache ◽

In Pregnancy

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Efficacy of galcanezumab in patients with episodic cluster headaches and a history of preventive treatment failure

Cephalalgia Reports ◽

10.1177/25158163211015654 ◽

2021 ◽

Vol 4 ◽

pp. 251581632110156

Author(s):

Brian Plato ◽

J Scott Andrews ◽

Mallikarjuna Rettiganti ◽

Antje Tockhorn-Heidenreich ◽

Jennifer Bardos ◽

...

Keyword(s):

Cluster Headache ◽

Treatment Failure ◽

Preventive Treatment ◽

Mean Difference ◽

Least Square ◽

Double Blind Study ◽

Double Blind ◽

Cluster Headache Attack ◽

Episodic Cluster Headache ◽

History Of

Objective: The efficacy of galcanezumab was evaluated in patients with episodic cluster headache and history of preventive treatment failure. Methods: In the randomized, 8-week, double-blind study (CGAL), patients with episodic cluster headache received once-monthly subcutaneous injections of galcanezumab 300 mg or placebo. Patients who completed CGAL and enrolled in an open-label study were queried for preventive treatment history. In a subset of patients with a known history of failure of verapamil or any other prior preventive treatment, a post hoc analysis of least square mean change from baseline in weekly cluster headache attack frequency across Weeks 1 to 3 was assessed. Results: Fifteen patients provided data for known history of prior preventive treatment failure (6 placebo, 9 galcanezumab), of whom 11 failed verapamil. The mean reduction in the weekly frequency of cluster headache attacks was greater with galcanezumab compared to placebo among patients with prior preventive treatment failure (8.2 versus 2.4); mean difference 5.8 (95% confidence interval [CI] 2.0, 13.6) and among patients with verapamil failure (10.1 versus 1.6); mean difference 8.5 (95% CI 0.4, 16.7). Conclusion: In this exploratory analysis of patients with a known history of prior preventive treatment failures, treatment with galcanezumab resulted in greater mean reductions in weekly cluster headache attacks compared with placebo. ClinicalTrials.gov: NCT02397473 (I5Q-MC-CGAL) NCT02797951 (I5Q-MC-CGAR)

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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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Oxygen Therapy Influences Episodic Cluster Headache and Related Cutaneous Brush and Cold Allodynia

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2008.01187.x ◽

2009 ◽

Vol 49 (1) ◽

pp. 134-136 ◽

Cited By ~ 6

Author(s):

Gerald Huber ◽

Christian Lampl

Keyword(s):

Cluster Headache ◽

Oxygen Therapy ◽

Cold Allodynia ◽

Episodic Cluster Headache

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The Medial Wall of the Cavernous Sinus: Microsurgical Anatomy

Neurosurgery ◽

10.1227/01.neu.0000126953.59406.77 ◽

2004 ◽

Vol 55 (1) ◽

pp. 179-190 ◽

Cited By ~ 75

Author(s):

Alexandre Yasuda ◽

Alvaro Campero ◽

Carolina Martins ◽

Albert L. Rhoton ◽

Guilherme C. Ribas

Keyword(s):

Pituitary Gland ◽

Cavernous Sinus ◽

Thin Sheet ◽

Single Layer ◽

Lateral Wall ◽

The Body ◽

Medial Wall ◽

Microsurgical Anatomy ◽

Pituitary Fossa ◽

Adjacent Structures

Abstract OBJECTIVE: This study was conducted to clarify the boundaries, relationships, and components of the medial wall of the cavernous sinus (CS). METHODS: Forty CSs, examined under ×3 to ×40 magnification, were dissected from lateral to medial in a stepwise fashion to expose the medial wall. Four CSs were dissected starting from the midline to lateral. RESULTS: The medial wall of the CS has two parts: sellar and sphenoidal. The sellar part is a thin sheet that separates the pituitary fossa from the venous spaces in the CS. This part, although thin, provided a barrier without perforations or defects in all cadaveric specimens studied. The sphenoidal part is formed by the dura lining the carotid sulcus on the body of the sphenoid bone. In all of the cadaveric specimens, the medial wall seemed to be formed by a single layer of dura that could not be separated easily into two layers as could the lateral wall. The intracavernous carotid was determined to be in direct contact with the pituitary gland, being separated from it by only the thin sellar part of the medial wall in 52.5% of cases. In 39 of 40 CSs, the venous plexus and spaces in the CS extended into the narrow space between the intracavernous carotid and the dura lining the carotid sulcus, which forms the sphenoidal part of the medial wall. The lateral surface of the pituitary gland was divided axially into superior, middle and inferior thirds. The intracavernous carotid coursed lateral to some part of all the superior, middle, and inferior thirds in 27.5% of the CSs, along the inferior and middle thirds in 32.5%, along only the inferior third in 35%, and below the level of the gland and sellar floor in 5%. In 18 of the 40 CSs, the pituitary gland displaced the sellar part of the medial wall laterally and rested against the intracavernous carotid, and in 6 there was a tongue-like lateral protrusion of the gland that extended around a portion of the wall of the intracavernous carotid. No defects were observed in the sellar part of the medial wall, even in the presence of these protrusions. CONCLUSION: The CS has an identifiable medial wall that separates the CS from the sella and capsule of the pituitary gland. The medial wall has two segments, sellar and sphenoidal, and is formed by just one layer of dura that cannot be separated into two layers as can the lateral wall of the CS. In this study, the relationships between the medial wall and adjacent structures demonstrated a marked variability.

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