scholarly journals An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series

2021 ◽  
Vol 2 (13) ◽  
Author(s):  
Abhijith V. Matur ◽  
Alaina M. Body ◽  
Mark D. Johnson ◽  
Matthew S. Smith ◽  
Ruchi Bhabhra ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Imaging Finding ◽  
Case Series ◽  
Optimal Sampling ◽  
Inferior Petrosal Sinus ◽  
Retrospective Case ◽  
Inferior Petrosal Sinus Sampling ◽  
Drainage Patterns ◽  
Sinus Drainage ◽  
Tumor Laterality

BACKGROUND Inferior petrosal sinus sampling (IPSS) is a useful technique in the diagnosis of Cushing’s disease (CD) when the imaging finding is negative or equivocal. Different authors have reported considerable variability in the ability to determine tumor laterality with IPSS. Here the authors present a retrospective case series of 7 patients who underwent IPSS using a systematic algorithm to improve lateralization accuracy by identifying optimal sampling sites on the basis of individual cavernous sinus drainage patterns in each patient. OBSERVATIONS Of the 7 patients identified, 6 were determined to have CD and subsequently underwent surgery. IPSS was accurate in all patients from whom laterality was predicted. Arterial and venous angiography were used to define cavernous sinus drainage patterns and determine optimal sampling sites. All patients who underwent surgery achieved hormonal cure. LESSONS All IPSS predictions of lateralization were correct when available, and all patients who underwent surgery achieved hormonal cure. Advances in angiographic techniques for identification of the site of primary drainage from the cavernous sinus and subsequent optimization of microcatheter placement may improve the ability to predict tumor laterality.

scholarly journals Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Heliyon ◽  
2020 ◽  
Vol 6 (10) ◽  
pp. e05299
Author(s):  
Mohammad Ghorbani ◽  
Hamideh Akbari ◽  
Christoph J. Griessenauer ◽  
Christoph Wipplinger ◽  
Alireza Dastmalchi ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Venous Drainage ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Drainage Patterns

To determine the efficacy of bilateral inferior petrosal sinus sampling in differentiating Cushing disease from ectopic Cushing syndrome

2020 ◽  
pp. 1-11
Author(s):  
Muhammad Azeemuddin ◽  
Tanveer Ul Haq ◽  
Shahmeer Khan ◽  
Raza Sayani ◽  
Ayesha Shoukat Hussain ◽  
...  
Keyword(s):  
Cushing Syndrome ◽  
Case Series ◽  
Invasive Procedure ◽  
University Hospital ◽  
Inferior Petrosal Sinus ◽  
Cushing Disease ◽  
Post Contrast ◽  
Inferior Petrosal Sinus Sampling ◽  
Positive Results

Abstract Management of endogenous Cushing syndrome is based on its aetiology. Increased Adrenocorticotropic Hormone (ACTH) levels are the most common cause of this disorder and, therefore, it is critical to determine the source of ACTH before further management. Dynamic post contrast MRI is currently the most common investigation implied to diagnose pituitary adenoma; however, it comes with the drawback of low specificity and high false positive results. Inferior petrosal sinus sampling (IPSS) is an established invasive procedure performed to differentiate central versus peripheral source of ACTH which, in turn, results in hypercortesolaemia. This is a series of 14 patients who underwent IPSS at the Department of Radiology, Aga Khan University Hospital, Karachi, from January 2006 to December 2018. The case series emphasises the role of IPSS in the management of ACTH-dependent Cushing syndrome and combined efficacy of Dynamic post-contrast MRI and the procedure under focus. Continuous....

Diagnosis and Outcome of Biopsies of Indeterminate Lesions of the Cavernous Sinus and Meckel's Cave: A Retrospective Case Series in 85 Patients

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 529-539 ◽  
Author(s):  
Joshua D Hughes ◽  
Joseph Kapurch ◽  
Jamie J Van Gompel ◽  
Fredric B Meyer ◽  
Bruce E Pollock ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Case Series ◽  
Retrospective Case ◽  
Meckel’S Cave ◽  
Retrospective Case Series ◽  
Meckel's Cave

Matricidal cavernous aneurysms: a multicenter case series

2019 ◽  
Vol 11 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Mallory R Dacus ◽  
Chris Nickele ◽  
Babu G Welch ◽  
Vin Shen Ban ◽  
Andrew J Ringer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Case Series ◽  
Treatment Modalities ◽  
Parent Artery ◽  
Retrospective Case ◽  
Parent Vessel ◽  
Elastic Compression ◽  
Presenting Symptoms ◽  
Atherosclerotic Stenosis

BackgroundCavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as ‘matricidal aneurysms.’Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and—in cases of matricidal aneurysms—ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive.MethodsWe present a multicenter retrospective case series of patients with matricidal CCAs.ResultsForty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases.ConclusionMatricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

scholarly journals HIV-associated cavernous sinus disease

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cait-lynn D. Wells ◽  
Anand A. Moodley
Keyword(s):  
Cavernous Sinus ◽  
Clinical Laboratory ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Retrospective Case ◽  
Primary Malignancy ◽  
Blurred Vision ◽  
Sinus Disease ◽  
The Mean ◽  
Histological Confirmation

Introduction: The underlying diagnosis of cavernous sinus disease is difficult to confirm in HIV-coinfected patients owing to the lack of histological confirmation. In this retrospective case series, we highlight the challenges in confirming the diagnosis and managing these patients.Results: The clinical, laboratory and radiological data of 23 HIV-infected patients with cavernous sinus disease were analysed. The mean age of patients was 38 years. The mean CD4+ count was 390 cells/μL. Clinically, patients presented with unilateral disease (65%), headache (48%), diplopia (30%) and blurred vision (30%). Third (65%) and sixth (57%) nerve palsies in isolation and combination (39%) were most common. Isolated fourth nerve palsy did not occur. Tuberculosis (17%) was the most commonly identified disorder followed by high-grade B-cell lymphoma (13%), meningioma (13%), metastatic carcinoma (13%) and neurosyphilis (7%). In 22% of the patients, there was no confirmatory evidence for a diagnosis. The patients were either treated empirically for tuberculosis or improved spontaneously when antiretroviral therapy was started. Cerebrospinal fluid was helpful in 4/13 (31%) of patients where it was not contraindicated. Only 3/23 (13%) of the patients had a biopsy of the cavernous sinus mass. The outcomes varied, and follow-up was lacking in the majority of patients.Conclusion: In HIV-infected patients, histological confirmation of cavernous sinus pathology is not readily available for various reasons. In resource-limited settings, one should first actively search for extracranial evidence of tuberculosis, lymphoma, syphilis and primary malignancy and manage appropriately. Only if such evidence is lacking should a referral for biopsy be considered.

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