Cavernous sinus sampling in patients with adrenocorticotrophic hormone—dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients

1998 ◽  
Vol 89 (5) ◽  
pp. 762-768 ◽  
Author(s):  
Akira Teramoto ◽  
Yoichi Yoshida ◽  
Naoko Sanno ◽  
Shigeru Nemoto
Keyword(s):  
Standard Deviation ◽  
Cavernous Sinus ◽  
Cushing’S Syndrome ◽  
False Negative ◽  
Cushing's Syndrome ◽  
Adrenocorticotrophic Hormone ◽  
Posterior Portion ◽  
Content Type ◽  
Catheterization Technique ◽  
Fine Print

Object. As an alternative method to inferior petrosal sinus sampling with administration of corticotropin-releasing hormone (CRH), the authors have developed a method of selective venous sampling directly from the cavernous sinus, which is performed using a superselective catheterization technique. The goal of this study is to assess this method. Methods. Catheterization to the cavernous sinus was performed in 44 patients with clinical and biochemical features of Cushing's syndrome. Forty of these patients in whom there was a definite clinical and/or histological diagnosis were evaluated. In 35 patients, a pituitary microadenoma was detected on magnetic resonance imaging and/or during surgery. Ectopic lesions were suspected in five patients, who later developed nonpituitary tumors. The central/peripheral (C/P) ratios of adrenocorticotrophic hormone (ACTH) without CRH administration ranged from 5.2 to 448.1 (mean ± standard deviation, 66.7 ± 91.2) in cavernous sinuses and from 1.1 to 52 (mean ± standard deviation, 8.5 ± 9.9) in the inferior petrosal sinuses. The petrosal sinus sampling contained false negative results in eight patients (23%) based on a cutoff point of 2. On the contrary, patients with ectopic lesions did not show any increase in ACTH levels in either sampling portion. The intercavernous gradients of ACTH, ranging from 1.2 to 506.4, indicated the correct lateralization of microadenoma in the lateral wing in all 30 patients. The interpetrosal gradients, ranging from 1 to 31.4, did not give a sufficient value (≥ 1.4) in four patients (13%) with a lateral lesion. In five cases of midline tumors, the intercavernous and interpetrosal gradients indicated false laterality in three and four cases, respectively. The intracavernous (posterior—anterior) gradients, ranging from 1.04 to 60.7 (mean 14.9), showed a higher concentration of ACTH in the posterior portion of the sinus in all patients. Conclusions. These results suggest that 1) cavernous sinus sampling without CRH administration can demonstrate hypersecretion of ACTH from the pitutary gland with a high diagnostic accuracy; 2) intercavernous gradients will indicate the correct lateralization in laterally localized microadenomas; and 3) sampling should be performed from the posterior portion of the cavernous sinus.

Neurosurgical implications of Carney complex

2000 ◽  
Vol 92 (3) ◽  
pp. 413-418 ◽  
Author(s):  
Joe C. Watson ◽  
Constantine A. Stratakis ◽  
Peter K. Bryant-Greenwood ◽  
Christian A. Koch ◽  
Lawrence S. Kirschner ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Pituitary Adenomas ◽  
Carney Complex ◽  
Cushing's Syndrome ◽  
Spinal Tumors ◽  
Common Component ◽  
Content Type ◽  
Cardiac Myxomas ◽  
Insight Into ◽  
Fine Print

Object. The authors present their neurosurgical experience with Carney complex. Carney complex, characterized by spotty skin pigmentation, cardiac myxomas, primary pigmented nodular adrenocortical disease, pituitary tumors, and nerve sheath tumors (NSTs), is a recently described, rare, autosomal-dominant familial syndrome that is relatively unknown to neurosurgeons. Neurosurgery is required to treat pituitary adenomas and a rare NST, the psammomatous melanotic schwannoma (PMS), in patients with Carney complex. Cushing's syndrome, a common component of the complex, is caused by primary pigmented nodular adrenocortical disease and is not secondary to an adrenocorticotropic hormone-secreting pituitary adenoma.Methods. The authors reviewed 14 cases of Carney complex, five from the literature and nine from their own experience. Of the 14 pituitary adenomas recognized in association with Carney complex, 12 developed growth hormone (GH) hypersecretion (producing gigantism in two patients and acromegaly in 10), and results of immunohistochemical studies in one of the other two were positive for GH. The association of PMSs with Carney complex was established in 1990. Of the reported tumors, 28% were associated with spinal nerve sheaths. The spinal tumors occurred in adults (mean age 32 years, range 18–49 years) who presented with pain and radiculopathy. These NSTs may be malignant (10%) and, as with the cardiac myxomas, are associated with significant rates of morbidity and mortality.Conclusions. Because of the surgical comorbidity associated with cardiac myxoma and/or Cushing's syndrome, recognition of Carney complex has important implications for perisurgical patient management and family screening. Study of the genetics of Carney complex and of the biological abnormalities associated with the tumors may provide insight into the general pathobiological abnormalities associated with the tumors may provide insight into the general pathobiological features of pituitary adenomas and NSTs.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

External carotid-cavernous sinus fistula diagnosed by common carotid arteriography

1974 ◽  
Vol 41 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Louis Wener ◽  
Giovanni Di Chiro ◽  
Robert A. Mendelsohn
Keyword(s):  
Cavernous Sinus ◽  
Carotid Arteries ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Cavernous Sinus Fistula ◽  
The Difference ◽  
Fine Print

✓ An external carotid-cavernous fistula diagnosed by serial common carotid arteriography is reported. The diagnosis was reached on the basis of the difference in time between filling of the distal internal and external carotid arteries and the visualization of the fistula.

Dose—response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery

1998 ◽  
Vol 88 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Klaus A. Leber ◽  
Jutta Berglöff ◽  
Gerhard Pendl
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Dose Response ◽  
Cranial Nerves ◽  
Visual Pathways ◽  
Content Type ◽  
Number Of Patients ◽  
Response Tolerance ◽  
Fine Print

As the number of patients treated with stereotactic radiosurgery increases, it becomes particularly important to define with precision adverse effects on distinct structures of the nervous system. Object. This study was designed to assess the dose—response tolerance of the visual pathways and cranial nerves after exposure of the cavernous sinus to radiation. Methods. A total of 66 sites in the visual system and 210 cranial nerves of the middle cranial fossa were investigated in 50 patients who had undergone gamma knife treatment for benign skull base tumors. The mean follow-up period was 40 months (range 24–60 months). Follow-up examinations consisted of neurological, neuroradiological, and neuroophthalmological evaluations. The actuarial incidence of optic neuropathy was zero for patients who received a radiation dose of less than 10 Gy, 26.7% for patients receiving a dose in the range of 10 to less than 15 Gy, and 77.8% for those who received doses of 15 Gy or more (p < 0.0001). Previously impaired vision improved in 25.8% and was unchanged in 51.5% of patients. No sign of neuropathy was seen in patients whose cranial nerves of the cavernous sinus received radiation doses of between 5 and 30 Gy. Because tumor control appeared to have been achieved in 98% of the patients, the deterioration in visual function cannot be attributed to tumor progression. Conclusions. The structures of the visual pathways (the optic nerve, chiasm, and tract) exhibit a much higher sensitivity to single-fraction radiation than other cranial nerves, and their particular dose—response characteristics can be defined. In contrast, the oculomotor and trigeminal nerves have a much higher dose tolerance.

Intraluminal occlusion of a carotid-cavernous sinus fistula with a balloon catheter

1971 ◽  
Vol 35 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Donald J. Prolo ◽  
John W. Hanbery
Keyword(s):  
Clinical Trial ◽  
Carotid Artery ◽  
Cavernous Sinus ◽  
Contrast Material ◽  
Balloon Catheter ◽  
Content Type ◽  
Carotid Cavernous Sinus Fistula ◽  
Cavernous Carotid Artery ◽  
Fine Print

✓ A technique for intraluminal occlusion of a carotid-cavernous sinus fistula with a balloon catheter is described. Passage of a balloon catheter into the cavernous carotid artery from the cervical carotid usually is easily accomplished. Inflation of the balloon with contrast material allows it to be visualized as the fistula is occluded. The simplicity and effectiveness of this method offer advantages over preexisting ones. Appraisal of its usefulness awaits further clinical trial.

A method of estimating intracranial decompensation in man

1976 ◽  
Vol 45 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Jerzy Szewczykowski ◽  
Pawel Dytko ◽  
Adam Kunicki ◽  
Jolanta Korsak-Sliwka ◽  
Stanislaw Sliwka ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Intracranial Pressure ◽  
Characteristic Feature ◽  
Computer System ◽  
Monitoring System ◽  
New Method ◽  
Icp Monitoring ◽  
Content Type ◽  
On Line ◽  
Fine Print

✓ A new method of estimating intracranial decompensation in man is described. An on-line computer system is connected to an intracranial pressure (ICP) monitoring system to compute regression plots of mean ICP vs standard deviation; standard deviation is used as a measure of ICP instability. Two zones with distinctly different slopes are a characteristic feature of these plots. It is thought that the changes of slope signify intracranial decompensation.

Routine intraoperative angiography during aneurysm surgery

2002 ◽  
Vol 96 (6) ◽  
pp. 988-992 ◽  
Author(s):  
Veronica L. Chiang ◽  
Phillipe Gailloud ◽  
Kieran J. Murphy ◽  
Daniele Rigamonti ◽  
Rafael J. Tamargo
Keyword(s):  
Surgical Treatment ◽  
False Negative ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Negative Results ◽  
Parent Vessel Occlusion ◽  
Fine Print

Object. The routine use of intraoperative angiography as an aid in the surgical treatment of aneurysms is uncommon. The advantages of the ability to visualize residual aneurysm or unintended occlusion of parent vessels intraoperatively must be weighed against the complications associated with repeated angiography and prolonged vascular access. The authors reviewed the results of their routine use of intraoperative angiography to determine its safety and efficacy. Methods. Prospectively gathered data from all aneurysm cases treated surgically between January 1996 and June 2000 were reviewed. A total of 303 operations were performed in 284 patients with aneurysms; 24 patients also underwent postoperative angiography. Findings on intraoperative angiographic studies prompted reexploration and clip readjustment in 37 (11%) of the 337 aneurysms clipped. Angiography revealed parent vessel occlusion in 10 cases (3%), residual aneurysm in 22 cases (6.5%), and both residual lesion and parent vessel occlusion in five cases (1.5%). When compared with subsequent postoperative imaging, false-negative results were found on two intraoperative angiograms (8.3%) and a false-positive result was found on one (4.2%). Postoperative angiograms obtained in both false-negative cases revealed residual anterior communicating artery aneurysms. Both of these aneurysms also subsequently rebled, requiring reoperation. In the group that underwent intraoperative angiography, in 303 operations eight patients (2.6%) suffered complications, of which only one was neurological. Conclusions. In the surgical treatment of intracranial aneurysms, the use of routine intraoperative angiography is safe and helpful in a significant number of cases, although it does not replace careful intraoperative inspection of the surgical field.

Trigeminal artery to cavernous sinus fistula treated by balloon occlusion

1983 ◽  
Vol 58 (4) ◽  
pp. 611-613 ◽  
Author(s):  
Charles W. Kerber ◽  
William Manke
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Femoral Artery ◽  
Balloon Occlusion ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Content Type ◽  
Flow Through ◽  
Sinus Flow ◽  
Fine Print

✓ A spontaneous cavernous sinus fistula developed following presumed sinusitis, and was found to originate not from the carotid artery but from a persistent trigeminal artery. The fistula was treated by introducing a detachable latex balloon via a femoral artery approach through the trigeminal artery and then into the cavernous sinus. Flow through the carotid, vertebral, and trigeminal arteries was preserved.

Normal position of the aqueduct of Sylvius

1975 ◽  
Vol 42 (5) ◽  
pp. 503-507 ◽  
Author(s):  
Karl Guldberg Krogness
Keyword(s):  
Standard Deviation ◽  
Cerebral Aqueduct ◽  
Posterior Surface ◽  
Normal Position ◽  
Normal Value ◽  
Content Type ◽  
Abnormal Position ◽  
Tuberculum Sellae ◽  
Fine Print

✓ Two new proportional methods for determination of the normal or abnormal position of the cerebral aqueduct are described. The position of the iter is expressed by the quotients and , when d-aq represents the distance between the upper posterior surface of the dorsum sellae and the dorsal center of the air-filled aqueduct. Ts = aq is the distance from the tuberculum sellae to the same point, and Tw is Twining's line. The normal value of the dorsum to aqueduct ratio was 0.32 ± 0.02 standard deviation (SD) and of the tuberculum to aqueduct ratio 0.44 ± 0.03 SD. Both proportional methods are independent of skull dimensions. These are compared to another proportional method described in Part 1 of this report.

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