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.

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

scholarly journals Endoscopic endonasal transcavernous approach for invasive corticotroph pituitary adenoma

2020 ◽  
Vol 2 (2) ◽  
pp. V2
Author(s):  
Ming-Ying Lan ◽  
Wei-Hsin Wang
Keyword(s):  
Cavernous Sinus ◽  
Diagnostic Tests ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Anatomy ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
The Right

This is a 37-year-old woman who presented with weight gain, a moon-shaped face, and muscle weakness for 4 months. Cushing’s disease was confirmed after a series of diagnostic tests. MRI demonstrated a pituitary macroadenoma with right cavernous sinus invasion and encasement of the right ICA. An endoscopic endonasal approach was performed, and gross-total resection could be achieved without injury of the cranial nerves. The Cushing’s syndrome improved gradually after the surgery. Histopathology revealed a corticotroph adenoma. In this surgical video, we demonstrate the strategies of tumor resection according to a surgical anatomy-based classification of the cavernous sinus from an endonasal perspective.The video can be found here: https://youtu.be/aNXFRdGfjpI.

Resection of a Posterior Fossa Endodermal Cyst With Exoscopic Assistance: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E173-E174
Author(s):  
Olena Kleshchova ◽  
Timothy Gerald White ◽  
Kevin Kwan ◽  
Amrit Chiluwal ◽  
Todd A Anderson ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Posterior Fossa ◽  
Cranial Nerves ◽  
Video Production ◽  
Neurenteric Cyst ◽  
Mr Images ◽  
Recommended Treatment ◽  
Facial Numbness ◽  
Endodermal Cyst ◽  
Upper Thoracic

Abstract Neurenteric cysts are rare benign congenital tumors of endodermal origin that most commonly occur in the cervical and upper thoracic spine, with only about 10% to 18% of the reported cases occurring intracranially.1 A definitive preoperative diagnosis is complicated by the variable appearance of neurenteric cysts on magnetic resonance (MR) imaging.2 The recommended treatment of neurenteric cysts is complete surgical resection when possible.3,4 We present a case of a posterior fossa neurenteric cyst. A 33-yr-old man without medical history presented with left-sided headache and mild left-sided facial numbness and weakness. Admission MR imaging revealed a nonenhancing mass, which was hyperintense on T1-weighted MR images, compressing the brainstem anteriorly. The lesion was isointense on T2 FLAIR images and hypointense on diffusion-weighted imaging, initially read as possible epidermoid cyst. The patient underwent a left-sided retrosigmoid craniotomy via far lateral transcondylar approach. The tumor was adjacent to both vertebral arteries, the left PICA, and cranial nerves (CN) VII-XII with superior extension to CN V. The cyst was encased in a thin capsule, and its contents were yellowish in color and ranged from thick liquid to colloidal and caseous consistency. The cyst also contained heavily calcified portions, which were excised using sharp dissection. Images of the cyst wall show that it is focally lined with ciliated columnar epithelium with intracellular mucin confirming an endodermal or neurenteric cyst. After the operation, the patient's symptoms resolved, and he was discharged on postoperative day 4. Postoperative MR images confirmed gross total resection. The patient consented to video production.

Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas—magnetic resonance imaging coregistration method

2003 ◽  
Vol 99 (1) ◽  
pp. 89-99 ◽  
Author(s):  
Jérôme Yelnik ◽  
Philippe Damier ◽  
Sophie Demeret ◽  
David Gervais ◽  
Eric Bardinet ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Parkinson Disease ◽  
Three Dimensional ◽  
Zona Incerta ◽  
Mr Images ◽  
Content Type ◽  
Anatomical Localization ◽  
Stimulating Electrodes ◽  
Fine Print

Object. The aim of this study was to correlate the clinical improvement in patients with Parkinson disease (PD) treated using deep brain stimulation (DBS) of the subthalamic nucleus (STN) with the precise anatomical localization of stimulating electrodes. Methods. Localization was determined by superimposing figures from an anatomical atlas with postoperative magnetic resonance (MR) images obtained in each patient. This approach was validated by an analysis of experimental and clinical MR images of the electrode, and the development of a three-dimensional (3D) atlas—MR imaging coregistration method. The PD motor score was assessed through two contacts for each of two electrodes implanted in 10 patients: the “therapeutic contact” and the “distant contact” (that is, the next but one to the therapeutic contact). Seventeen therapeutic contacts were located within or on the border of the STN, most of which were associated with significant improvement of the four PD symptoms tested. Therapeutic contacts located in other structures (zona incerta, lenticular fasciculus, or midbrain reticular formation) were also linked to a significant positive effect. Stimulation applied through distant contacts located in the STN improved symptoms of PD, whereas that delivered through distant contacts in the remaining structures had variable effects ranging from worsening of symptoms to their improvement. Conclusions. The authors have demonstrated that 3D atlas—MR imaging coregistration is a reliable method for the precise localization of DBS electrodes on postoperative MR images. In addition, they have confirmed that although the STN is the main target during DBS treatment for PD, stimulation of surrounding regions, particularly the zona incerta or the lenticular fasciculus, can also improve symptoms of PD.

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.

MR imaging of cavernous sinus invasion by mucormycosis: a case study

2001 ◽  
Vol 103 (2) ◽  
pp. 101-104 ◽  
Author(s):  
Pitchaiah Mandava ◽  
Gregory Chaljub ◽  
Kristine Patterson ◽  
John W. Hollingsworth
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
Cavernous Sinus Invasion
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