Cavernous Sinus Invasion by Pituitary Adenomas

Daita, G; Yonemasu, Yukichi; Nakai, Hirofumi; Takei, Hidetoshi; Ogawa, Katsuhiro

doi:10.2176/nmc.35.17

Cited by 16 publications

(5 citation statements)

References 8 publications

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“…5,12,19–21 Data from these studies demonstrated that extrapituitary tumor invasion of surrounding sella dura could be frequent (24%–94%) and that increasing tumor size as well as age is directly associated with the incidence of invasion. 5,12,19,21 Further, the data showed that dural invasion was associated with incomplete tumor removal and recurrence. 12 While these studies provided important information about the incidence of adenoma-associated dural invasion, they were limited by several methodological factors that have made it difficult to draw direct conclusions related to the precise origin and incidence of this pathological feature in CD.…”

Section: Discussionmentioning

confidence: 99%

“…5,12,19–21 First, all previous reports of pituitary adenoma–associated dural invasion were based on retrospective case series, and most examined nonconsecutive specimens. 5,12,19–21 This resulted in a selection bias in which only patients with sites of apparent invasion during surgery 12,21 and/or primarily macroadenomas (most ACTH-positive adenomas are microadenomas) were included in the analysis. 5,12,20,21 Second, in previous studies of anterior dura samples, 12 the sample was coagulated.…”

Section: Discussionmentioning

confidence: 99%

“…5,12,19–21 This resulted in a selection bias in which only patients with sites of apparent invasion during surgery 12,21 and/or primarily macroadenomas (most ACTH-positive adenomas are microadenomas) were included in the analysis. 5,12,20,21 Second, in previous studies of anterior dura samples, 12 the sample was coagulated. This can cause tissue distortion and alter dural histology, leading to a misdiagnosis of invasion as a result of adherence of the underlying surface of the pituitary to the inner layer of dura.…”

Section: Discussionmentioning

confidence: 99%

“…Third, although immunohistochemical analysis of the tumor was commonly performed, it was not done for the dural specimen. 5,12,19,21 Fourth, no correlation between adenoma location and dural invasion location was established, including situations in which the anterior dura was sampled. 12,19,21 …”

Section: Discussionmentioning

confidence: 99%

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Prospective evaluation of the characteristics and incidence of adenoma-associated dural invasion in Cushing disease

Lonser

Ksendzovsky

Wind

et al. 2012

JNS

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Object Dural invasion by adrenocorticotropic hormone (ACTH)-secreting adenomas is a significant risk factor for incomplete resection and recurrence in Cushing disease (CD). Since ACTH-producing adenomas are often the smallest of the various types of pituitary tumors at the time of resection, examining their invasion provides the best opportunity to identify the precise sites of early dural invasion by pituitary adenomas. To characterize the incidence and anatomical distribution of dural invasion by ACTH-secreting adenomas, the authors prospectively and systematically analyzed features of dural invasion in patients with CD. Methods The authors prospectively studied consecutive patients with CD undergoing the systematic removal of ACTH-secreting adenoma and histological analysis of the anterior sella dura as well as other sites of dural invasion that were evident at surgery. Clinical, imaging, histological, and operative findings were analyzed. Results Eighty-seven patients with CD (58 females and 29 males) were included in the study. Overall, dural invasion by an ACTH-positive adenoma was histologically confirmed in 30 patients (34%). Eighteen patients (60% of dural invasion cases, 21% of all patients) had evidence of cavernous sinus wall invasion (4 of these patients also had other contiguous sites of invasion), and 12 patients (40% of dural invasion cases) had invasion of the sella dura excluding the cavernous sinus wall. Eleven patients (13% all patients) had invasion of the routinely procured anterior sella dura specimen. Preoperative MR imaging revealed an adenoma in 64 patients (74%) but accurately predicted dural invasion in only 4 patients (22%) with cavernous sinus invasion and none of the patients with non–cavernous sinus invasion. Adenomas associated with dural invasion (mean ± SD, 10.9 ± 7.8 mm, range 2–37 mm) were significantly larger than those not associated with dural invasion (5.7 ± 2.1 mm, range 2.5–12 mm; p = 0.0006, Mann-Whitney test). Conclusions Dural invasion by ACTH-producing adenomas preferentially occurs laterally into the wall of the cavernous sinus. Preoperative MR imaging infrequently detects dural invasion, including cavernous sinus invasion. Invasion is directly associated with tumor size. To provide a biochemical cure and avoid recurrence after resection, identification and removal of invaded sella dura, including the medial cavernous sinus wall, are necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective evaluation of the characteristics and incidence of adenoma-associated dural invasion in Cushing disease

Lonser

Ksendzovsky

Wind

et al. 2012

JNS

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“…This finding is clinically and biologically relevant, and is most probably the consequence of better surgical visualization provided by an endoscope: the improved possibility of visually checking the medial wall of the cavernous sinus intraoperatively, behind the cavernous ICA loop, has shown that the medial wall can be frequently displaced and not invaded in grade 3A PAs; in other cases, it can be spontaneuosly dehiscent and provide a natural corridor for extension of PAs in the cavernous sinus [62]. Other radiological classifications, which include features of the previous ones, have been suggested to attempt an in detail analysis of PA extensions [110], or provide a radiological pathology-specific grading [83,[111][112][113][114].…”

Section: Radiological Criteria and Classificationsmentioning

confidence: 99%

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Serioli

Doglietto

Fiorindi

et al. 2019

Cancers

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Invasiveness in pituitary adenomas has been defined and investigated from multiple perspectives, with varying results when its predictive value is considered. A systematic literature review, following PRISMA guidelines, was performed, searching PubMed and Scopus databases with terms that included molecular markers, histological, radiological, anatomical and surgical data on invasiveness of pituitary adenomas. The results showed that differing views are still present for anatomical aspects of the sellar region that are relevant to the concept of invasiveness; radiological and histological diagnoses are still limited, but might improve in the future, especially if they are related to surgical findings, which have become more accurate thanks to the introduction of the endoscope. The aim is to achieve a correct distinction between truly invasive pituitary adenomas from those that, in contrast, present with extension in the parasellar area through natural pathways. At present, diagnosis of invasiveness should be based on a comprehensive analysis of radiological, intra-operative and histological findings.

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