Oculomotor Anomalies in Sellar and Parasellar Pathology

Neetens, A; Selosse, P

doi:10.1159/000308639

Cited by 23 publications

(5 citation statements)

References 16 publications

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“…28 The mechanism includes direct compression, indirect edematous expansion onto the cavernous sinus wall, direct infiltration of the tumor, and vascular compromise of the nerve.…”

Section: Discussion Cavernous Sinus Invasion and Oculomotor Trackingmentioning

confidence: 99%

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Hoang¹,

Tran²,

Herde

et al. 2016

JNS

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T reaTmenT management strategies for pituitary macroadenomas depend on numerous factors that guide the determination of medical management, surgical approach, and/or adjuvant therapeutic options. Maximal resection and adequate decompression of the neurological structures is the paradigm of care for symptomatic pituitary macroadenomas, with the exception of medically responsive prolactinomas.Since its inception by Schloffer in 1907 and then refinement and popularization by Hirsch, Guiot, and Hardy, the transsphenoidal approach has become the preferred route to the sella because of its relative safety profile. 9,14,16,17 The transcranial route still plays an important role in providing access to the sella in 1% to 4% of pituitary macroadenomas where direct visualization and accessibility via the transsphenoidal approach are limited. 38A transcranial approach should be considered in the surgical management of pituitary adenomas that display constriction at the diaphragma sellae, parasellar extension or inaccessible suprasellar extension off the midline, tumors of fibrous consistency with large suprasellar extension, and in patients with an active sinus infection or a coexisting adjacent aneurysm. Other cases that should be approached transcranially include those patients with ectatic intrasellar carotid arteries, 40 retrosellar extension, brain invasion with edema, involvement or vasospasm of the arteries of the circle of Willis, or encasement of the optic apparatus or invasion of the optic foramina. obJective Oculomotor cistern extension of pituitary adenomas is an overlooked feature within the literature. In this study, 7 cases of pituitary macroadenoma with oculomotor cistern extension and tracking are highlighted, and the implications of surgical and medical management are discussed. methods The records of patients diagnosed with pituitary macroadenomas who underwent resection and in whom preoperative pituitary protocol MRI scans were available for review were retrospectively reviewed. The patient and tumor characteristics were reviewed along with the operative outcomes and complications. results Seven patients (4.1%) with oculomotor cistern extension and tracking were identified in a cohort of 170 patients with pituitary macroadenoma. The most common presenting symptoms were visual deficit (6 patients; 86%), apoplexy (3 patients; 43%), and oculomotor nerve palsy (3 patients; 43%). Lone oculomotor nerve palsy was seen in 2 patients without apoplexy and 1 patient with an apoplectic event. Gross-total resection was achieved via a microscopic endonasal transsphenoidal approach with or without endoscopic aid to the sella in 14%, near-total resection in 29%, and subtotal resection in 57% of patients in the data set. coNclusioNs Pituitary adenoma extension along the oculomotor cistern is uncommon; however, preoperatively recognizing such extension should play an important role in the surgeon's operative considerations and postoperative clinical management because this extension can limit gross-total resection using t...

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“…28 The mechanism includes direct compression, indirect edematous expansion onto the cavernous sinus wall, direct infiltration of the tumor, and vascular compromise of the nerve.…”

Section: Discussion Cavernous Sinus Invasion and Oculomotor Trackingmentioning

confidence: 99%

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Hoang¹,

Tran²,

Herde

et al. 2016

JNS

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“…Patients with pituitary tumours causing third cranial nerve palsy without visual field defects have been reported. 3,13,14 The prognosis of these patients has been shown to be better than patients with visual field defects. 8,9,13 In the present study, however, we did not detect any significant difference in the recovery time of third cranial nerve palsy with or without visual field defects.…”

Section: Discussionmentioning

confidence: 99%

“…They can cause diverse clinical symptoms, generally pressure symptoms and endocrinological abnormalities. 1 Cranial nerve dysfunction due to pituitary tumour has been previously described, [2][3][4][5] and is thought to occur in 5-17% of pituitary tumour patients, generally manifesting as dysfunction of the third, fourth, fifth and sixth cranial nerves, which pass through the cavernous sinus.…”

Section: Introductionmentioning

confidence: 99%

Cranial nerve palsies accompanying pituitary tumour

Kim

Lee

Kim

2007

Journal of Clinical Neuroscience

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“…Among the ocular motor nerves, the sixth nerve is probably most affected by intrinsic lesions of the cavernous sinus because of its relatively free-floating position. 12,13 In contrast, the third nerve is often the first involved with lateral expansion of sellar masses and pituitary apoplexy because of its location adjacent to the pituitary fossa ( Fig. 4).…”

Section: Cavernous Sinus and Superior Orbital Fissurementioning

confidence: 99%

Third Nerve Palsies

Bruce¹,

Biousse²,

Newman³

2007

Semin Neurol

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The diagnosis and management of third nerve dysfunction vary according to the age of the patient, the characteristics of the third nerve palsy, and the presence of associated symptoms and signs. Third nerve palsies can result from lesions located anywhere from the oculomotor nucleus to the termination of the third nerve in the extraocular muscles within the orbit, and may be the herald manifestation of underlying neurological emergencies such as intracranial aneurysm, pituitary apoplexy, and giant cell arteritis. Recent advances in noninvasive neuroimaging facilitate early diagnosis, but the management of a patient presenting with isolated third nerve palsy remains a challenge.

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Oculomotor Anomalies in Sellar and Parasellar Pathology

Cited by 23 publications

References 16 publications

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Cranial nerve palsies accompanying pituitary tumour

Third Nerve Palsies

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