Pituitary Adenomas with Parasellar Invasion

Knosp, Engelbert; Kitz, K.; Steiner, Erich; Matula, Ch.

doi:10.1007/978-3-7091-9183-5_12

Cited by 77 publications

(44 citation statements)

References 17 publications

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“…Tumor resection was accomplished by circumferential dissection of the pseudocapsule in most cases. Consistent with prior observations, 1,2,3,6,8 histological evidence of dural invasion was common, occurring in 34% of patients. Of note, 7% of patients had dural invasion of the anterior sella without apparent gross surgical invasion.…”

supporting

confidence: 91%

“…These findings were impossible to determine with the larger tumors described in previous studies of extensive cavernous sinus or other parasellar dural involvement. 2,3,7 Further, our findings indicate that dural invasion can occur early in the evolution of tumor growth and that it initially occurs preferentially laterally, perhaps along lateral pathways where the veins draining the pituitary penetrate the pituitary capsule and the cavernous sinus wall (as noted by Dr. Edward Oldfield).…”

Section: Disclosuresupporting

confidence: 55%

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Editorial: Invasion of the corticotrophs

Mayberg¹

2012

JNS

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Lonser and colleagues 4 performed a prospective observational analysis to determine the incidence, location, and tumor characteristics of dural invasion associated with corticotropic pituitary adenomas. Eighty-seven consecutive pediatric and adult patients with Cushing disease at a single institution underwent a procedure in which the anterior dura was routinely resected and the medial cavernous sinus wall was resected when dural invasion was encountered. The uncoagulated dural specimens were processed for adrenocorticotropic hormone immunohistochemistry and were compared with highresolution MR imaging determinations. Tumor resection was accomplished by circumferential dissection of the pseudocapsule in most cases. Consistent with prior observations, 1,2,3,6,8 histological evidence of dural invasion was common, occurring in 34% of patients. Of note, 7% of patients had dural invasion of the anterior sella without apparent gross surgical invasion. Dural invasion occurred most frequently at the cavernous sinus, but also along the anterior, inferior, and posterior dura of the sella. Magnetic resonance imaging was a poor predictor of dural invasion, correctly identifying cavernous sinus invasion in only 22% of cases. Tumor size was related to invasion, yet many small tumors adjacent to the dura were invasive. In contrast to prior studies, 6 there was no apparent increase in dural invasion with age.There are several important observations in this study. First, the authors have confirmed the high frequency of dural invasion in a prospective consecutive series of patients with Cushing disease. Proximity of the tumor to dura seems to be the most important factor for invasion, and MR imaging is a poor diagnostic test to identify invasion. Even direct observation of dural invasion was inaccurate in a small number of cases. Second, dural invasion can occur at various sites within the sella, not only the cavernous sinus, as might be expected. Third, the authors' approach of extracapsular tumor dissection and resection of adjacent dura, combined with reexploration when immediate postoperative serum cortisol levels remain normal or elevated, resulted in an immediate biochemical remission rate of 98% and no early recurrences. Although this series is not controlled, the immediate remission rate is higher than that achieved in most larger studies by experienced pituitary surgeons.

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supporting

confidence: 91%

Section: Disclosuresupporting

confidence: 55%

Editorial: Invasion of the corticotrophs

Mayberg¹

2012

JNS

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“…We did not correlate our data with p53 expression, because it does not seem to be of pathogenetic significance in pituitary tumors. 23,32,33,45,48,55,63 Tumor proliferation markers, such as the Ki-67-targeted MIB-1 labeling index, were observed by others 47 and our group 42,43,68,71,72 to correlate with more aggressive biological pituitary adenoma behavior, such as an increased growth rate and invasive growth. These recent data support our previous results, although MIB-1 did not achieve significance between the grades, most likely because all of the included tumors were macroadenomas.…”

Section: Mib-1 Indexmentioning

confidence: 51%

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

Micko¹,

Wöhrer

Wolfsberger³

et al. 2015

JNS

396

281

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abbreviatioNs CS = cavernous sinus; ER = endocrinological remission; GTR = gross-total resection; ICA = internal carotid artery. submitted May 22, 2014. accepted December 2, 2014. iNclude wheN citiNg Published online February 6, 2015; DOI: 10.3171/2014.12.JNS141083. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect An important prognostic factor for the surgical outcome and recurrence of a pituitary adenoma is its invasiveness into parasellar tissue, particularly into the space of the cavernous sinus (CS). The aims of this study were to reevaluate the existing parasellar classifications using an endoscopic technique and to evaluate the clinical and radiological outcomes associated with each grade. methods The authors investigated 137 pituitary macroadenomas classified radiologically at least on one side as Grade 1 or higher (parasellar extension) and correlated the surgical findings using an endoscopic technique, with special reference to the invasiveness of the tumor into the CS. In each case, postoperative MRI was performed to evaluate the gross-total resection (GTR) rate and the rate of endocrinological remission (ER) in functioning adenomas. results The authors found a 16% rate of CS invasion during surgery for these macroadenomas. Adenomas radiologically classified as Grade 1 were found to be invasive in 1.5%, and the GTR/ER rate was 83%/88%. For Grade 2 adenomas, the rate of invasion was 9.9%, and the GTR/ER rate was 71%/60%. For Grade 3 adenomas, the rate of invasion was 37.9%, and the GTR/ER rate was 75%/33%. When the superior compartment of the CS (Grade 3A) was involved, the authors found a rate of invasion that was lower (p < 0.001) than that when the inferior compartment was involved (Grade 3B). The rate of invasion in Grade 3A adenomas was 26.5% with a GTR/ER rate of 85%/67%, whereas for Grade 3B adenomas, the rate of surgically observed invasion was 70.6% with a GTR/ER rate of 64%/0%. All of the Grade 4 adenomas were invasive, and the GTR/ER rate was 0%. A comparison of microscopic and endoscopic techniques revealed no difference in adenomas with Grade 1 or 4 parasellar extension. In Grade 2 adenomas, however, the CS was found by the endoscopic technique to be invaded in 9.9% and by microscopic evaluation to be invaded in 88% (p < 0.001); in Grade 3 adenomas, the difference was 37.9% versus 86%, respectively (p = 0.002). Grade 4 adenomas had a statistically significant lower rate of GTR than those of all the other grades. In case of ER only, Grade 1 adenomas had a statistically significant higher rate of remission than did Grade 3B and Grade 4 adenomas. coNclusioNs The proposed classification proved that with increasing grades, the likelihood of surgically observed invasion rises and the chance of GTR and ER decreases. The direct endoscopic view confirmed the low rate of invasion of Grade 1 adenomas but showed significantly lower rates of invasion in Grade 2 and 3 adenomas than those previousl...

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“…However, more recent studies have found that invasion of pituitary adenomas into the cavernous sinus is not uncommon and invasion into the dura of the pituitary fossa is frequent.15) Histological studies of surgical specimens of pitui tary adenomas have verified that dural invasion is common. 7,9,14) Magnetic resonance (MR) imaging has been used in many studies on the clinical diagnosis of invasion into the cavernous sinus, but the criteria still remain controversial. ',"',")…”

Section: Introductionmentioning

confidence: 99%

Dural Invasion and Proliferative Potential of Pituitary Adenomas

Daita

Yonemasu

1996

Neurol. Med. Chir.(Tokyo)

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The relationship between invasiveness and proliferative potential was studied in 31 cases of pituitary adenomas. The invasiveness was determined by histological examination of sellar floor dura resected during transsphenoidal surgery. The proliferative potential of adenoma specimens was examined im munohistochemically using monoclonal antibody (MIB-1). There were 11 adenomas with histological ly verified dural invasion out of 31 cases. These adenomas had a higher MIB-1-positive ratio than adenomas without dural invasion (p < 0.05). Pituitary adenomas with a high proliferative potential tend to be invasive.

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Pituitary Adenomas with Parasellar Invasion

Cited by 77 publications

References 17 publications

Editorial: Invasion of the corticotrophs

Editorial: Invasion of the corticotrophs

Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification

Dural Invasion and Proliferative Potential of Pituitary Adenomas

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