The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome

Hayashi, Nakamasa; Kurimoto, Masanori; Kubo, Michinori; Kuwayama, Naoya; Kurosaki, Kunikazu; Nagai, Shoichi; Endo, Shunro

doi:10.3174/ajnr.a0745

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…BIPSS is not ideal for identifying the diseased side [31,46], which may be due to the presence of branches joined to the cavernous sinus and frequent contralateral venous return. A previous study used cavernous sinus sampling instead of BIPSS to obtain a good differential diagnosis for CD and EAS [47]. For BIPSS, the success rate is closely related to the operator's technique and experience, and accurate catheterization is very important.…”

Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of bilateral inferior Petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing syndrome: a systematic review and Meta-analysis

et al. 2020

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Background Previous studies have shown inconsistent results about the usefulness of bilateral inferior petrosal sinus sampling (BIPSS) in differential diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome. This meta-analysis evaluated the diagnostic value of BIPSS via the published literature. Methods This study searched PubMed, Embase, Web of Science, Cochrane library, and Wanfang database for published data on the use of BIPSS in Cushing syndrome differential diagnosis as of October 2019. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curves were calculated based on the relevant data. Results This meta-analysis included a total of 23 studies with 1642 patients. The calculated sensitivity, specificity, PLR, and NLR were 0.94 (95% confidence interval, CI: 0.91–0.96), 0.89 (95% CI: 0.79–0.95), 8.8 (95% CI: 4.3–17.9), and 0.07 (95% CI: 0.04–0.11), respectively. The pooled DOR and area under the ROC curve were 129 (95% CI: 48–345) and 0.97 (95% CI: 0.95–0.98), respectively. Conclusion This meta-analysis indicated that BIPSS had high diagnostic value for detecting ACTH in patients with ACTH-dependent Cushing syndrome, and BIPSS should be used as an effective method to identify ACTH-secretion sources.

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Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of bilateral inferior Petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing syndrome: a systematic review and Meta-analysis

et al. 2020

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“…The best sampling points in the sinus to obtain a reliable enough gradient of ACTH remains under debate. 72 – 75) Sampling from the medial venous axis of the CS may better reflect the ACTH secretion from the pituitary gland, because pituitary venous blood first flows into this medial axis. In other venous axes, it may be diluted by venous flows from the brain or the orbit.…”

Section: Discussionmentioning

confidence: 99%

Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

Mitsuhashi

Hayasaki

Kawakami

et al. 2016

Neurol. Med. Chir.(Tokyo)

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The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.

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“…The IPS is poorly formed and exists as a plexus of veins in 7% of cases, 3) and the main routes of drainage from the CS to the pterygoid venous plexus may pass via the foramen ovale and the emissary sphenoid foramen. 8,9) Two of our patients with well-developed pterygoid venous plexus as the main route of drainage from the CS developed edema of the temporal lobe postoperatively. Surgical interruption of the main route of drainage from the CS by epidural procedures in the ATPA may result in venous congestion and edema of the temporal lobe, in addition to retraction damage to the temporal lobe.…”

Section: Discussionmentioning

confidence: 85%

Consequences of Preoperative Evaluation of Patterns of Drainage of the Cavernous Sinus in Patients Treated Using the Anterior Transpetrosal Approach

Hayashi

Sato

Tsuboi

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Extradural procedures in an anterior transpetrosal approach (ATPA) may interrupt the route of drainage from the superficial middle cerebral veins (SMCVs) and the cavernous sinus (CS) to the pterygoid venous plexus at the temporal skull base. Patterns of drainage of the SMCV and the CS and the results of surgery were examined in 12 patients with petroclival lesions treated using the ATPA between 2000 and 2008. The angiographic patterns of drainage of the SMCV were examined in 22 sides of the 12 patients. The SMCV drained into the sphenoparietal sinus in 12 sides, the sphenobasal veins in 4 sides, and the cortical veins in 6 sides. The patterns of drainage of the CS were examined on 12 sides in which the SMCV drained into the sphenoparietal sinus. The CS drained into the inferior petrosal sinus (IPS) in 7 sides and equally into the pterygoid plexus and IPS in 3 sides. The CS drained mainly into the pterygoid plexus in 2 sides of 2 patients, who both suffered temporal lobe swelling postoperatively. The pattern of venous drainage of the CS must be considered in planning surgical approaches to petroclival lesions. In patients with a well-developed pterygoid plexus, surgical interruption of this drainage route may be a cause of injury of the temporal lobe.

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The Impact of Cavernous Sinus Drainage Pattern on the Results of Venous Sampling in Patients With Suspected Cushing Syndrome

Cited by 11 publications

References 24 publications

Differential diagnostic value of bilateral inferior Petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing syndrome: a systematic review and Meta-analysis

Differential diagnostic value of bilateral inferior Petrosal sinus sampling (BIPSS) in ACTH-dependent Cushing syndrome: a systematic review and Meta-analysis

Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations

Consequences of Preoperative Evaluation of Patterns of Drainage of the Cavernous Sinus in Patients Treated Using the Anterior Transpetrosal Approach

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