Cavernous sinus invasion by pituitary macroadenomas. Neuroradiological, clinical and surgical correlation

• Published in: Arquivos de neuro-psiquiatria 1998-03, Vol.56 (1), p.107-110
• Main Authors: Cukiert, A, Andrioli, M, Goldman, J, Nery, M, Salgado, L, Knoepfelmacher, M, Pimentel, F, Liberman, B
• Format: Article
• Language: English
• Subjects: Acromegaly - diagnosis; Cavernous Sinus - pathology; Cavernous Sinus - surgery; cavernous sinus invasion; Cushing Syndrome - diagnosis; Humans; magnetic resonance image; Magnetic Resonance Imaging; NEUROSCIENCES; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - surgery; pituitary tumors; Prolactinoma - diagnosis; Prolactinoma - surgery; PSYCHIATRY
• ISSN: 0004-282X; 1678-4227; 0004-282X; 1678-4227
• DOI: 10.1590/S0004-282X1998000100017

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 cavernous 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.