Intraoperative and Histological Evaluation of Invasion of the Medial Wall of the Cavernous Sinus in 100 Consecutive Pituitary Adenomas. (16th November 2020)

• Record Type: Journal Article
• Authors: Mohyeldin, Ahmed; Ahmadian, Saman; Katznelson, Laurence; Fernandez-Miranda, Juan C
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_849
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Biochemical remission rates and patterns of recurrence among different histological subtypes of pituitary adenomas varies widely. Parasellar invasion into the cavernous sinus is a well-documented mechanism that may account for this behavior as residual disease escapes confinement to the sella and complete surgical resection becomes challenging. Unfortunately, differential patterns of invasion and the mechanisms behind them among various pathological subtypes of pituitary adenomas remains poorly understood. METHODS: Direct intraoperative visulization of the medial wall was performed and resected medial walls were sent for pathological anaylsis and immunostaining. RESULTS: In this series we report a 53% rate of medial wall resection among all adenomas with 42% of the walls confirming invasive cells positive on both histological evaluation and immunocytochemistry. Furthermore, we show that the rate of medial wall invasion among pathological subtypes is dramatically different. Somatotrophs invade the medial wall of the cavernous sinus more than any other pituitary adenoma subtype at a rate of 77%. The next highest rate of invasion was seen among lactotrophs (50%) and plurihormonal tumors (40%). The least likely pathological subtype to invade were corticotroph and null cell adenomas that invaded at a rate of 23% and 0% respectively. CONCLUSION: These findings may explain the failed biochemical remission rates seen in acromegaly and also lays the foundation down to better understand the molecular and physiological mechanisms that underly their invasive potential.