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J Neurol Surg B Skull Base 2021; 82(05): 567-575
DOI: 10.1055/s-0040-1715597
Original Article

Classification of Pituitary Adenomas Invading the Cavernous Sinus Assisted by Three-Dimensional Multimodal Imaging and Its Clinical Application

Yukun Zhang   *
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
3   Department of Neurosurgery, Peking University International Hospital, Beijing, China
,
Shaohua Tu   *
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
,
Lian Duan
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
,
Weilun Fu
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
,
Jianbo Wang
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
,
Sumin Geng 
1   Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
2   China National Clinical Research Center for Neurological Diseases, Beijing, China
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Abstract

Introduction To help diagnose and evaluate the prognosis of pituitary adenoma with cavernous sinus (CS) invasion and guide endonasal endoscopic surgery (EES) assisted by intraoperative navigation (ION) with three-dimensional multimodal imaging (3D-MMI). We propose a classification of CS invasion based on 3D-MMI.

Methods We picked some appropriate cases and reconstructed the 3D-MMI and then classified them into 3 grades according to the stereo relationship among ICA, tumor and CS in 3D-MMI. Then, we applied different strategies according to their grade to remove pituitary adenomas that invaded the CS.

Results All 38 patients were divided into 3 grades. Tumors compressing the ICA and CS without CS invasion were divided into grade 1. Tumors encasing the ICA and invading the superior-posterior compartment and/or anterior-inferior compartment but without distinct separation of the ICA and CS lateral wall were deemed as grade 2. Tumors encasing the ICA and filling the lateral compartment of the CS that dissociated the lateral wall from the ICA were deemed as grade 3. The 3D-MMI enabled adequate spatial visualization of the ICA, CS and tumors. All patients were operated on under the guidance of ION with 3D-MMI.

Conclusion Classification based on 3D-MMI can better demonstrate the relationships among tumor, ICA and CS in a stereo and multi-angle view, which will have significance in guiding the surgical strategy.

Keywords

classification - 3D multimodal imaging - endonasal endoscopic surgery - pituitary adenomas - cavernous sinus - intraoperative navigation

* These authors contributed equally to this work.




Publication History

Received: 15 March 2020

Accepted: 21 June 2020

Article published online:
20 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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