Top

Acta Neurochirurgica

Published in:

01-02-2021 | Pituitary Adenoma | Original Article - Pituitaries

Oculomotor nerve palsy in pituitary apoplexy associated with pituitary adenoma: a radiological analysis with fast imaging employing with steady-state acquisition

Authors: Yasuo Sasagawa, Hiroyuki Aburano, Kazumasa Ooiso, Masahiro Oishi, Yasuhiko Hayashi, Mitsutoshi Nakada

Published in: Acta Neurochirurgica | Issue 2/2021

Abstract

Purpose

Oculomotor nerve palsy (ONP) occasionally occurs in cases of pituitary apoplexy (PA) associated with pituitary adenoma, but its mechanism remains unclear. Intracranial nerves are clearly visualized by fast-imaging employing with steady-state acquisition (FIESTA). Here, we assessed the oculomotor nerve compression in patients with PA associated with pituitary adenoma using FIESTA.

Methods

Twenty-eight cases of PA, with or without ONP, were retrospectively reviewed. All patients had undergone preoperative FIESTA. Two neuroradiologists, unaware of the patient’s clinical symptoms, evaluated the presence and location of oculomotor nerve compression due to the tumor.

Results

Thirteen of the twenty-eight PA cases were associated with ONP. Tumor size and degree of cavernous sinus invasion were not significantly different between the ONP and non-ONP groups. Even in the ONP group, 8/13 (62%) tumors did not show cavernous sinus invasion. Via FIESTA, the presence of oculomotor nerve compression was confirmed in 11/13 (85%) and 5/15 (33%) cases in the ONP and non-ONP groups, respectively (p = 0.008). The radiologists’ diagnoses of laterality of nerve compression (right or left) were consistent with the patient’s affected eye. In the ONP group, the location of the nerve compression was located at the entry point to the cavernous sinus, the so-called oculomotor triangle, in 9/11 (82%) cases and intra cavernous sinus in 2/11 (18%) cases.

Conclusion

Compression at the oculomotor triangle is considered the main cause of ONP with PA in pituitary adenomas.

Amemiya S, Aoki S, Ohtomo K (2009) Cranial nerve assessment in cavernous sinus tumours with contrast-enhanced 3D fast-imaging employing steady-state acquisition MR imaging. Neuroradiology 51:467–470. https://doi.org/10.1007/s00234-009-0513-zCrossRefPubMed

Bailey P (1898) Pathological report of a case of acromegaly, with special reference to the lesions in the hypophysis cerebri and in the thyroid gland; and a case of hemorrhage into the pituitary. Philadelphia Med J 1:789–792

Bonicki W, Kasperlik-Załuska A, Koszewski W, Zgliczyński W, Wisławski J (1993) Pituitary apoplexy: endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir 120:118–122. https://doi.org/10.1007/BF02112028CrossRefPubMed

Cahill M, Bannigan J, Eustace P (1996) Anatomy of the extraneural blood supply to the intracranial oculomotor nerve. Br J Ophthalmol 80:177–181. https://doi.org/10.1136/bjo.80.2.177CrossRefPubMedPubMedCentral

Dubuisson AS, Beckers A, Stevenaert A (2007) Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg 109:63–70. https://doi.org/10.1016/j.clineuro.2006.01.006CrossRefPubMed

Everton KL, Rassner UA, Osborn AG, Harnsberger HR (2008) The oculomotor cistern: anatomy and high-resolution imaging. AJNR Am J Neuroradiol 29:1344–1348. https://doi.org/10.3174/ajnr.A1089CrossRefPubMed

Hage R, Eshraghi SR, Oyesiku NM, Ioachimescu AG, Newman NJ, Biousse V, Bruce BB (2016) Third, fourth, and sixth cranial nerve palsies in pituitary apoplexy. World Neurosurg 94:447–452. https://doi.org/10.1016/j.wneu.2016.07.026CrossRefPubMedPubMedCentral

Hisanaga S, Kakeda S, Yamamoto J, Watanabe K, Moriya J, Nagata T, Fujino Y, Kondo H, Nishizawa S, Korogi Y (2017) Pituitary macroadenoma and visual impairment: postoperative outcome prediction with contrast-enhanced FIESTA. AJNR Am J Neuroradiol 38:2067–2072. https://doi.org/10.3174/ajnr.A5394CrossRefPubMed

Hoang N, Tran DK, Herde R, Couldwell GC, Osborn AG, Couldwell WT (2016) Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management. J Neurosurg 125:315–322. https://doi.org/10.3171/2015.5.JNS15107CrossRefPubMed

10.

Kawase T, van Loveren H, Keller JT, Tew JM (1996) Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery 39:527–534; discussion 534–536. https://doi.org/10.1097/00006123-199,609,000-00019CrossRefPubMed

11.

Kim SH, Lee KC, Kim SH (2007) Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci 14:1158–1162. https://doi.org/10.1016/j.jocn.2006.07.016CrossRefPubMed

12.

Kimura T, Morita A, Shirouzu I, Sora S (2011) Preoperative evaluation of unruptured cerebral aneurysms by fast imaging employing steady-state acquisition image. Neurosurgery 69:412–419; discussion 419–20. https://doi.org/10.1227/NEU.0b013e318213431eCrossRefPubMed

13.

Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618. https://doi.org/10.1227/00006123-199,310,000-00008CrossRefPubMed

14.

Kobayashi H, Kawabori M, Terasaka S, Murata J, Houkin K (2011) A possible mechanism of isolated oculomotor nerve palsy by apoplexy of pituitary adenoma without cavernous sinus invasion: a report of two cases. Acta Neurochir 153:2453–2456; discussion 2456. https://doi.org/10.1007/s00701-011-1165-4CrossRefPubMed

15.

Iaconetta G, Fusco M, Cavallo LM, Cappabianca P, Samii M, Tschabitscher M (2007) The abducens nerve: microanatomic and endoscopic study. Neurosurgery 61:7–14; discussion 14. https://doi.org/10.1227/01.neu.0000289706.42061.19CrossRefPubMed

16.

Mohr G, Hardy J (1982) Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol 18:181–189. https://doi.org/10.1016/0090-3019(82)90388-3CrossRefPubMed

17.

Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 51:181–188. https://doi.org/10.1046/j.1365-2265.1999.00754.xCrossRef

18.

Sibal L, Ball SG, Connolly V, James RA, Kane P, Kelly WF, Kendall-Taylor P, Mathias D, Perros P, Quinton R, Vaidya B (2004) Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 7:157–163. https://doi.org/10.1007/s11102-005-1050-3CrossRefPubMed

19.

Umansky F, Valarezo A, Elidan J (1994) The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914–920. https://doi.org/10.3171/jns.1994.81.6.0914CrossRefPubMed

20.

Watanabe K, Kakeda S, Yamamoto J, Watanabe R, Nishimura J, Ohnari N, Nishizawa S, Korogi Y (2012) Delineation of optic nerves and chiasm in close proximity to large suprasellar tumours with contrast-enhanced FIESTA MR imaging. Radiology 264:852–858. https://doi.org/10.1148/radiol.12111363CrossRefPubMed

21.

Woo HJ, Hwang JH, Hwang SK, Park YM (2010) Clinical outcome of cranial neuropathy in patients with pituitary apoplexy. J Korean Neurosurg Soc 48:213–218. https://doi.org/10.3340/jkns.2010.48.3.213CrossRefPubMedPubMedCentral

22.

Yagi A, Sato N, Taketomi A, Nakajima T, Morita H, Koyama Y, Aoki J, Endo K (2009) Normal cranial nerves in the cavernous sinuses: Contrast-Enhanced Three-Dimensional Constructive Interference in the Steady State MR Imaging. Neuroradiology 51(7):467–470CrossRef

23.

Yamaguchi R, Tosaka M, Miyagishima T, Osawa T, Horiguchi K, Honda F, Yoshimoto Y (2019) Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions. J Neurosurg Dec 13:1–9. https://doi.org/10.3171/2019.9.JNS191365 Online ahead of printCrossRef

Title: Oculomotor nerve palsy in pituitary apoplexy associated with pituitary adenoma: a radiological analysis with fast imaging employing with steady-state acquisition
Authors: Yasuo Sasagawa
Hiroyuki Aburano
Kazumasa Ooiso
Masahiro Oishi
Yasuhiko Hayashi
Mitsutoshi Nakada
Publication date: 01-02-2021
Publisher: Springer Vienna
Keywords: Pituitary Adenoma
Oculomotor Nerve Palsy
Pituitary Apoplexy
Published in: Acta Neurochirurgica / Issue 2/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04632-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Oculomotor nerve palsy in pituitary apoplexy associated with pituitary adenoma: a radiological analysis with fast imaging employing with steady-state acquisition

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2021

Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model

Revision and complication rates in adult shunt surgery: a single-institution study

Surgical anatomy and nuances of the expanded transpterygoid approach to the pterygopalatine fossa and upper parapharyngeal space: a stepwise cadaveric dissection

Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas

Predictors of postoperative complications after selective dorsal rhizotomy

Consensus statement from the international consensus meeting on post-traumatic cranioplasty