Grading of cavernous sinus invasion by pitutary macroadenoma

Case contributed by Dr Elnur Mehdi

A coronal view of cavernous sinus and adjacent structures. Three lines passes through supra- and intracavernous parts of internal carotid artery: medial line - connects the medial wall of ICAs; median line - crosses across the centers of ICAs; lateral line - touches the lateral wall of ICAs.

Case Discussion

Knosp et al offered a grading system for showing invasion of cavernous sinus by pituitary macroadenoma. Briefly, the much laterally adenoma grows and surrounds the ICA, the more grade level is. The grading defined by the relation of carotid lines with the limits of invasion. These lines passes through supra- and intra-cavernous parts of ICA in coronal view. There are medial, median and lateral carotid lines.

  • grade 0: adenoma does not extend the medial carotid line
  • grade 1: adenoma extends the medial line, but doesn't reach the median line, so-called "intracarotid" line
  • grade 2: tumor extends beyond the median line, but doesn't extend beyond or tangent to the lateral line
  • grade 3: tumor extends beyond the lateral line
  • grade 4: tumor totally wraps around the intracavernous carotid artery
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Case Information

rID: 29524
Case created: 1st Jun 2014
Last edited: 16th Mar 2016
Inclusion in quiz mode: Excluded

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