Grading of cavernous sinus invasion by pitutary macroadenoma
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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.
Knosp et al 1 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
In 2015 Micko et al 2 divided the 3rd grade to:
- 3A - the tumor extends lateral to the lateral tangent of the intracavernous and supracavernous ICAs into the superior CS compartment.
- 3B - the tumor extends lateral to the lateral tangent of the intracavernous and supracavernous ICAs into the
inferior CS compartment.
- 1. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993 Oct;33(4):610-7. Pubmed citation
- 2. Micko AS, Wöhrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015 Apr;122(4):803-11. Epub 2015 Feb 6. doi: 10.3171/2014.12.JNS141083 - Pubmed citation