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F X Roux

Publications and source records attributed to F X Roux.

At least 19 recordsLinked to original sources
PubMed2002

[The role of surgery in the treatment of prolactinomas].

TECHNIQUE: Almost all prolactinomas are operated through a transsphenoidal route, even in case of significant suprasellar extension or intracavernous invasion. Since 1996, we use the only endonasal route which is easier, quicker, less haemorrhagic and less aggressive than the sublabial one. If the removal of a large macroadenoma cannot be completed (50-70% of cases), a second procedure, usually transsphenoidal, is performed a few weeks later. INDICATIONS: Microprolactinomas: usually surgery is proposed as soon as medical treatment is not well tolerated or if the patient wishes to be pregnant. Macroprolactinomas: bromocriptine or quinagolide are sometimes prescribed in a first stage. Surgery beeing indicated in case of inefficacy or intolerance of the medical treatment, or in emergency due to an acute visual pathways compression (tumoral necrosis). Giant adenomas (= 30-40 mm): usually dopaminergic agonists allow a tumoral volume reduction and assure a limitation of visual risks due to rapid decompression of visual pathways. Exceptionally, medical treatment leads to a complete regression of the adenoma. RESULTS: Morbidity of transsphenoidal procedures: insipidus diabetes: transient 5-15%, definitive: 1-2%; septal perforation: 3-5%; rhinorrhea: 5%; visual aggravation: 2%. The most frequent complaint for patients operated through sublabial route is gum and dental pain, non-existent with endonasal procedures. Operative mortality: 0-1.7% (0% in our series). In men, normalization of prolactinemia is linked to the tumoral volume: 90-100% in case of microprolactinoma, 30-35% for enclosed macroprolactinomas, 0-5% for invasive macroprolactinomas. Conventional, conformational or stereotactic radiotherapy can be useful in case of contraindication to surgery and failure of medical treatment.

Female↗
PubMed2001

[Characteristics of epileptic seizures associated with cerebral arteriovenous malformations].

PURPOSES: The purpose of this study is to analyze the characteristics of epileptic seizures associated with cerebral arteriovenous malformations treated by radiosurgery. PATIENTS AND METHODS: Seven hundred and two patients are studied (406 men, 296 women) with a mean age of 33 when radiosurgery was performed. 210 patients had epileptic seizures; those seizures either uniquely revealed the arteriovenous malformation or were associated with other clinical signs. Seizures occurring after an hemorrhage were excluded from the study. We studied the age category upon seizures occurrence, the malformation localization, type of seizure (partial, generalized, or partial secondary generalized), the history related to the epileptic seizures, the clinical topographical correlation, the number of seizures, their duration prior to the radiosurgery, antiepileptic treatment provided, electroence-phalographic characteristics, angiographic characteristics, prior endovascular or surgical treatment, and factors associated with severe seizure. RESULTS: Epileptic seizures revealed the arteriovenous malformations in 30% of the cases; they predominated between 10 and 40 years (80.5%) with a peak between 20 and 30 years. The malformation localization most frequently associated with seizures were temporal and rolandic for partial seizures, whereas frontal or sylvian localization were predominantly associated with generalized seizures. The type of seizure was, in all cases, related to the malformation localization because of the initial signs seizure. 47.6% of the patients showed a limited number of seizures (between 2 and 20), 27.6% showed only a single seizure, and 24.7% suffered from severe epilepsy. Generalized seizures are unique in the majority of cases (61.8%) whereas partial seizures were severe in 47.6% of the cases. The majority of patients are under a single-drug therapy (79%). The EEG patterns showed a small increase of slow and sharp localized waves in patients presenting seizures compared with the global population (27% and 15% respectively). Severe seizures predominated between 10 and 19 years of age; seizures were exclusively partial in 59.6% of the cases and secondary generalized in 40.4%, their frequencies were between 1 to 4 per month in the majority of cases (59.1%), the delay was often more than 10 years (57.7%), status epilepticus was rare (5.8%), temporal and rolandic localization were predominant, social and professional insertion of the patient was preserved in 87.5% of the cases, and seizures did not provoke any death. The angiographic characteristics associated with seizures were: superficial localization, volume, superficial venous drainage, recruitment and venous divergence. CONCLUSION: Anatomic and topographic characteristics of cerebral arterio-venous malformations may provide information on the features of seizures associated with them.

Adolescent↗
PubMed2001

[Characteristics of headache associated with cerebral arteriovenous malformations].

BACKGROUND: and purposes. The purpose of this study was to identify the specific characteristics of headaches associated with cerebral arteriovenous malformations in order to differentiate them from other known entities of headaches such as migraine, cluster headache, and trigeminal neuralgia. This differentiation allows an early diagnosis of cAVM and a treatment to be administrated before any cerebral hemorrhage. PATIENTS AND METHODS: The study included 700 patients with cAVM and treated by radiosurgery. Out of this series, only 109 (48 males, 61 females, mean age of 33) presented with headaches. Headaches were studied as a possible revelation mode of a cAVM, either as an isolated sign, preceding an epileptic seizure, a cerebral hemorrhage, or associated with a neurological deficit. Analysis concerned 13 clinical parameters and 30 anatomic parameters based on angiography. RESULTS: Headaches were found in 15.6%; they were isolated in 6%. They preceded a cerebral hemorrhage in 12.6%, constituting an early alarm signal when increasing in intensity, frequency and duration. They were associated with seizures or a neurological deficit in 9.6%. We found a predominant female sex-ratio (0.78) and occurrence at a young age (72.3% between 10 and 40 years). Headaches were non-pulsating in 95.3%; nausea, vomiting, light or sound phobia were only found in 4.7%. Headaches were unilateral and homolateral to the malformation in 80%, corresponding to the malformation topography in 97.4% in posterior location and 80% in anterior location. Associated neurological symptoms existed in 20.2%; related to the malformation and lasting 5 to 30 minutes. Duration of pain episodes was less than 3 hours in 77% with a frequency of 1 to 2 per month in 82.5%. Pain was mild and responded to simple analgesics. A family migraine was found in only 3 patients. The angiographic characteristics of the malformations were meningeal afferences, superficial venous drainage and posterior location. CONCLUSIONS: Headaches associated with cerebral arterio-venous malformations form a distinct category that can be determined from specific characteristics; this should help an early diagnosis of cerebral arterio-venous malformations in order to start a treatment before the occurrence of cerebral hemorrhage.

Adolescent↗
PubMed2001

[Cerebral arteriovenous malformations treated by radiosurgery: a series of 705 cases].

BACKGROUND AND PURPOSE: After a review of the main radiosurgical published series, to evaluate our own series of 705 patients with cerebral arteriovenous malformations treated by radiosurgery alone or in combination with embolization or surgery. PATIENTS: and method. From January 1984 to December 1998, 705 patients were treated by a multidisciplinary team including neurosurgeons, neuroradiologists, radiophysicians and radiotherapists. Age of revelation of the cerebral arteriovenous malformations ranged between birth to 73 years (mean 27, median 25). Age at time of radiosurgery ranged between 7 and 75 years (mean 33, median 31). There were 410 males for 295 females (sex- ratio 1.4). Symptoms of revelation were hemorrhage for 59%, seizures for 23%, headaches for 14% and progressive deficits for 4%. Discovery of cerebral arteriovenous malformation was fortuitous in 4% of cases. Repartition following Spetzler's grading was 12% in grade I, 36% in grade II, 40% in grade III, 12% in grade IV and 0% in grade V. Maximal size ranged between 4 and 60 mm (mean 23, median 20). Volume ranged between 0.2 and 24.3 cc (mean 3.8, median 2.8). Majority of cerebral arteriovenous malformations were large size (42% with size higher than 25 mm) and large volume (54% higher than 10 cc. 54% of patients had treatment prior radiosurgery: 38% had embolization, 10% were operated, 4% were treated by radiosurgery (reirradiation) and 3% were operated and embolized. RESULTS: Overall complete obliteration rate was 55%. The obliteration rate was correlated with size (77% for cAVMs lower than 15 mm, 62% for cerebral arteriovenous malformations between 15 and 25 mm, and 44% for cerebral arteriovenous malformations higher than 25 mm), with volume (94% for cerebral arteriovenous malformations lower than 1 cc, 64% between 1 and 4 cc, 48% between 4 and 10 cc, and 62% for cerebral arteriovenous malformations higher than 10 cc), dose at reference isodose, minimal dose, morphological parameters (presence of dural components, arteriolovenous fistula, plexiform angioarchitecture, arterial steal, arterial recruitment, deep exclusive drainage, venous plicature, venous confluence, venous ectasia, venous reflux), sectional topography and good recovery of the target. Embolization was a confusion factor not associated with obliteration rate. After multivariate analysis, only Dmin and complete coverage of the cerebral arteriovenous malformations were correlated with obliteration rate. Delay of obliteration was significantly correlated after multivariate analysis with Dmin, complete coverage, arteriolovenulary angioarchitecture (positive correlation) and venous ectasia (negative correlation). CONCLUSION: Overall complete obliteration rate is unreliable data to assess efficacy of radiosurgical method in the tretment of cerebral arteriovenous malformations. The obliteration rate must be interpretated after stratification on several morphological and dosimetric parameters.

Adolescent↗
PubMed2001

[Retrospective analysis of failures in radiosurgery treatment of cerebral arteriovenous malformations].

The aim of this paper is to analyze retrospectively the reasons for the failure in cerebral arteriovenous malformations radiosurgery. Several factors are evoked and discussed mainly: inaccurate target, intentional partial irradiation, repermeabilization of a previously embolized cerebral arteriovenous malformation. The results suggest the necessity of a complete irradiation of the nidus. The strategy of partial volume irradiation should be avoided, even if it necessitates lowering of the doses in large cerebral arteriovenous malformations. Accuracy in the target determination is required and a complete stereoangiography is necessary.

Adolescent↗
PubMed2001

[Evolution of epileptic seizures associated with cerebral arteriovenous malformations after radiosurgery].

The goal of this study is to evaluate the response of epileptic seizures associated with cerebral arteriovenous malformations following radiosurgery and determine the factors associated with a positive outcome. The series included 210 patients (123 men, 87 women) with a mean age of 33. One hundred seventy three patients out of 210 were controlled after radiosurgery. Seizures completely disappeared in 58% of cases and decreased in 18%. Anti-epileptic treatment was stopped in 44%. Sex and age upon seizure appearance were not found as determining factors in patients whose seizures disappeared after radiosurgery. Generalized seizures disappeared following radiosurgery in 90.7%, partial secondary generalized seizures in 53.5%, and partial seizures in only 39.6%. Frontal or temporal malformations are associated with a better response after radiosurgery than sylvian or rolandic location. Seizure disappearance was maximal in case of isolated seizure prior to the radiosurgery (84.4%), was reduced to 61.2% when seizures were limited to 2 to 20, and disappeared in 21.4% in severe seizures. Epilepsy present less than 3 years prior to radiosurgery disappeared in 71.9%; was reduced to 45% when the delay was over 3 years. Seizures disappeared in 64.4% when the malformation was obliterated, they were reduced to 46.9% when malformations persisted. The persistence of severe seizures following radiosurgery was linked to persistence of the malformation. On the other hand early seizures occurred in 3.3% during the first 48 hours following radiosurgery; they disappeared in 72.2% after that period. De novo seizures also occurred in 1.7% and disappeared in all these cases. In conclusion, seizures associated with cerebral arteriovenous malformations respond well to radiosurgery; the malformation obliteration evokes its association with the seizure; the seizure disappearance in spite of persistence of the malformation evokes the positive effect of radiotherapy on epileptic seizures.

Adolescent↗
PubMed2001

[Course of headaches associated with cAVMs after radiosurgery].

The purpose of this study is to evaluate the response of headaches associated with cerebral arteriovenous malformations following radiosurgery and determine the factors that are associated with a positive outcome. From our series of 700 patients whose cAVM was treated by radiosurgery, this study includes 109 patients (48 males, 61 females) with a mean age of 32 when radiosurgery was performed. Headaches resolved in 37 patients (53.7%), decreased in 14 patients (20.3%), persisted in 16 patients (23.2%), and even increased in frequency in 2 (2.9%). Headaches disappeared 2 years following radiosurgery in the majority of patients (31 out of 37: 83.3%). The disappearance rate of headaches was better when it was the only sign of the malformation (64%) or preceded an epileptic seizure (60%) with respect to the case when it preceded cerebral hemorrhage (34.8%). Headaches having the best response were those with 1 to 2 episodes per month (64.9%) and whose episode duration was less than 3 hours (67.6%). Unilateral headaches accounted for 86.5% of resolved headaches whereas bilateral headaches were only 8.1% and even less were the diffuse ones (5.4%). The best evolution was obtained for those associated with a parietal location of the cerebral arteriovenous malformation, followed by rolandic (respectively 55.5% and 50%). Occipital malformation was associated with headache disappearance in 38.1% and temporal with 34.3%, whereas frontal location was associated with headache disappearance in only 25% of the cases. Headache disappearance was often correlated with cerebral arteriovenous malformation outcome after radiosurgery (64.9% of disappearance in case of complete obliteration). However, in 24.8%, headaches disappeared prior to the malformation obliteration and were associated with a decrease of the flow, of the nidus volume or with the nidus disappearance with the persistence of a precocious venous drainage. Headaches disappeared in spite of the malformation persistence in 5.4% of the cases. We found de novo headaches in one patient one year following RS. Another patient presented an episode of headache 12 hours following RS. The course of headaches associated with cerebral arteriovenous malformations after radiosurgery is positive in the majority of cases and correlated to the malformation outcome. This correlation suggests a link between cerebral arteriovenous malformations and headaches and the equal benefit of radiosurgery on both of them.

Adolescent↗
PubMed2001

[Parenchymal changes after radiosurgery of cerebral arteriovenous malformations. Clinical and MRI data].

BACKGROUND AND PURPOSE: Purposes of this study are to describe different parenchymal changes seen after radiosurgery of cerebral arteriovenous malformations and the clinical symptoms which can be associated, and risk factors correlated with them. PATIENTS: and method. From the whole population of 705 patients with a cerebral arteriovenous malformations treated by radiosurgery between 1984 and 1998, clinical from 615 patients and post radiosurgery MRI data from 367 patients were reviewed. Neurological deficit occurred in 5.37% of cases and was still persistant in 1.46% of cases. Delay of occurrence of deficits ranged from 6 to 83 months (mean: 27 months, median: 15 months). Parenchymal changes seen in MRI were classified in 4 grades: 1 without parenchymal changes, 2 hypersignal in sp T2, 3=2 with homogenous enhancement with gadolinium, 4 with hyposignal in spT1 and annular irregular enhancement. Several parameters (size, volume, angioarchitecture of the cerebral arteriovenous malformation, dosimetric parameters) were studied and correlations were searched by uni and multivariate analysis with occurrence and delay of occurrence of deficits or parenchymal changes. RESULTS: In multivariate analysis, only size was significantly correlated with occurrence of parenchymal changes (p=0.0016); only size of the malformation was significantly correlated with delay of occurrence of parenchymal changes (p=0.0082); only grade 4 was correlated with occurrence of neurological deficit (p<0.00001). However, when only "a priori" parameters (known before radiosurgery) are introducted in logistic model, size taille (p=0.02) and hypoplasy of a sinus (p=0.0049) are significantly correlated with occurrence of neurological deficit. Only parenchymal changes grade 4 was significantly correlated with delay of occurrence of a neurological deficit (p<0.00001). However, when only a priori parameters (known before radiosurgery) are introducted in logistic model, only arterial steal (p=0.054) was significantly correlated with delay of occurrence of a neurological deficit. CONCLUSION: Parenchymal changes are various in expression, signification and clinical symptoms associated with them. They must be known and recognized for better prevention and symptomatic treatment as well.

Adolescent↗
PubMed2001

[Treatment of cerebral arteriovenous malformations: decision making strategy].

We have evaluated our therapeutic strategy through the results of modalities used alone or in association. Should the place of each modality be modified? What could be the influence of the first consulting physician? We feel at the present time that small cerebral arteriovenous malformations could be treated by radiosurgery, surgery and embolization according to their characteristics and location. For middle size and some large cerebral arteriovenous malformations, we consider that embolization and/or surgery are adjuvant modalities, specifically when the cerebral arteriovenous malformation is located in an eloquent area.

Case Management↗
PubMed2000

[Cancer of the ethmoid sinus].

Ethmoid sinuses are located at the level of the anterior skull base. Seventy to 80% of the ethmoid sinus malignant tumors are adenocarcinomas. Wood dust exposure is a carcinogen agent to ethmoid adenocarcinoma. More than 90% of patients with ethmoid adenocarcinoma are woodworkers. Craniofacial computed tomography scan and magnetic resonance imaging are always performed before treatment. It is always a multidisciplinary treatment including surgical resection followed by external radiation therapy. Some authors recommend a neoadjuvant chemotherapy. A total ethmoidectomy including the cribriform plate through a transcranial subfrontal approach is the best surgical technique. Local recurrence is the most frequent cause of failure; 5-year survival of patients with ethmoid adenocarcinoma is around 50%. A regular follow-up including clinical and radiological examination is always required.

Adenocarcinoma↗
PubMed1999

Subcranial fronto-orbito-nasal approach for ethmoidal cancers surgical techniques and results.

BACKGROUND: The authors report their experience with the subfronto-orbito-nasal approach (SFON) for the treatment of 30 patients suffering from ethmoidal cancers over the past 3 years. The advantages and pitfalls of this technique are described and compared with other classic approaches. METHODS: Among 156 patients suffering from ethmoidal cancers and treated between January 1984 and January 1998, 30 patients were operated on using the SFON approach during the past 3 years. There were 27 males and 3 females, ranging in age from 15 to 77 years. Histologic composition of the lesions was as follows: 15 adenocarcinomas, 6 esthesioneuroblastomas, 3 melanomas, 2 epidermoid carcinomas, 1 nondifferentiated carcinoma, 1 neuroendocrine carcinoma, 1 villous carcinoma, and 1 cystic adenoid carcinoma (cylindroma). According to the authors' classification, 7% were T1, 6% T2, 22% T3, 38.5% T4a, and 26.5% T4b. All patients were operated on through a SFON approach, followed by removal of the tumor and reconstruction of the skull base with a pericranial flap. RESULTS: Since the mean follow-up was of short duration (12 months, ranging from 3 to 29 months), significant carcinologic results could not be obtained. However, a detailed analysis of the surgical procedure was performed. No patient died or had major complications related to the SFON approach. One cerebrospinal fluid (CSF) fistula and four oculomotricity dysfunctions were observed. Definitive anosmia was reported in all cases. CONCLUSION: The advantages of the procedure include a wide exposure of the anterior skull base through a limited approach, the possibility of modifying the approach according to the size and location of the lesion, total resection of tumors, simplified skull base reconstruction technique, and reduction of postoperative confusion and hospital stay.

Adolescent↗
PubMed1998

High-power diode laser in neurosurgery: clinical experience in 30 cases.

BACKGROUND: High-power semiconductor diode lasers were recently introduced and have been tested in ophthalmology and general surgery. These lasers are attractive from the practical and economical standpoint, and have enough power to perform most surgical procedures. They could replace other surgical lasers such as CO2, argon, 1.06 microm, and 1.32 microm Nd-YAG lasers for many applications in neurosurgery. We report our initial experience with the first available 0.805-microm surgical diode laser, the Diomed 25 (Diomed, Ltd, Cambridge, U.K.) in a series of 30 patients. METHODS: The diode laser was evaluated during surgical resection of various types of central nervous system tumors in 30 patients. It was used free-hand in 27 patients in contact and non-contact, continuous wave (cw) and pulsed modes, and during ventricular endoscopy in three patients. Average time of laser use during a procedure was 248 seconds. Output power ranged from 1 to 25 watts, with an average power per patient of 2.64 to 15.5 watts (mean, 8.78 watts). Total energy delivered ranged from 65 to 11,051 joules per patient. RESULTS: Using 600- or 400-microm non-contact optic fiber, well pigmented tumor tissue hemostasis was obtained at cw 3 to 10 watts with a defocused beam, whereas vaporization required 10-25 cw or pulsed watts with a focused beam. Soft and tough tissue section could be obtained using a sculpted cone-shaped (600-300 microm tip) contact fiber at 7-10 cw watts after fiber tip charring. Because of the deeper penetration of 0.805-microm light in non-pigmented tissues, non-contact mode is not recommended for white matter or poorly vascularized tumors. The contact mode was not efficient on very soft tissues such as edematous brain parenchyma. The contact fibers proved to be very fragile because of heat generation. CONCLUSIONS: The high power diode laser proved to be efficient for hemostasis, section and vaporization, using contact and non-contact modes, at different output powers. Economical and ergonomical advantages of this new generation of surgical lasers may cause them to replace other surgical lasers such as argon, CO2, and Nd-YAG lasers, mostly for tumor surgery.

Adolescent↗
PubMed1998

[Therapeutic strategy for cerebral arteriovenous malformations. Proposal for classification of individual hemorrhagic risk].

BACKGROUND AND PURPOSE: Therapeutic strategy for the cerebral arteriovenous malformations (cAVM) is mainly based on the assessment of hemorrhage risk. This risk is estimated between 2 and 4% according to various series. However, this is a collective risk projected upon a given population. To improve therapeutic strategy for cAVM, we propose a grading of the individual hemorrhage risk based on 5 angiographic parameters: 4 are increasing risk factors and one is a favorable index. METHOD: This grading system has been achieved by univariate then multivariate analysis by logistic regression from angiographic data of 250 consecutive patients with cAVM. Thirty angiographic parameters were studied. RESULTS: Grade I has no risk factors and has two subgrades: Ia with venous recruitment (which is the lonely favorable parameter), Ib without venous recruitment. Grade II is the presence of venous stenosis or venous reflux. Grade III is the presence of exclusive deep venous drainage. Grade IV is the presence of intra or juxta-nidal aneurysm. There were 13% of hemorrhage in grade Ia, 38% in grade Ib, 48% in grade II, 90% in grades III and IV. CONCLUSIONS: This model can be helpful for the treatment decision making and also contributes to a better understanding of the natural history of cAVM. It must be further confirmed by a prospective study.

Adolescent↗
PubMed1998

[Use of endoscopy in pituitary surgery].

Endoscopy has changed many of surgical procedures concerning nasal and paranasal cavities. It has been proposed for transnasal removal of pituitary adenomas. The authors report their experience concerning four pituitary macroadenomas operated with the neurosurgical team of Sainte-Anne hospital. The endonasal trans-septal route seemed to be more anatomical and less traumatic than the rhinoseptal sublabial route. The 30 degrees rigid Hopkins endoscope was a good help for controlling the absence of any tumor remnant in the supra and parasellar regions after complete removal of the tumor performed through the endoscope or with the operating microscope. The authors discuss the advantages and limitations of such endoscopic procedures in the light of recent literature.

Adenoma↗
PubMed1998

[The place of radiosurgery in the treatment of hypophyseal adenoma].

Since 1984, the neurosurgical team of Sainte-Anne Hospital in Paris has taken in charge almost 750 patients for linear accelerator radiosurgery. But only a small percentage of them were harbouring a pituitary tumor. That is why the present paper is based mostly on literature data. Pituitary adenoma radiosurgery (RS) is a second intention therapeutic method. It should be recommended only after failure of medical and/or surgical treatment. Two main methods can be used: linear accelerator-radiosurgery and Cobalt-60 gamma unit. Both procedures provide equivalent results in terms of dosimetry, accuracy and clinical data. Results of various series presented in recent and updated literature have been studied and analysed. They show and confirm the efficiency of radiosurgery on tumor and hormone secretion controls, with few cases of pituitary insufficiency. However, results were disappointing concerning visual disorders, particularly if visual dysfunction and impairment existed before radiosurgery. All authors agree nowadays on different points: a) indications: invasive adenomas, with an incomplete resection, or adenomatous recurrences, b) contraindications: tumoral size > 20 mm, distance to visual pathways < 5 mm, c) imperative precautionary measures: less than 8 Gray must be delivered on visual pathways, less than 40 Gray on oculomotor nerves. In some cases, stereotactic fractioned radiotherapy may be an alternative treatment for large tumors close to visual pathways.

Adenoma↗
PubMed1998

[Intracavernous extension of hypophyseal macroadenomas: infiltration or invagination?].

Frequency of intracavernous invasion by a pituitary adenoma varies from 9% to 40% depending on the publications. Without putting off the possibility of true intracavernous invasion, it seems less frequent than evocated on CT-Scan and/or MRI data. We studied 153 files of pituitary adenomas operated upon recently: 72 prolactinomas (47.3%), 30 GH-secreting adenomas (19.7%), 7 corticotrop adenomas (4.6%), 44 non secreting adenomas (28.3%). 108 patients (70.4%) harboured a macroadenoma (diameter > 10 mm). A suprasellar expansion was seen 90 times on CT-Scan and/or MRI views. 19 times (17.7% of macroadenomas, 12.5% of the whole series) MRI evocated an infiltration of one or both cavernous sinuses (CS). Such data were found 3 times before 1991, 16 times since 1991, i.e. since MRI is systematically performed preoperatively. Except in two patients who respectively presented with a large intraorbital or temporal expansion, we have not been able to confirm the reality of the intracavernous invasion. We think that most of CT-Scan or MRI data of so-called intracavernous invasion correspond in fact to a compression or to a fingerglove invagination of the medial wall of the CS. In fact, anatomical studies by Harris & Rhoton (1976) and by Taptas (1990) demonstrated that such an invagination of the medial wall exists in almost one third of normal pituitary glands. These data must bring up to much carefulness when considering a possible pathological CS invasion by a macroadenoma. Therefore, it should be thoroughly assessed with anatomoradiological and radio-surgical correlations.

Adenoma↗