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

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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.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Yasuo Sasagawa, Masahiro Oishi & Mitsutoshi Nakada

  2. Department of Radiology, Kanazawa University, Ishikawa, Japan

    Hiroyuki Aburano & Kazumasa Ooiso

  3. Department of Neurosurgery, Kanazawa Medical University, Ishikawa, Japan

    Yasuhiko Hayashi

Authors
  1. Yasuo Sasagawa
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  2. Hiroyuki Aburano
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  3. Kazumasa Ooiso
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  4. Masahiro Oishi
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  5. Yasuhiko Hayashi
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  6. Mitsutoshi Nakada
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Correspondence to Yasuo Sasagawa.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with either the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

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Sasagawa, Y., Aburano, H., Ooiso, K. et al. Oculomotor nerve palsy in pituitary apoplexy associated with pituitary adenoma: a radiological analysis with fast imaging employing with steady-state acquisition. Acta Neurochir 163, 383–389 (2021). https://doi.org/10.1007/s00701-020-04632-y

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