REGULAR CONTENT
Final ID
458
Type
Original Scientific Research-Oral or Pos
Authors
V Rajpurohit1, A Doshi1, F Hui1
Institutions
1Johns Hopkins University, Baltimore, MD
Purpose
The inferior petrosal sinus (IPS) is the main transvenous access route to sample the secretions of patients with suspected pituitary adenomas. Sampling techniques have utilized preoperative CT Venography (CTV) in addition to Digital Subtraction Angiography (DSA) and intraoperative fluoroscopy to detail venous anatomy. The goal of our study was to evaluate the need of preoperative CTV with respect to radiation exposure and anatomical guidance.
Materials & Methods
We observed venous anatomy and radiation exposure in nine patients referred for IPS sampling with suspected Cushing's syndrome. Each patient obtained a preoperative CTV, which was followed by intraoperative DSA and fluoroscopy. Venous anatomy was detailed by an experienced neuroradiologist using both CTV and DSA. Radiation exposure was obtained and comparisons made using approximate values of effective dose conversion factors.
Results
All nine patients demonstrated patent IPS-IJV connections. There were four hypoplastic IPS, one IPS draining into the IJV inferiorly at the level of C3-C4 (type II), and another IPS which divided into multiple channels before draining into the IJV (type III). Each IPS was successfully catheterized.The average effective dose for CTV and DSA/Fluoroscopy was 5.4 mSv and 3.0 mSv, respectively.
Conclusions
While preoperative CTV may elucidate IPS venous drainage and accelerate the performance of inferior petrosal sinus sampling, catheterization can be accomplished under DSV and fluoroscopic guidance alone in the majority of patients. Prior knowledge of venous anatomy may be helpful in altering operative planning when confronting complex aberrant venous access. In light of nearly doubled radiation dose, standard preoperative CTV should be used judiciously and with hesitation.
Final ID
458
Type
Original Scientific Research-Oral or Pos
Authors
V Rajpurohit1, A Doshi1, F Hui1
Institutions
1Johns Hopkins University, Baltimore, MD
Purpose
The inferior petrosal sinus (IPS) is the main transvenous access route to sample the secretions of patients with suspected pituitary adenomas. Sampling techniques have utilized preoperative CT Venography (CTV) in addition to Digital Subtraction Angiography (DSA) and intraoperative fluoroscopy to detail venous anatomy. The goal of our study was to evaluate the need of preoperative CTV with respect to radiation exposure and anatomical guidance.
Materials & Methods
We observed venous anatomy and radiation exposure in nine patients referred for IPS sampling with suspected Cushing's syndrome. Each patient obtained a preoperative CTV, which was followed by intraoperative DSA and fluoroscopy. Venous anatomy was detailed by an experienced neuroradiologist using both CTV and DSA. Radiation exposure was obtained and comparisons made using approximate values of effective dose conversion factors.
Results
All nine patients demonstrated patent IPS-IJV connections. There were four hypoplastic IPS, one IPS draining into the IJV inferiorly at the level of C3-C4 (type II), and another IPS which divided into multiple channels before draining into the IJV (type III). Each IPS was successfully catheterized.The average effective dose for CTV and DSA/Fluoroscopy was 5.4 mSv and 3.0 mSv, respectively.
Conclusions
While preoperative CTV may elucidate IPS venous drainage and accelerate the performance of inferior petrosal sinus sampling, catheterization can be accomplished under DSV and fluoroscopic guidance alone in the majority of patients. Prior knowledge of venous anatomy may be helpful in altering operative planning when confronting complex aberrant venous access. In light of nearly doubled radiation dose, standard preoperative CTV should be used judiciously and with hesitation.