• Simona Serioli, Barbara Buffoli, Marika Vezzoli, Caterina Franco, Edoardo Agosti, Costanza Maria Zattra, Lucio De Maria, Davide Mattavelli, Mario Rigante, Marco Ferrari, PierPaolo Mattogno, Lena Hirtler, Rita Rezzani, Philippe Herman, Damien Bresson, Alberto Schreiber, Roberto Maroldi, Roberto Gasparotti, Simona Gaudino, Piero Nicolai, Marco Maria Fontanella, Pietro Luigi Poliani, Liverana Lauretti, Alessandro Olivi, and Francesco Doglietto.
• 1Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Division of Neurosurgery, Spedali Civili of Brescia, University of Brescia, Italy.
• J. Neurosurg. 2024 Sep 27: 1111-11.

ObjectiveThe oculomotor cistern (OMC) is a meningeal cuff filled with CSF that contains the oculomotor nerve (cranial nerve [CN] III) at the level of the lateral wall of the cavernous sinus. Only a few studies have investigated the involvement of the OMC by pituitary adenomas (pituitary neuroendocrine tumors [PitNETs]), mainly with relatively small case series. The aim of this study was to perform a histomorphological description of the OMC and systematically analyze its involvement by PitNETs from radiological, clinical, and surgical perspectives.MethodsTen hemisellae from formalin-fixed specimens were studied with 3-µm sections. Digital image analysis software was used for morphological and quantitative assessments. Clinical, radiological, surgical, and histological data of patients undergoing endoscopic transsphenoidal surgery for PitNETs at the University of Brescia, Italy, between 2014 and 2021 were recorded. OMC involvement was graded as not compressed, compressed, and invaded. The same surgical team operated on all patients.ResultsThe OMC had an elliptical shape with an average area of 3.1 mm2 and a length of 5.5 mm. No cisternal points of weakness were recognized in the histomorphological study. Of 315 patients, 246 had complete data: apoplexy and CN III palsy were documented in 6.9% and 8.5%, respectively. OMC compression and invasion were recorded in 106 (43.1%) and 23 (9.3%) patients. Significant associations between OMC involvement and PitNET dimensions (p < 0.001), Knosp grade (p < 0.001), preoperative oculomotor palsy (p < 0.001), Ki-67 percentage (p = 0.009), and recurrence/progression of residual tumor (p = 0.008) were found. A new postoperative CN III palsy was evident in 2%: transient in 4 cases, and persistent in 1 patient treated for a recurrent PitNET who experienced a local infection complication. Preoperative CN III palsy improved in 10 cases.ConclusionsSignificant OMC involvement by PitNETs might be underrecognized, but it can be treated using the endoscopic transsphenoidal approach, and it affects patient outcomes.

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