OBJECTIVE The demonstration of a central to peripheral ACTH gradient in a hypercortisolaemic patient is diagnostic of Cushing's disease. We tried to determine whether single blood samples for ACTH obtained sequentially from each of the inferior petrosal sinuses following human corticotrophin-releasing hormone (hCRH) stimulation can reliably establish such a gradient. DESIGN Prospective study....

BACKGROUND The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups. METHODS This study examines one venog...

Bilateral inferior petrosal sinus sampling is the most reliable test to differentiate Cushing’s disease from ectopic adrenocorticotropic hormone (ACTH) production. Catheters, whether preshaped polyethylene or coaxial Tracker systems, are supple and atraumatic. Retrograde venograms are gentle procedures performed only to document catheter position at the time of sampling. And yet, as reported by...

Transvenous coil embolization has been successfully applied for the treatment of cavernous sinus dural arteriovenous fistula (CSDAVF). Unfortunately, the technique cannot be applied in cases of poor or absent inferior petrosal sinus or facial venous access route to the fistula. Recently, we experienced a successful embolization using direct superior ophthalmic vein approach in cases of CSDAVF w...

PURPOSE To evaluate the anatomy of the junction of the inferior petrosal sinus and the internal jugular vein. METHODS Using a previously described classification system, we prospectively classified venous anatomy bilaterally in 135 of 136 persons consecutively undergoing inferior petrosal sinus sampling. RESULTS Type IV anatomy, with no anastomosis between the inferior petrosal sinus and th...

We report the endovascular treatment of a dural carotid cavernous fistula in a 67-year-old woman in whom superior petrosal sinus catheterization was performed to access the venous site of the fistula. To our knowledge, this retrograde venous route via the superior petrosal sinus has not been previously described.

Neurologic complications associated with inferior petrosal sinus sampling for adrenocorticotropic hormone in the diagnosis of Cushing syndrome are rare. Previously reported complications include brain stem infarction and pontine hemorrhage. We report a case of venous subarachnoid hemorrhage with subsequent acute obstructive hydrocephalus occurring during inferior petrosal sinus sampling for Cus...

cushing’s syndrome is a rare endocrine disease characterized by hypercortisolemia caused by excess acth secreted by the pituitary. distinguishing pituitary sources from the ectopic sources of acth is challenging because of the limited accuracy of noninvasive assays. the test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (bipss). in patients wi...

In this article, the authors review the history of the posterior petrosal approach. The early foundation of the retrolabyrinthine lateral petrosectomy has its roots in the otolaryngology literature. These early approaches were limited in exposure by the tentorium superiorly and the sigmoid sinus posteriorly. Although the concept of a transtentorial approach was originally combined with a comple...

INTRODUCTION Cushing's syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. CASE OUTLINE A 38-year-old woman with a typical appearance of Cushing's syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol a...