Synchronous subarachnoid drop metastases from a pituitary adenoma with multiple recurrences: Case report

Norman L. Lehman, Dikran S. Horoupian, Griffith R. Harsh IV

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

The authors report the case of a 49-year-old man with synchronous drop metastases from a multiply recurrent somatotroph pituitary adenoma. The metastatic lesions were found in the subarachnoid space of the cauda equina and foramen magnum 18 years after the initial diagnosis of the disease. Five transsphenoidal resections had previously failed to cure the sellar tumor. Two of these, performed 4 and 5 years before the patient's current presentation, had been complicated by cerebrospinal fluid rhinorrhea that necessitated lumbar drainage. Resections of the two subarachnoid lesions, separated by 14 months, removed pathologically aggressive pituitary adenomas. There were no signs of local recurrence or subarachnoid dissemination of disease during the postoperative follow-up periods, which lasted 18 and 4 months, respectively. Previous cases of subarachnoid spread of a pituitary adenoma have been associated with multiple intracranial metastases, multiple intraspinal metastases, or widely disseminated disease. This case demonstrates that subarachnoid metastasis of a pituitary adenoma, particularly when it follows multiple operations, is not invariably widely disseminated or associated with a very poor prognosis.

Original languageEnglish (US)
Pages (from-to)1120-1123
Number of pages4
JournalJournal of Neurosurgery
Volume98
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Keywords

  • Acromegaly
  • Drop metastasis
  • Lumbar drain
  • Pituitary adenoma
  • Subarachnoid space

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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