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AJNR - American Journal of Neuroradiology

Published ahead of print on January 31, 2008
doi: 10.3174/ajnr.A0930

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American Journal of Neuroradiology 29:760-765, April 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Neurologic Complications of Inferior Petrosal Sinus Sampling

C.D. Gandhi^c, S.A. Meyer^a, A.B. Patel^a,b, D.M. Johnson^a,b and K.D. Post^a

^a Departments of Neurosurgery,Mount Sinai School of Medicine, New York, NY
^b Departments of Radiology, Mount Sinai School of Medicine, New York, NY
^c Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ

Please address correspondence to Chirag D. Gandhi, MD, Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ 07103; e-mail: gandhicd{at}umdnj.edu

BACKGROUND AND PURPOSE: Inferior petrosal sinus sampling (IPSS) is a useful diagnostic technique in adrenocorticotropic hormone (ACTH)-dependent hypercortisolism with normal or equivocal MR imaging. The procedure is believed to be safe, with mostly minor complications. However, there are rare, but severe, neurologic complications that need to be considered.

MATERIALS AND METHODS: We performed an institutional review board–approved retrospective review of our institutional IPSS experience from July 2001 to January 2007. IPSS was performed for the evaluation of Cushing disease. The end points of particular interest were the indications for IPSS and the incidence of associated complications.

RESULTS: During the study period of 5 years, 44 patients underwent IPSS for evaluation of Cushing disease. There were 33 women and 11 men with a mean age of 43.1 years. Because of equivocal imaging and endocrine testing, 36 of 44 patients underwent IPSS, and 8 of 44 underwent IPSS after failed transsphenoidal exploration. The only complication was injury to the brain stem that occurred after an unremarkable procedure in a 42-year-old woman. She developed clinical evidence of pontomedullary dysfunction with MR imaging consistent with brain stem infarction. The cause of this injury is unclear, but a venous variant leading to transient venous hypertension or thrombosis is suspected.

CONCLUSION: Neurologic injury is a rare but serious complication associated with IPSS. Despite this, if performed under a strict paradigm, IPSS is both accurate and safe and can be very useful in the management of Cushing disease.