Treatment Response to Acute Total Ophthalmoplegia in Primary Pituitary Lymphoma: A Case Report and Review of the Literature.

Primary pituitary lymphoma (PPL) is an extremely rare localized lymphoma without systemic involvement. The most common clinical presentations of PPL are hypopituitarism, headaches, and ophthalmoplegia. Diagnosing PPL without a biopsy is almost impossible. There is no study that has specifically investigated and reviewed treatment responses to the ophthalmological symptoms of PPL patients. Herein, we present a 66-year-old female patient who had acute-onset total ophthalmoplegia and headache as admission symptoms, which was diagnosed as PPL after subtotal resection. In the present study, we discussed the response of ophthalmological symptoms to treatment with a review of the literature. Only 18 reported cases had postoperative ophthalmological examination, and in 94.4% of these cases, ophthalmoplegia resolves after surgery and chemotherapy. The complete resection rate of the PPL in the literature was found to be as low as 12.3% in this region because of the hard and adhesive nature of the tumor. Our review unveiled that complete recovery of ophthalmoplegia can be achieved even in the late phase of the symptoms. In the present case, ophthalmoplegia resolved completely following subtotal resection and rituximab, high-dose methotrexate, and cytarabine treatment.

A new classification of parasagittal bridging veins based on their configurations and drainage routes pertinent to interhemispheric approaches: a surgical anatomical study.

OBJECTIVE: Opening the roof of the interhemispheric microsurgical corridor to access various neurooncological or neurovascular lesions can be demanding because of the multiple bridging veins that drain into the sinus with their highly variable, location-specific anatomy. The objective of this study was to propose a new classification system for these parasagittal bridging veins, which are herein described as being arranged in 3 configurations with 4 drainage routes. METHODS: Twenty adult cadaveric heads (40 hemispheres) were examined. From this examination, the authors describe 3 types of configurations of the parasagittal bridging veins relative to specific anatomical landmarks (coronal suture, postcentral sulcus) and their drainage routes into the superior sagittal sinus, convexity dura, lacunae, and falx. They also quantify the relative incidence and extension of these anatomical variations and provide several preoperative, postoperative, and microneurosurgical clinical case study examples. RESULTS: The authors describe 3 anatomical configurations for venous drainage, which improves on the 2 types that have been previously described. In type 1, a single vein joins; in type 2, 2 or more contiguous veins join; and in type 3, a venous complex joins at the same point. Anterior to the coronal suture, the most common configuration was type 1 dural drainage, occurring in 57% of hemispheres. Between the coronal suture and the postcentral sulcus, most veins (including 73% of superior anastomotic veins of Trolard) drain first into a venous lacuna, which are larger and more numerous in this region. Posterior to the postcentral sulcus, the most common drainage route was through the falx. CONCLUSIONS: The authors propose a systematic classification for the parasagittal venous network. Using anatomical landmarks, they define 3 venous configurations and 4 drainage routes. Analysis of these configurations with respect to surgical routes indicates 2 highly risky interhemispheric surgical fissure routes. The risks are attributable to the presence of large lacunae that receive multiple veins (type 2) or venous complex (type 3) configurations that negatively impact a surgeon's working space and degree of movement and thus are predisposed to inadvertent avulsions, bleeding, and venous thrombosis.

Calvarial Tumors: A Retrospective Analysis and Clinical Experience.

AIM: To elucidate the prognosis, frequency, and diverse nature of pathologies for calvarial tumors among different age groups. MATERIAL AND METHODS: Seventy-six patients who underwent surgery for calvarial lesions between January 2007 and March 2021 are included in this study. Clinical data obtained retrospectively from patients? electronic records. Radiological images and surgical notes are reviewed to determine extent of the tumor and resection. RESULTS: Among 76 patients, 33 (43.4%) were male and 43 (56.6%) were female. The mean age was 36.0 years (range: 1?81 years) at the time of initial operation. Children consisted 28.9% (n=22) of the patients. In children, 59.1% (n=13) had tumor-like pathologies, while 27.3% (n=6) had benign pathologies, and 13.6% (n=3) had malignant tumors. In the adult population, 42.6% (n=23) had malignant tumors, 31.5% (n=17) had benign tumors, 16.7% (n=9) had tumor-like pathologies, and 9.2% (n=5) had intermediate-grade tumors. F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan was performed in 16 patients, 10 cases underwent whole-body bone scintigraphy (WBBS), and 4 cases underwent both. Among these examinations, 16 (80%) of the FDG-PET scans and 5 (35.7%) of the WBBS scans revealed an extracranial pathological lesion. A calvarial tumor was diagnosed in 13 of 18 cases of metastatic lesions (72.2%) before the primary tumor detection. CONCLUSION: Lesions of the calvarium include malignant tumors, intermediate grade tumors, tumor-like lesions, and benign tumors. These masses may be the first presentation in patients with underlying primary tumors. In our study, the malignant tumor rate in the calvaria was 34.2%, and 72.2% of the metastatic tumors were diagnosed with a calvarial resection before the primary tumor was found. Operating a calvarial lesion and making an early diagnosis are crucial for the treatment of the primary lesions.