Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis.

Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded-one intracranial infection and one case of tinnitus-both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.

Knowledge mapping of syringomyelia from 2003 to 2022: A bibliometric analysis.

BACKGROUND: Syringomyelia is a chronic, progressive disease of the spinal cord. Syringomyelia is an etiologically diverse affliction caused by disturbance of normal cerebrospinal fluid flow dynamics. Lesions are characterized by the formation of tubular cavities in the gray matter of the spinal cord and gliosis; however, the etiology is unknown and treatment methods differ. Many existing studies have focused on the relationship between other diseases and syringomyelia. There is a lack of comprehensive and objective reports on the research status of syringomyelia. Therefore, this study aimed to conduct a bibliometric analysis to quantify studies on Syringomyelia and trending issues in the last 20 years. METHODS: Articles were acquired from the Web of Science Core Collection database. We used the Library Metrology online analysis platform, BICOMB, gCLUTO, CiteSpace bibliometrics tools for analysis, VOSviewer 1.6.16 (Nees Jan van Eck and Ludo Waltman, 2010), and Microsoft Excel 2019 to perform bibliometric analysis and visualization. Individual impact and collaborative information were quantified by analyzing annual publications, journals, co-cited journals, countries/regions, institutions, authors, and co-cited authors. We then identified the trending research areas of syringomyelia by analyzing the co-occurrence of keywords and co-cited references. RESULTS: From January 2003 to August 2022, 9,556 authors from 66 countries published a total of 1,902 research articles on syringomyelia in 518 academic journals. Most publications come from the United States, China, the United Kingdom, and Japan, with the United States dominating. Nanjing University and the University of Washington are the most active institutions, Dr. Claire Rusbridge has published the most papers, and Miholat has the most co-citations. The Journal of Neurosurgery has the highest number of co-cited articles, which are mainly in the fields of neurology, surgery, and biology. High-frequency keywords included syringomyelia, Chiari-I malformation, children, surgical treatment, and spinal cord. CONCLUSIONS: The number of articles on syringomyelia has increased steadily over the past two decades. At present, research on syringomyelia is mainly focused on the age of onset, potential therapeutic interventions, surgical treatment, avoidance of recurrence, and delay of pain. The use of surgical treatment of the disease and the mechanism of further treatment are the current hot research topics. The correlation between trauma and congenital factors, translational application, the effect of surgical treatment, postoperative recurrence, and complications are further hot research areas. These may provide ideas for further research into a radical cure for syringomyelia.

Keyhole supraorbital eyebrow approach for fully endoscopic resection of tuberculum sellae meningioma.

Background: The fully endoscopic supraorbital trans-eyebrow keyhole approach is a technique utilized for the transcranial resection of tuberculum sellae meningioma (TSM). Surgery is the first choice for TSM treatment. This study aimed to summarize and analyze the safety, feasibility, limitations, and technical requirements of the fully endoscopic supraorbital trans-eyebrow keyhole approach for TSM resection. Methods: Data of 19 TSM fully endoscopic supraorbital trans-eyebrow keyhole approach resections cases (six and 13 on the left and right eyebrows, respectively) were retrospectively analyzed at the Neurosurgery Department of the First Affiliated Hospital of Bengbu Medical College (Bengbu, China) from August 2015 to March 2022. Results: All 19 patients were diagnosed with meningioma (World Health Organization grade I), and according to the scope of tumor resection (EOR), 18 patients (94.7%) had gross total resection (GTR), and one patient (5.3%) had near-total resection (NTR). Preoperative chief complaints were symptomatic visual dysfunction (n = 12), headache and dizziness (n = 6), and accidental discovery (n = 1). Postoperative visual function improved in 83.3% of cases (10/12), and headache and dizziness were relieved in 83.3% of cases (5/6 patients). Postoperative intracranial infection occurred in one case and was cured by external drainage of the lumbar cistern and anti-infective treatment. Two cases of frontal lobe injury were discharged after conservative treatment. There was no postoperative olfactory dysfunction, eyelid ptosis, cerebrospinal fluid leakage, or death. There were no reports of disease recurrence or death during the 3-month follow-up at an outpatient clinic or by telephone. Conclusion: Fully endoscopic TSM resection through the keyhole approach is safe and feasible. It can be used to explore angles that cannot be seen under a microscope and show the true value of endoscopy technology. The endoscopic equipment and technical skills of the surgeon and surgical team are important in this technique.

Analysis of neuroendoscopy for the treatment of macroadenomas and giant pituitary adenomas.

Objective: This study investigated the use and effectiveness of endoscopic transnasal, transsphenoidal surgery, a minimally invasive method for the treatment of macroadenomas and giant pituitary a denomas, in a medical setting. The surgical results of 429 patients who received neuroendoscopic treatment of macroadenomas or giant pituitary adenomas were evaluated, and the experiences and lessons learned from treatment complications were assessed. Patients and methods: From January 2012 to December 2021, 429 patients with macroadenomas or giant pituitary adenomas, including 60 patients with giant adenomas (diameter ≥4 cm) and 369 patients with macroadenomas (diameter 1-4 cm), received a 3D head CT, a MRI with contrast enhancement, and an endocrinology examination prior to surgery. Preoperative clinical and radiological features, visual measurements, hormone levels, length of stay, length of surgery, postoperative stay, visual and hormone outcomes, resection range, complication and recurrence rates, and routine patient information were recorded. The patients were followed up for 6-72 months (median = 40 months). Results: Of 429 patients with macroadenomas or giant pituitary adenomas who received neuroendoscopic treatment, 348 (81.12%) had gross-total resections (GTR), 53 (12.35%) had near-total resections (NTR), and 28 (6.53%) had subtotal resections. There were 138 cases of post-operative diabetes insipidus (32.17%), including 7 cases of permanent diabetes insipidus (1.63%), 16 cases of nasal hemorrhage (3.73%), 39 cases of intraoperative cerebrospinal fluid leakage (9.09%), 4 cases of intracranial infection (0.9%), 16 cases of hypophysis (3.7%), and 15 cases of anosmia (3.50%). The clinical symptoms and endocrinology indices of the patients improved after surgery, and all patients were discharged 5-18 days (8.36 ± 2.65) postop. Conclusion: Neuroendoscopy is a safe operation with a short recovery period and hospital stay and is thus an effective method to treat macroadenomas and giant pituitary adenomas. Preoperative evaluation and prediction can help to accurately address possible intraoperative situations and improve GTR.

Endoscope-assisted microneurosurgery for intracranial aneurysms: A systematic review and meta-analysis.

BACKGROUND: In the surgical approach to treat deep-seated intracranial lesions, endoscopes can be used to assist microsurgical operations and improve outcomes. This technique is often called endoscope-assisted microneurosurgery (EAM). This systematic review and meta-analysis aimed to evaluate the feasibility, safety, and effectiveness of EAM. METHODS: We performed a meta-analysis of relevant articles identified using PubMed, Embase, and the Cochrane Central Register to assess the efficacy of EAM according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Primary outcomes were repositioning of the definitive clip, better surgical field, the overall and endoscope-related complication rates, mortality, and the rate of follow up. RESULTS: A total of 10 studies of 1,432 patients with 1,717 aneurysms treated with EAM were included. EAM led to repositioning of the definitive clip in 13% (95% CI, 9%-17%; I2 = 72.61%; p < 0.001); 77% of aneurysms treated with endoscopically assisted vision and information had a better outcome than that with standard surgery (95% CI, 52%-95%; I2 = 97.63%; p < 0.001). There was an overall complication rate of 6% (95% CI, 1%-13%; I2 = 91.39%; p < 0.001). The incidence of endoscope-related complications was 0% (95% CI, 0%-1%; I2 = 64%; p < 0.001). The mortality was 0% (95% CI, 0-1%; I2 = 0.0%); and 94% of patients had an excellent to good recovery and good outcome (95% CI, 88%-98%; I2 = 88.42%; p < 0.001). CONCLUSIONS: Our comprehensive study showed that EAM for intracranial aneurysms is feasible, the safety of the surgery is good, and the patients have a good prognosis, Therefore, we think EAM can be more widely adopted in the future.

An m6A/m5C/m1A/m7G-Related Long Non-coding RNA Signature to Predict Prognosis and Immune Features of Glioma.

Background: Gliomas are the most common and fatal malignant type of tumor of the central nervous system. RNA post-transcriptional modifications, as a frontier and hotspot in the field of epigenetics, have attracted increased attention in recent years. Among such modifications, methylation is most abundant, and encompasses N6-methyladenosine (m6A), 5-methylcytosine (m5C), N1 methyladenosine (m1A), and 7-methylguanosine (m7G) methylation. Methods: RNA-sequencing data from healthy tissue and low-grade glioma samples were downloaded from of The Cancer Genome Atlas database along with clinical information and mutation data from glioblastoma tumor samples. Forty-nine m6A/m5C/m1A/m7G-related genes were identified and an m6A/m5C/m1A/m7G-lncRNA signature of co-expressed long non-coding RNAs selected. Least absolute shrinkage and selection operator Cox regression analysis was used to identify 12 m6A/m5C/m1A/m7G-related lncRNAs associated with the prognostic characteristics of glioma and their correlation with immune function and drug sensitivity analyzed. Furthermore, the Chinese Glioma Genome Atlas dataset was used for model validation. Results: A total of 12 m6A/m5C/m1A/m7G-related genes (AL080276.2, AC092111.1, SOX21-AS1, DNAJC9-AS1, AC025171.1, AL356019.2, AC017104.1, AC099850.3, UNC5B-AS1, AC006064.2, AC010319.4, and AC016822.1) were used to construct a survival and prognosis model, which had good independent prediction ability for patients with glioma. Patients were divided into low and high m6A/m5C/m1A/m7G-LS groups, the latter of which had poor prognosis. In addition, the m6A/m5C/m1A/m7G-LS enabled improved interpretation of the results of enrichment analysis, as well as informing immunotherapy response and drug sensitivity of patients with glioma in different subgroups. Conclusion: In this study we constructed an m6A/m5C/m1A/m7G-LS and established a nomogram model, which can accurately predict the prognosis of patients with glioma and provides direction toward promising immunotherapy strategies for the future.

Case Report: Langerhans Cell Sarcoma With Intracranial and Extracranial Communication on the Left Frontal Bone.

Background: Langerhans cell sarcoma (LCS) is an extremely rare type of malignant tumor that originates from Langerhans cells (LC). It is characterized by the malignant proliferation and dissemination of LC and is extremely invasive, with rapid progression and a poor prognosis. Treatment includes resection of lesions, radiotherapy, chemotherapy, immunotherapy, and transplantation of hematopoietic stem cells. However, a unified and optimized treatment plan is lacking, and individualized treatment is accepted. Case presentation: We report an 18-year-old man with intracranial and extracranial communicative LCS that occurred in only the left forehead without metastasis to other regions. Clinical and hematological data were normal. We undertook complete resection of diseased tissue, which was pathologically examined. Staining (hematoxylin and eosin) showed positivity for cluster of differentiation (CD)1a (++), S-100 protein (++), P53 (++), CD68 (+), cyclin D1 (+), cyclin A (+), cyclin B1 (+), IGF2BP3 (+), and Ki-67 (45%-50%). Recurrence or metastasis were not observed after long-term follow-up. Conclusion: LCS is a rare malignant tumor, and one that occurs with intracranial and extracranial communication is even rarer. Active adoption of an individualized treatment plan is crucial.

Hereditary intraspinal schwannomatosis with SMARCB1 gene mutation: A case report.

BACKGROUND: Schwannomatosis is the third subtype of neurofibromatosis. Schwannomatosis, particularly the familial variant, is uncommon. Recently, germline mutations of the SMARCB1 gene have been found to cause schwannomatosis. In this report, we describe a case of familial inherited intraspinal schwannomatosis. Postoperative pathology indicated a schwannoma. The results of gene testing showed that the SMARCB1 gene had a spliced mutation. CASE DESCRIPTION: A patient with a rare case of familial intraluminal schwannomatosis was admitted to our hospital. Peripheral blood gene testing was performed on the patient and her son, and a splice mutation of the SMARCB1 gene located at C. 1118+1G>A on intron 8 was identified. CONCLUSIONS: Schwannomatosis is an incomplete dominant autosomal dominant genetic disorder. The structural and functional abnormalities of proteins caused by mutations in the SMARCB1 gene may be the molecular basis for familial schwannomatosis.

Keyhole Approach for Clipping Anterior Circulation Aneurysms: Clinical Outcomes and Technical Note.

Purpose: Keyhole craniotomy is a minimally invasive approach for the treatment of anterior circulation aneurysm. In this study, we evaluated the benefits and value of the keyhole approach by analyzing the surgical results in 235 patients with anterior circulation aneurysm treated by the keyhole approach and identifying lessons learned from addressing various complications in this approach. Patients and Methods: This was a retrospective study in a single institution of 235 surgical patients with 248 anterior circulation aneurysms who had the supraorbital keyhole approach (SKA) or pterional keyhole approach (PKA) between January 2016 and January 2021. The modified Rankin Scale (mRS) was used to measure long-term results during follow up. Results: All 235 patients' aneurysms were fully clamped and have not recurred. Among them, 31 (13.2%) had intraoperative aneurysm rupture, 8 (3.4%) had cerebral vascular spasm, and 4 (1.7%) had intraoperative brain edema. There were seven (3.0%) cases of postoperative infection, eight (3.4%) cases of postoperative cerebral infarction, one (0.4%) case of postoperative hematoma, and two (0.8%) patients had some form of cognitive impairment after surgery. Follow up after surgery demonstrated that 189 out of the 235 patients (80.4%) had favorable outcomes (mRS score 0-2), and 43 (18.3%) had poor outcomes (mRS from 3-5). There were three deaths (1.28%). Conclusions: The keyhole approach has a quick postoperative recovery, a mild postoperative response, and a good surgical outcome. Our findings indicate that the keyhole approach is a safe and effective surgical method for the treatment of anterior circulation aneurysm.

Primary ectopic parasellar craniopharyngioma: a case report.

BACKGROUND: Craniopharyngioma (CP) is a slow-growing, benign tumor of the central nervous system located within the sellar and suprasellar regions. The tumor may extend from the suprasellar region to other areas. CPs are generally believed to originate from squamous remnants of an incompletely involuted craniopharyngeal duct that also develops from Rathke's pouch. Primary parasellar craniopharyngioma is a relatively rare tumor, and nasal endoscopy, computed tomography, and enhanced magnetic resonance imaging can be applied to better evaluate the invasiveness and characteristics of these tumors. CASE PRESENTATION: We report a case of right parasellar craniopharyngioma in a 49-year-old female patient with a 10-day history of dizziness and blurred vision. Preoperative imaging examination revealed right parasellar space-occupying lesions, and the patient underwent transnasal neuroendoscopic resection of the right parasellar space-occupying lesion. The postoperative pathological result confirmed craniopharyngioma. CONCLUSIONS: Primary ectopic parasellar craniopharyngioma is a relatively rare tumor, and preoperative imaging examination can assist in the evaluation of tumor characteristics. However, the final diagnosis continues to depend on the histopathological results.

Cushing's Disease Caused by a Pituitary Microadenoma Coexistent with a Meningioma: A Case Report and Literature Review.

Cushing's disease (CD), also known as adrenocorticotropic hormone (ACTH)-dependent pituitary Cushing's syndrome, is a rare and serious chronic endocrine disease that is usually caused by a pituitary adenoma (especially a pituitary microadenoma). Meningioma is the most common type of primary intracranial tumor and is usually benign. The patient in this case report presented with CD coexisting with pituitary microadenoma and meningioma, which is an extremely rare comorbidity. The pathogenesis of CD associated with meningioma remains unclear. Here, we describe the case of bilateral lower extremity edema, lower limb pain, abdominal purplish striae, and abdominal distension for 9 months in a 47-year-old woman. Two years ago, the patient underwent a hysterectomy at a local hospital for hysteromyoma. She had no previous radiotherapeutic treatment or other medical history. Magnetic resonance imaging of her head revealed a sellar lesion (7.8 mm × 6.4 mm) and a spherical mass (3.0 cm × 3.0 cm) in the right frontal convexity. Her level of serum adrenocorticotropic hormone (ACTH) was 169 pg/mL, and her cortisol levels were 933 nmol/mL and 778 nmol/mL at 8 am and 4 pm, respectively. Preoperatively, she was diagnosed with ACTH-secreting pituitary microadenoma and meningioma. Excision of the meningioma was performed through a craniotomy, while an endoscopic endonasal transsphenoidal approach was used to remove the pituitary adenoma. Meningioma and pituitary adenoma were confirmed by postoperative pathology. On the basis of this unusual case, the relevant literature was reviewed to illustrate the diagnosis and treatment of Cushing's disease and to explore the pathogenesis of pituitary adenoma associated with meningioma.

Intracranial Primary Malignant Solitary Fibrous Tumor/Hemangiopericytoma Masquerading as Meningioma: Report of a Rare Case.

BACKGROUND: Intracranial solitary fibrous tumors/hemangiopericytomas (SFTs/HPCs) are rare spindle cell tumors originating from interstitial tissue that are usually benign. Primary malignant intracranial SFTs/HPCs are extremely rare. Here we describe a case of malignant intracranial SFT/HPC. CASE PRESENTATION: A 59-year-old woman presented with a space-occupying lesion in the left cerebellar tentorium. Based on imaging findings, we made a preoperative diagnosis of meningioma. During the operation, we found that the tumor had an abnormally rich blood supply and could not be completely removed. Histologic findings, immunophenotype (positive for cluster of differentiation [CD]34, CD99, signal transducer and activator of transcription 6, and B cell lymphoma 2), and a Ki-67 proliferative index of 20-30% for the primary tumor were typical of malignant intracranial SFT/HPC. The tumors showed high sensitivity to radiotherapy and the residual tumor was significantly reduced after intensity-modulated radiation therapy. The patient has had no neurologic symptoms and no recurrence of the tumor in 2 years of follow-up. CONCLUSION: Intracranial SFTs/HPCs are extremely rare. Radiologic examination before the operation is helpful for making a definite diagnosis and judging tumor grade; STAT6 immunohistochemistry is a sensitive alternative diagnostic method. Adjuvant radiotherapy is effective in cases of incomplete resection, and strict follow-up is essential in order to monitor for possible recurrence.

Endoscopic Vascular Decompression for the Treatment of Trigeminal Neuralgia: Clinical Outcomes and Technical Note.

PURPOSE: Microvascular decompression (MVD) surgery is considered as an effective method with which to treat trigeminal neuralgia (TN). However, sometimes MVD surgery fails due to incomplete decompression of the responsible vessels caused by a poor visual field. In this study, we evaluated the benefits of endoscopic visualization and the value of full endoscopic vascular decompression (EVD) by describing the surgical results of 20 patients with TN after EVD. PATIENTS AND METHODS: This was a retrospective study in a single institution of 20 patients with TN who received EVD between April 2018 and October 2019. All patients underwent EVD via the suboccipital retrosigmoid approach without microscopy at any stage. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEPs) were routinely monitored throughout the procedure. Follow-up was conducted by outpatient and telephone interviews. The degree of facial pain was graded using the Barrow Neurological Institute (BNI) pain intensity score; a BNI of 1 was considered as the best result while a BNI of 2 or 3 was considered as a satisfactory result. Follow-up time ranged from 8 to 24 months, with a mean of 18±4.36 months. RESULTS: All 20 patients with severe preoperative pain (BNI of 5) achieved immediate relief or complete control of pain after surgery (BNI of 1 to 2). Vascular conflicts were observed during surgery in all of the patients. None of the patients experienced hearing loss, facial paralysis, intracranial infection, cerebrospinal fluid leakage, cerebral hemorrhage, or death, following the operation. CONCLUSION: When carried out by surgeons with endoscopic experience, EVD can provide a clear surgical field of view and reduce the risk of surgical injury. Our findings indicate that EVD is a safe and effective surgical method for the treatment of TN.

Pituitary inflammatory pseudotumor with amenorrhea, polyuria, and impaired vision: case report and review of the literature.

BACKGROUND: Inflammatory pseudotumor (IPT) is a soft tissue lesion of unknown etiology. In 2002 the WHO classified it as a soft tissue tumor, and renamed it inflammatory myofibroblastic tumor. Inflammatory pseudotumor may involve various organs and tissues of the body, mainly the lungs and eyes. Primary intracerebral inflammatory pseudotumor is rare. If the differential diagnosis of IPT is made, surgical treatment can be avoided and the patient's trauma and risk can be reduced. CASE SUMMARY: We present a case of a 25-year-old female who presented with amenorrhea, galactorrhea, polydipsia, and polyuria. Magnetic resonance image (MRI) demonstrated a tumor (15 mm in diameter) with suprasellar extension, optic nerve compression, and pituitary stalk involvement. Preoperative examination showed a large increase in prolactin and laboratory data showed elevation of the erythrocyte sedimentation rate, but other data were within normal ranges. We applied a lateral transfrontal approach by microscopic resection of the endplate saddle area, because it was large. Postoperative pathology confirmed IPT. Small doses of hormone and thyroxine were given after surgery, and most of the tumor was resected after re-examination. Two years after the operation, no recurrence or other abnormalities were found. CONCLUSION: Attention should be paid to the differential diagnosis of inflammatory pseudotumor of pituitary. Steroid hormone therapy can be used first to observe its effect. It can reduce the harm caused by invasive operation.

Primary spinal cord melanocytoma: a case report and review of literature.

BACKGROUND: Primary spinal cord melanocytoma is an extremely rare condition and the pathogenesis of melanocytomas remains unclear. The diagnosis and treatment of primary spinal cord melanocytomas does not have a standard method. CASE PRESENTATION: We present a case of a 73-year-old male who presented with a six-month history of progressive numbness and weakness in his lower extremities without gatism. Spinal magnetic resonance image (MRI) revealed a spinal cord tumor at the level of T10-T11. At surgery, the spinal cord was covered with black-brown neoplastic tissue. There were no metastatic lesions. At one year after surgery, the patient is still alive. CONCLUSIONS: The diagnosis of melanocytoma needs to take a comprehensive consideration and surgical resection is still the best treatment.

Postoperative Complications of Endoscopic Versus Microscopic Transsphenoidal Pituitary Surgery: A Meta-Analysis.

Transsphenoidal microscopic pituitary surgery is an effective way of treating pituitary tumors. However, minimal invasive approach endoscopic transsphenoidal pituitary surgery has become much more prevalent these days. Endoscopic surgery resects the maximum tumour with less complications. As endoscopic surgery is much safer and less invasive as compared to the microscopic transsphenoidal surgery, selection of technology for the treatment of pituitary adenoma is becoming increasingly equivocal. The main aim of this systematic review was to assess the safety of endoscopic and microscopic transsphenoidal pituitary surgery in terms of postoperative complications. Relevant studies between January 1992 and January 2017 were searched in the Cochrane Library electronic databases, EMBASE and MEDLINE, through a systematic literature search. A total of 1,463 patients reviewed (microscopic group=684, endoscopic group=779), the proportion of diabetes insipidus, septal perforation and other complications related to surgery (include lip anesthesia, nasal anesthesia, deviated septum, saddle nose, sinusitis, synechiae, anosmia) in those patients who had endoscopic surgery were significantly lower (p<0.05). No significant difference emerged between the two approaches in the incidence rates of cerebrospinal fluid leak, meningitis, epistaxis or hypopituitarism (p>0.05). These results support the safety of endoscopic transsphenoidal pituitary adenoma surgery.

Relationship between expression of vascular endothelial growth factor and the proliferation of prolactinomas.

OBJECTIVE: Prolactinomas are the most common functional hormone-producing pituitary lesions, accounting for 30-40% of all pituitary tumors, while in autopsy series their incidence reaches 50%. However, patients with prolactinoma had a higher recurrence percentage and rate than patients with acromegaly or Cushing's disease. Furthermore, prolactinomas have the highest rate of recurrence post-surgery as compared with other pituitary adenomas. At present, this behavior of prolactinoma is largely unexplained, but may be related to definition of cure, or to more frequent microscopic tumor infiltration into normal pituitary tissue, which is not removed at surgery. Many factors may influence the proliferation of pituitary adenomas, such as angiogenesis, apoptosis, growth factors, oncogenes, tumor suppressor genes, and hormone receptors. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis and vascular permeability of various brain tumors. But, little is known about the role of VEGF expression in the process of the growth of prolactinomas. The purpose of this study is to investigate the relationship between VEGF expression and the growing of prolactinomas. METHODS: VEGF expression was assessed by reverse transcriptase polymerase chain reaction (RT-PCR) in 18 prolactinomas. Clinical factors to investigate were age, gender, hormonal functioning, and radiological findings of pituitary adenomas. Radiological findings which were investigated by magnetic resonance (MR) images were tumor size. The relationship between these factors and VEGF expression was statistically analyzed. RESULTS: VEGF was expressed in all cases (100%). VEGFA mRNA and VEGFB mRNA were expressed in all examined pituitary adenomas; the mean expression level of VEGFA mRNA was 8.67±1.59; and the mean expression level of VEGFB mRNA was 10.01±2.67. There was no significant difference in the VEGFA mRNA and VEGFB mRNA expression level among the adenomas we examined(P=0.24). There was no significant correlation between VEGFA and VEGFB mRNA expression and patient age, gender, and tumor size. However, The expression of VEGFA mRNA significantly (P<0.001)decreased in tumor groups compared to the control groups. And the expression of VEGFB mRNA significantly (P<0.05) decreased in tumor groups compared to the control groups as well. CONCLUSIONS: This study suggests that angiogenesis in prolactinomas may not be primarily mediated by VEGF pathway, and low level of VEGF expression may not always have significant influence in prolactinomas with a higher recurrence percentage and rate.

Analysis of differential gene expression in plurihormonal pituitary adenomas using bead-based fiber-optic arrays.

Plurihormonal pituitary adenomas (PHPAs) are defined as those pituitary adenomas secreting two or more hormones that differ in chemical composition, immunoreactivity, and biologic effects. Since the pathogenesis of these adenomas is not well understood, our study aimed to explore mechanisms underlying the pathogenesis of PHPAs. We used bead-based fiber-optic arrays (Illumina Human GeneChip WG-6 v3.0) to examine the gene expression profiles in seven PHPAs compared with three normal pituitary glands. Four differentially expressed genes were chosen randomly for validation by quantitative real-time reverse-transcription polymerase chain reaction. We then performed pathway analysis of all differentially expressed genes using the Kyoto Encyclopedia of Genes and Genomes. Our array analysis showed significant increases in the expression of 6 genes and decreases in 334 genes and 15 expressed sequence tags in the PHPAs. Bioinformatic analysis showed that genes HIGD1B, EPS8, ECT2, and BTG2 might play an important role in the tumorigenesis and progression of PHPAs. Pathway analysis showed that the p53 and Notch signaling pathways may play an important role in tumorigenesis and progression of PHPAs, and extracellular matrix (ECM)-receptor interactions likely play a role in the inhibition of invasion and metastasis in these tumors. Our data suggested that there are numerous aberrantly expressed genes and pathways involved in the pathogenesis of PHPAs. Bead-based fiber-optic arrays combined with pathway analysis of gene expression data appears to be a valid method for investigating the pathogenesis of tumors.

Analysis of differential gene expression using fiber-optic bead array and pathway analyses in pituitary adenomas.

Pituitary adenomas are commonly occurring, benign neoplasms that account for 15% of intracranial neoplasms but their pathogenesis remains elusive. To explore the possible pathogenesis of pituitary adenomas, we used fiber-optic bead arrays to compare the gene expression profiles in five major pituitary adenoma subtypes to normal pituitary gland from three recently deceased males. We used reverse transcriptase-real time quantitative polymerase chain reaction (RT-qPCR) to randomly validate the expression of four differentially expressed genes in the five pituitary adenoma subtypes and three normal pituitary glands. We then analyzed the profiles of the differentially expressed genes using the Kyoto Encyclopedia of Genes and Genomes pathways. Array analysis showed that 129 genes and two expressed sequence tags were differentially co-expressed in all pituitary adenomas. Pathway analyses showed that the extracellular matrix-receptor interaction pathway and the transforming growth factor-beta signaling pathway may have an important role in tumorigenesis of the five pituitary adenoma subtypes. Thus, we suggest the presence of a common mode of pathogenesis in pituitary adenoma subtypes. Fiber-optic bead array analysis combined with pathway analysis of differentially expressed genes appears to be a valid method of investigating the pathogenesis of different tumors.

Analysis of differential gene expression by fiber-optic BeadArray and pathway in prolactinomas.

Prolactinomas are the most common secretory pituitary tumors; however, their pathogenesis is unclear. In order to explore the pathogenesis of prolactinomas, we used fiber-optic BeadArray to examine gene expression profiles in five prolactinomas compared with three normal pituitaries. Three down-regulated genes and one up-regulated gene were chosen for validation by quantitative real-time reverse-transcription polymerase chain reaction. We then performed pathway analysis on the identified differentially expressed genes using the Kyoto Encyclopedia of Genes and Genomes. Array analysis showed significant increases in the expression of 27 genes and 3 expressed sequence tags (ESTs), and decreases in 182 genes and 9 ESTs, including HIG1 domain family, member 1B, S100 calcium binding protein A9, angiopoietin 2, interleukin 8, hydroxyprostaglandin dehydrogenase 15-(NAD), suppression of tumorigenicity18, and WNT inhibitory factor 1. Pathway analysis showed that the P53 and GnRH signaling pathways may play an important role in tumorigenesis of prolactinomas. Our data suggest fiber-optic BeadArray combined with pathway analysis of differential gene expression profile appears to be a valid approach for investigating the pathogenesis of tumors.