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1.
Eur J Endocrinol ; 181(3): 95-105, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32530258

RESUMO

CONTEXT: Association of central diabetes insipidus (CDI) and pituitary stalk thickening (PST) may have several etiologies (including malignancies) and differential diagnosis remains often difficult. OBJECTIVE: The purpose of this study was to identify which clinical, biochemical or radiological features could help clinicians to make an etiological diagnosis, especially distinguishing neoplastic from non-neoplastic pituitary stalk lesions. DESIGNS AND METHODS: We retrospectively analyzed clinical, biochemical, radiological and histological data of 38 adult patients diagnosed with CDI and PST of proven etiology. RESULTS: Of the 38 pituitary stalk lesions included, 11 (29%) were neoplastic. A histopathological diagnosis was obtained in 22/38 (58%) patients. The three most frequently observed etiologies of PST were neuroinfundibulitis (34%), germinoma (21%) and histiocytosis (18%). Pituitary stalk thickness was larger for neoplastic lesions, particularly germinomas. Male gender and a very young age were statistically associated with a risk of germinoma. At least one anterior pituitary deficit was observed in nearly 60% of patients. Patients with neoplastic PST were more affected by multiple anterior pituitary dysfunction than patients with benign PST. A high serum prolactin level was individually the best predictor of a neoplastic origin (90% sensitivity and 60% specificity for a serum prolactin level 1.27-fold above the normal upper limit (ULN)). CONCLUSION: We confirm a relatively high risk of malignancy in adult patients presenting with the association of CDI and PST. Young age, male gender, a very large thickening of the stalk, multiple anterior pituitary deficits and prolactin above 1.3× ULN increase the likelihood of a neoplastic origin.


Assuntos
Diabetes Insípido Neurogênico/patologia , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Adulto , Fatores Etários , Idoso , Diabetes Insípido Neurogênico/diagnóstico por imagem , Feminino , Germinoma/complicações , Germinoma/patologia , Histiocitose/complicações , Histiocitose/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais
3.
World Neurosurg ; 137: 281-285, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32081825

RESUMO

BACKGROUND: Pituitary abscesses within pre-existing pituitary conditions, such as craniopharyngioma, pituitary adenoma, or Rathke cleft cyst, are quite rare. A case of pituitary abscess secondary to adenoma is presented, and the literature is reviewed. CASE DESCRIPTION: An 11-year-old boy presented with a 3-day history of sudden-onset headache and visual loss. Magnetic resonance imaging demonstrated a sellar region lesion with intralesional hemorrhage. Preoperative diagnosis was pituitary adenoma with apoplexy. An endoscopic transnasal transsphenoidal approach was used for emergent total tumor resection. Pathology confirmed the diagnosis of pituitary adenoma with apoplexy and inflammation, and microbiologic examination was positive for Staphylococcus aureus. CONCLUSIONS: Secondary pituitary abscess is a rare entity, and preoperative diagnosis is challenging. The treatment strategy includes prompt surgical resection and drainage of the abscess, followed by prolonged antibiotic therapy.


Assuntos
Adenoma/complicações , Abscesso Encefálico/etiologia , Procedimentos Neurocirúrgicos , Apoplexia Hipofisária/complicações , Neoplasias Hipofisárias/complicações , Sinusite Esfenoidal/complicações , Infecções Estafilocócicas/etiologia , Doença Aguda , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Antibacterianos/uso terapêutico , Abscesso Encefálico/patologia , Abscesso Encefálico/terapia , Criança , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/patologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/terapia , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Transtornos da Visão/etiologia
4.
Med Sci Monit ; 26: e919565, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31904008

RESUMO

BACKGROUND Controversies exist in imaging modalities for predicting adenoma consistency. In this study, we proposed a method of predicting consistency by magnetic resonance T2-sequence imaging based on adenoma to cerebellar peduncle signal (TCTI) ratio. MATERIAL AND METHODS Between January 2013 and May 2017, 191 consecutive patients with pituitary adenoma diagnosed at our institution were retrospectively studied. The consistency grade for each lesion was assigned. And the TCTI ratio based on preoperative and postoperative T2-weighted imaging was calculated. RESULTS The median TCTI ratio was 1.55, 1.28, and 1.25 for soft, fibrous, and hard adenomas, respectively. The differences were significant for all groups (p<0.001). A cutoff value of 1.38 for soft adenomas was found to be 80.2% sensitive and 88.7% specific. The median ratio of the outermost layer of residual tumor was 1.25 (SD±0.408, 95% CI 1.27-1.42). It was less than that ratio of the upper, lower quarter, and middle region of adenoma, respectively, and the inter-group differences were all statistically significant with p≤0.001. The extent of resection for the soft group was significantly greater than that of the hard group (85.3% vs. 70.6%, p=0.011). Analysis of Variance (ANOVA) revealed that the consistency grade was the influencing factor of degree of resection. p=0.003. CONCLUSIONS The TCTI ratio showed a good correlation with pituitary adenoma consistency. We also determined the optimal ratio of the residual adenoma.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adulto , Idoso , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Pedúnculo Cerebelar Médio/metabolismo , Neoplasias Hipofisárias/metabolismo , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
5.
World Neurosurg ; 134: 293-296, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715411

RESUMO

BACKGROUND: When medical devices and equipment in an operating room are connected to a network, vast amounts of data concerning the progress of the operation and the patient's condition can be comprehensively processed to improve the precision and safety of the surgical procedure. To make this possible, a next-generation networked operating room, "Smart Cyber Operating Theater" (SCOT), has been developed with medical-engineer cooperation. SCOT integrates stand-alone medical devices using the "OPeLiNK" communication interface. Using OPeLiNK, medical devices are connected and various data, such as intraoperative magnetic resonance imaging, neuromonitoring, biochemical monitoring, and navigation system, are integrated and displayed in the same timeline. CASE DESCRIPTION: The authors succeeded in clinical tumor resection via the endoscopic endonasal approach using the SCOT system in a 79-year-old man with a large nonfunctioning pituitary adenoma. The surgeons performed the operation while sharing information in real time between all staff in the operating room and supervising expert surgeons at the surgical strategy desk. Any decisions, such as intraoperative surgical procedures, were made with discussion between the operating room and the surgical strategy desk. The patient's postoperative course was uneventful. CONCLUSIONS: This is the first case report of endoscopic endonasal approach performed successfully in the SCOT. Further developments in this technology may lead to innovations in not only microscopic neurosurgery but also endoscopic neurosurgery.


Assuntos
Adenoma/cirurgia , Cuidados Intraoperatórios/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Invenções , Neuroendoscopia/métodos , Salas Cirúrgicas , Neoplasias Hipofisárias/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Idoso , Hemianopsia/etiologia , Humanos , Cuidados Intraoperatórios/instrumentação , Monitorização Neurofisiológica Intraoperatória/instrumentação , Imagem por Ressonância Magnética , Masculino , Cavidade Nasal , Neuroendoscopia/instrumentação , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem
6.
World Neurosurg ; 133: e711-e715, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589983

RESUMO

BACKGROUND: Transsphenoidal surgical approaches involve dissection of the posterior wall of the sphenoid sinus in close proximity to the internal carotid arteries. To reduce the risk of vascular injury, a detailed study of embalmed cadavers' sellae was conducted and found the internal carotid artery approached within 4 mm of the midline in 10% of cases, and the closest intercarotid distance (ICD) occurred in the cavernous sinus, sphenoid sinus, and supraclinoid segments in 82%, 14%, and 4% of cases, respectively. These measurements have not previously been compared with living patients with modern imaging techniques. METHODS: This study measured the closest ICD of 233 coronal magnetic resonance imaging head scans from 183 patients (male = 88, female = 95) at the cavernous sinus, sphenoid sinus, or supraclinoid segments of the internal carotid artery. ICD at the sphenoid sinus was taken for all scans. RESULTS: The internal carotid approached within 4 mm of the midline in 1.3% of cases. The closest ICD occurred in the cavernous sinus, sphenoid sinus, and supraclinoid segments in 24.5%, 35.8%, and 39.7%, respectively. Both results were significantly different from previous cadaveric studies (chi-squared tests, P = 1.4 × 10-4 and P = 6.1 × 10-8, respectively). CONCLUSIONS: Surgically relevant measurements of the carotid arteries in the sellar are different in cadavers and living subjects. This is likely due to postmortem changes of surrounding structures. This study suggests clinically relevant anatomic studies using measurements taken from cadaveric specimens be updated with modern imaging techniques taken from living patients.


Assuntos
Artéria Carótida Interna/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/anatomia & histologia
7.
World Neurosurg ; 133: 260-265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605847

RESUMO

BACKGROUND: Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION: A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS: This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.


Assuntos
Adenoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neuroendoscopia/métodos , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
World Neurosurg ; 133: 56-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568904

RESUMO

BACKGROUND: Spindle cell oncocytomas (SCOs) are rare neuroendocrine tumors of the posterior pituitary that are often misdiagnosed as nonfunctional pituitary tumors. Fewer than 50 cases of SCOs have been described in the literature, and many of these reports have documented the tumors to be hypervascular on imaging or histology. CASE DESCRIPTION: We present the first cerebral angiography imaging findings of an SCO before primary resection. The discovery of a prominent tumor blush, enlarged meningohypophyseal feeders bilaterally, and prominent tumor draining veins aided in preoperative planning and subsequent successful endoscopic transsphenoidal surgical resection. CONCLUSIONS: Despite being a rare entity, SCOs should be included in the differential diagnosis when working up a hypervascular sellar tumor. Flow voids may be present on initial magnetic resonance imaging evaluation. Subsequent digital subtraction angiography can be used to further investigate abnormal vasculature and aid in surgical planning.


Assuntos
Adenoma Oxífilo/diagnóstico por imagem , Neuro-Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma Oxífilo/cirurgia , Angiografia Digital , Angiografia Cerebral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuro-Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia
9.
World Neurosurg ; 133: e241-e251, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505289

RESUMO

BACKGROUND: Cystic sellar masses (CSMs) pose diagnostic and therapeutic challenges associated with subtotal cyst wall resection, cerebrospinal fluid (CSF) leak repair, and disease recurrence. Current magnetic resonance imaging (MRI) interpretation often cannot reliably differentiate CSMs, mandating adaptable intraoperative strategies. We reviewed our diagnostic and therapeutic experience after endoscopic endonasal approaches (EEAs) for CSMs. METHODS: A retrospective record review of patients with CSM managed via EEA at the University of Southern California from 2011 to 2018 was conducted. Patient demographics, preoperative characteristics, surgical details, pathologic findings, and postoperative outcomes were assessed. RESULTS: Analysis included 47 patients (mean age, 43.2 years); of these, 78.7% were women. Preoperative symptoms included headache (76.6%) and vision loss (42.6%). Histologically verified sellar pathology included 27 Rathke cleft cysts (RCCs) (57.4%), 17 cystic pituitary adenomas (CPAs) (36.2%), 2 arachnoid cysts (4.3%), and 1 xanthogranuloma (2.1%). Twelve patients (70.6%) with CPAs underwent complete resection and 5 (29.4%) underwent subtotal resection. All 27 patients with RCC and 2 patients with arachnoid cyst underwent complete fenestration and drainage. One xanthogranuloma was completely resected. There were 14 intraoperative (29.8%) and 4 postoperative CSF leaks (8.5%). Headaches, vision, and endocrinopathy improved in 69.2%, 80.0%, and 33.3% of patients with CPA and 73.9%, 71.4%, and 40.9% of patients with RCC, respectively. There were 2 RCC recurrences and 1 CPA recurrence over the follow-up period. CONCLUSIONS: Surgeons must prepare for versatile management strategies of CSMs based on pretest probability associated with MRI and intraoperative findings. Outcomes after EEA for CSMs show low complication profiles and excellent rates of headache and visual improvement, albeit lower rates of endocrine normalization.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Neuroimagem/métodos , Sela Túrcica , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem , Fadiga/etiologia , Feminino , Cefaleia/etiologia , Humanos , Hipopituitarismo/etiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/cirurgia , Transtornos da Visão/etiologia , Xantomatose/complicações , Xantomatose/diagnóstico , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
10.
Clin Nucl Med ; 45(1): e65-e66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31524674

RESUMO

A 69-year-old man presented with lower urinary tract symptoms and prostate biopsy showed prostate cancer. F-Fluciclovine PET/CT revealed abnormal increased radiotracer uptake within the prostate gland, and multiple osseous structures, suspicious for tumoral involvement. Incidentally, an expansile soft tissue density mass arising from sella turcica demonstrated increased radiotracer activity. MRI showed a lobulated enhancing mass centered in the sella and eroding into the sphenoid sinus. The differential diagnosis includes pituitary macroadenoma versus prostate cancer metastasis. The tumor was resected and the pathological diagnosis was pituitary adenoma.


Assuntos
Adenoma/diagnóstico por imagem , Ácidos Carboxílicos , Ciclobutanos , Neoplasias Hipofisárias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Adenoma/patologia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/patologia , Neoplasias da Próstata/secundário
11.
Radiol Med ; 125(3): 319-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863360

RESUMO

Hypophysitis (HP) is a rare acute or chronic inflammatory condition of the pituitary gland. The greatest challenge in the management of HP is establishing a diagnosis through clinical criteria and non-invasive methods and predicting the patients' clinical outcome. The aim of this review is to describe the neuroradiological findings of this rare disease, providing some information regarding the possible differential diagnosis in order to avoid unnecessary surgery. Gadolinium-enhanced pituitary magnetic resonance imaging (MRI) is considered the neuroradiological investigation of choice. The features suggestive for HP include an enlarged triangular- or dumbbell-shaped gland with a thickened and not obviously deviated stalk, further supported by the absence of posterior pituitary bright spot on T1weighted images, particularly in patients presenting with diabetes insipidus. Contrast enhancement pattern is quite variable; dural enhancement has been reported in some cases after intravenous contrast administration. The characterization of the unusual sellar mass is not straightforward and generally results in a wide differential. HP should be primarily differentiated from pituitary adenomas (including pituitary apoplexy), from pituitary metastases, and from other sellar and parasellar tumors, e.g., craniopharyngiomas, germinomas, gliomas, lymphomas, meningiomas, pituicytomas, chordomas, teratomas, dermoids and epidermoids, Rathke's cleft cysts, and abscesses. In patients suspected for secondary forms related to systemic pathology, additional imaging is helpful in identifying other involved sites. Neuroradiologists need to know MRI appearance of this rare disease, as well as its typical symptoms and serological markers. A strict collaboration with endocrinologists and neurosurgeons is mandatory in order to reach a definitive diagnosis, allowing to promptly initiating an appropriate treatment.


Assuntos
Hipofisite/diagnóstico por imagem , Imagem por Ressonância Magnética , Neurorradiografia , Hipófise/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Hipofisite Autoimune/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Gadolínio , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
12.
Clin Nucl Med ; 45(2): 151-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876824

RESUMO

A 72-year-old woman had undergone a right mastectomy for breast cancer 3 years earlier. PET/CT revealed a tumor with bony destruction of the skull base and FDG accumulation (SUVmax, 7.86). MRI showed the well-circumscribed tumor in the sphenoid sinus. The possibility of bone metastasis could not be denied. Tumor removal surgery was performed; the tumor was separate from the normal pituitary gland, and an ACTH-producing ectopic pituitary adenoma was diagnosed pathologically.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Compostos Radiofarmacêuticos , Base do Crânio/diagnóstico por imagem
13.
World Neurosurg ; 136: 78-82, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31874293

RESUMO

BACKGROUND: Pituicytoma is a rare neoplasm arising in the sellar region (World Health Organization grade I). Clinically, pituicytomas mimic nonfunctioning pituitary macroadenomas and are occasionally incidentally discovered at autopsy. Pituitary adenomas can occur with other sellar pathologies, and the term "collision sellar lesions" has been coined for this rare entity. There have only been a few reports of the coexistence of pituicytoma and pituitary adenoma. We present 2 cases of pituicytoma coexisting with acromegaly and Cushing disease. CASE DESCRIPTION: Case 1: A 29-year-old woman had acromegaly. The macroadenoma was partially removed in her first surgery; thus an endonasal reoperation was required for debulking and posterior radiosurgery. Pituicytoma coexisting with somatotropinoma was diagnosed on pathologic examination. Case 2: A 33-year-old woman had adrenocorticotropic hormone-dependent Cushing disease. She underwent endonasal resection. Undetectable postoperative cortisol levels provided evidence that the underlying adrenocorticotropic hormone source was successfully removed. On the basis of morphologic features and the immunohistochemical profile, pituicytoma was diagnosed on pathologic examination. Pituitary adenoma was not confirmed histologically in this patient. CONCLUSIONS: Only 117 cases of pituicytoma have been reported since it was first described in 1955. Before our report, only 5 cases of patients with pituicytoma coexisting with pituitary adenoma had been described. The coexistence of these 2 entities may not just be a mere coincidence but may be due to a yet unknown pathophysiologic link or common progenitor lineage of both lesions. Association between pituicytoma and pituitary adenoma is increasingly being reported.


Assuntos
Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Neoplasias Primárias Múltiplas/patologia , Hipersecreção Hipofisária de ACTH/patologia , Neuro-Hipófise/patologia , Neoplasias Hipofisárias/patologia , Adulto , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Imagem por Ressonância Magnética , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Hipersecreção Hipofisária de ACTH/diagnóstico por imagem , Hipersecreção Hipofisária de ACTH/cirurgia , Neuro-Hipófise/diagnóstico por imagem , Neuro-Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia
14.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 819-825, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795542

RESUMO

Objective: To investigate magnetic resonance imaging (MRI) characteristic and differential diagnostic keypoints of common sellar regional cystic lesions with the purpose of improving differential diagnostic accuracy. Methods: In total, 174 cases of the pathologically diagnosed cystic lesions in sellar region between March 2016 and June 2019 were included in the current retrospective analysis. These cases included Rathke's cleft cyst (n=68), craniopharyngioma (n=48), pituitary adenoma (n=56) and arachnoid cyst (n=2) in the sellar region. The position, texture and morphology of leisions, signal of cystic and solid part, invasion of surrounding tissues and maximum diameter of cysts on the MRI images were evaluated and compared between different groups. SPSS 25.0 software was used for statistical analysis. Results: There were several specific changes on several MRI sequences in Rathke's cleft cysts, craniopharyngioma and pituitary adenoma groups. For Rathke's cleft cysts, round shape, rare polycystic structure, lack of solid part and maximum diameter of cysts which was significantly less than that of craniopharyngioma and pituitary adenoma groups ((17.37±6.12) mm vs (30.29±13.51) mm vs (28.18±11.13) mm, t value was 6.680, 5.838, respectively, all P<0.05), were favorable diagnostic criteria. While, the intracystic nodules were mostly found in craniopharyngioma. There was no high signal intensity in cystic wall on T1WI and T2WI of pituitary adenoma. MRI signal of arachnoid cyst in sellar region was basically the same as CSF signal, with low signal intensity on T1WI and DWI, high signal intensity on T2WI, without enhanced signal. Conclusions: Common sellar regional cystic lesions showed characteristic manifestations on different MRI sequences. Valuable information in the morphology, MRI signal intensity, maximum diameter measurements may improve accuracy of differential diagnosis for sellar regional cystic lesions.


Assuntos
Adenoma/diagnóstico por imagem , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Estudos Retrospectivos
15.
Neurol India ; 67(6): 1448-1455, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31857533

RESUMO

Introduction: Increasing attention has been paid to the pseudocapsule-based extracapsular resection in transsphenoidal surgery for pituitary adenomas. Prior reports focused more on Cushing disease or nonfunctional pituitary adenomas. In this study we present systematic research, especially concerning all kinds of noninvasive functional pituitary adenomas (NIFPAs) adopting various strategies of extracapsular resection, in order to evaluate the effectiveness and safety of these surgical methods for NIFPAs. Materials and Methods: From October 2008 to November 2014, 116 patients suffering from NIFPAs underwent pseudocapsule-based extracapsular resection (ER) with different surgical strategies; that is, by a microscope or endoscope via the endonasal transsphenoidal approach. During the same period, 90 patients suffering NIFPAs also underwent traditional transsphenoidal intracapsular resection (IR). In different postoperative periods, we re-examined the endocrine series and recorded the complications. Enhanced magnetic resonance imaging examination was also performed three months later. Results: In the ER and IR group, the tumors were completely removed in 97 (83.7%) and 62 (68.9%) cases, whereas the endocrine disorders were remitted in 89 (76.7%) and 53 (58.9%) cases, respectively. Statistical analyses to compare the overall complete resection rates and the overall endocrine remission rates in both groups showed significant differences (P = 0.028 and 0.006, respectively). Intraoperative rhinorrhea occurred in 26.7% patients of the ER group and 13.3% of the IR group, showing a significant difference (P = 0.019). Transient diabetes insipidus occurred in 73.3% patients of the ER group and 63.3% of the IR group, with no difference between groups (P = 0.126). There was no case with intracranial hematoma or pituitary crisis in both the groups. Conclusion: With our various surgical strategies of ER, the patients can achieve content imaging resection, high and sustained endocrine remission, which are effective and safe for NIFPAs.


Assuntos
Adenoma/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/diagnóstico por imagem , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
17.
Radiología (Madr., Ed. impr.) ; 61(6): 467-476, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189393

RESUMO

OBJETIVO: El propósito de este artículo es destacar la utilidad de la resonancia magnética en la caracterización anatómica y patológica de la región selar haciendo hincapié en diagnósticos diferenciales de tumores no adenomatosos y pseudotumores poco frecuentes estudiados en nuestra institución. CONCLUSIÓN: La región selar es un espacio anatómico complejo, con múltiples tipos de tejidos a partir de los cuales puede surgir un amplio espectro de patologías. La resonancia magnética es el mejor método por imágenes para estudiar esta región debido a su alta resolución tisular, la caracterización de los patrones de crecimiento tumoral y el comportamiento biológico


OBJECTIVE: To show the usefulness of magnetic resonance imaging in the anatomic and pathologic characterization of the sellar region, emphasizing the differential diagnosis of uncommon non-adenomatous tumors and pseudotumors studied in our institution. CONCLUSION: The sellar region is a complex anatomic space with diverse types of tissues from which a wide spectrum of diseases can arise. Magnetic resonance imaging's high tissue resolution and ability to characterize the patterns of tumor growth and biological behavior make it the best imaging technique to study this region


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Imagem por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem
18.
Stereotact Funct Neurosurg ; 97(4): 266-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31694011

RESUMO

BACKGROUND: Craniopharyngioma is a difficult entity to treat, which is particularly true for mixed craniopharyngioma (i.e., a mixture of both solid and cystic components). The present case report illustrates a minimally invasive, two-component, stereotactic treatment approach as an alternative to standard microsurgery. CASE DESCRIPTION: A 38-year-old patient presented with progressive intracranial hypertension followed by pan-hypopituitarism, deterioration of the visual field, and cognitive impairment. Brain MRI revealed hydrocephalus and a suprasellar mixed solid and polycystic lesion that was suggestive of craniopharyngioma. Using a robot-assisted, stereotactic treatment approach, we combined the installation of catheters for 2 Ommaya reservoirs with 5-fraction CyberKnife radiosurgery of the solid tumor. The high intracranial pressure and visual field deterioration resolved completely. A partial improvement in endocrine function was noted, and the patient returned to work 6 weeks after surgery. CONCLUSION: A combined, robot-assisted, stereotactic approach to the treatment of mixed (solid and polycystic) craniopharyngioma is a safe alternative to microsurgery. Further studies including larger numbers of patients will be needed to assess the long-term efficacy and morbidity and mortality rates associated with this approach.


Assuntos
Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Radiocirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Terapia Combinada/métodos , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Resultado do Tratamento
19.
Pituitary ; 22(6): 640-646, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31677129

RESUMO

PURPOSE: Ectopic salivary glands have been found in both extracranial and intracranial locations, however, intrasellar symptomatic salivary gland is extremely rare and its clinical manifestation, radiological characteristics and outcome have not been systematically studied. Here we present a case series of intrasellar symptomatic salivary gland and perform a literature review to better characterize this disease. METHODS: We retrospectively reviewed the data of three patients with intrasellar symptomatic salivary gland from our institutional and other cases available in literatures. Information for sex, age at diagnosis, clinical symptoms, radiological features, treatment strategy and prognosis were recorded. RESULTS: A total of 11 cases (including our own) were identified. There were three men and eight women, with an average age at diagnosis of 28.3 years. The peak incidence was in the second and the third decade (72.7% of all cases). The most common symptom was headache (81.8% of all patients). About 63.6% patients had one or more abnormal hormone levels, and prolactin was likely the most vulnerable hormone. The radiological appearances of intrasellar salivary gland were various, and four cases mimicked pituitary adenoma radiologically. All patients underwent transsphenoidal surgery with no mortality. CONCLUSION: Although intrasellar symptomatic salivary gland is rare, it should be considered in the differential diagnosis of intrasellar lesions. Preoperative diagnosis is challenging since it mimics pituitary neoplasm in clinical and radiological manifestations, and confirmation for this disease could only be conducted through pathological examination. Transsphenoidal surgical resection is the preferred therapy and the patient prognosis is usually good.


Assuntos
Neoplasias Hipofisárias/diagnóstico por imagem , Glândulas Salivares/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Adulto Jovem
20.
J Pak Med Assoc ; 69(11): 1752-1754, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740895

RESUMO

Trans-sphenoidal approach for resection of pituitary adenomas is a safe and common neurosurgical procedure. It can be done both through microscopic or endoscopic methods, and both methods can be facilitated by a perioperative lumbar drain insertion, that in theory improves tumour resection and reduces risk of post-operative cerebrospinal fluid leak. Herein we have reviewed the literature to find out the evidence in support of perioperative lumbar drain insertion for trans-sphenoidal resections.


Assuntos
Drenagem/métodos , Região Lombossacral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Osso Esfenoide/cirurgia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem
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