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1.
BMC Neurol ; 20(1): 129, 2020 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-32278345

RESUMO

BACKGROUND: Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors. METHODS: We performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors. RESULTS: In the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors. CONCLUSION: SPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sela Túrcica/patologia
2.
World Neurosurg ; 138: e940-e954, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32298827

RESUMO

BACKGROUND AND OBJECTIVE: Endoscopic endonasal surgery (EES) for the management of sellar, suprasellar, and anterior skull base lesions is gaining popularity. Our aim was to analyze and present the clinical outcomes of EES for the management of these lesions in a community hospital setting. METHODS: We retrospectively reviewed the charts of 56 patients with sellar, suprasellar, and anterior skull base lesions who underwent EES between 2010 and 2018. RESULTS: There was male predominance (53.6%) with a mean age of 54.9 ± 13.7 years. Lesions were 45 pituitary adenomas, 5 meningiomas, 3 metastatic, 1 craniopharyngioma, 1 Rathke cyst, and 1 mucocele. Gross total excision was achieved in 57.1%, subtotal excision occurred in 37.5%, and decompression and biopsy were achieved in 5.4% patients. Postoperative vision normalized or improved in 27 patients (86.1%) and was stable in 4 patients (13.9%). Recovery of a preexisting hormonal deficit occurred in 13 (23.2%) patients, and a new hormonal deficit occurred in 9 patients (16.1%). The mean hospital stay was 6.1 ± 4.9 days. Postoperative complications included cerebrospinal fluid leak in 8 patients (14.3%). Four patients (7.1%) had meningitis. Diabetes insipidus was present in 19 patients (33.9%), and postoperative intracranial hematoma requiring evacuation was necessary in 2 patients (3.6%). The mean follow-up duration was 47.5 ± 25.8 months. Lesion progression or recurrence requiring redo surgery occurred in 5 patients (8.9%). Regarding the learning curve, the postoperative cerebrospinal fluid leak, meningitis, new hormonal deficits, and diabetes insipidus decreased in the second half of the patients. CONCLUSIONS: EES provides an effective and safe surgical option with low morbidity and mortality for the treatment of sellar, suprasellar, and anterior skull base lesions in a community hospital setting.


Assuntos
Endoscopia , Procedimentos Neurocirúrgicos , Sela Túrcica/cirurgia , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fossa Craniana Anterior/cirurgia , Endoscopia/educação , Endoscopia/métodos , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/educação , Estudos Retrospectivos , Resultado do Tratamento
3.
J Laryngol Otol ; 134(4): 369-371, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234087

RESUMO

OBJECTIVE: This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma. CASE REPORT: A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control. CONCLUSION: This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.


Assuntos
Carcinoma de Células Escamosas/secundário , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sela Túrcica/patologia , Neoplasias Tonsilares/patologia , Biópsia/métodos , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Síndrome de Horner/diagnóstico , Síndrome de Horner/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Recidiva Local de Neoplasia , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/etiologia , Cuidados Paliativos/métodos , Radioterapia/métodos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/efeitos da radiação , Resultado do Tratamento
4.
Odontology ; 108(4): 730-737, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32232696

RESUMO

The purpose of this study was to investigate the association between the size and bridging of the sella turcica and tooth agenesis, and whether the likelihood of second premolar agenesis can be predicted from the sella turcica size and bridging in Japanese orthodontic patients. Patients were divided into four groups of 32: groups 1 and 2 consisted of patients with agenesis of the maxillary and mandibular second premolars, respectively; group 3, patients with severe tooth agenesis; and group 4, patients without tooth agenesis. Each group was divided into two subgroups of 16 each based on the patient's age: patients under 14 years of age (groups 1A through 4A, group A) and patients 14 years of age or older (groups 1B through 4B, group B). Lateral cephalograms were used to evaluate the size and bridging of the sella turcica. The interclinoidal distance (ID) was significantly shorter in groups 1 and 3 than in group 4, and in group 3 than in group 2. Group B exhibited significantly greater depth, diameter, area, and perimeter of the sella turcica than group A. Groups 3 and 1B had a significantly higher prevalence of sella turcica bridging than groups 4 and 4B, respectively. Maxillary second premolar agenesis and severe tooth agenesis were associated with a reduced ID irrespective of age and increased occurrence of sella turcica bridging. The early emergence in life of a short ID might be a predictor of possible second premolar agenesis in later life.


Assuntos
Maxila , Sela Túrcica , Adolescente , Dente Pré-Molar , Cefalometria , Humanos , Japão
6.
Otolaryngol Head Neck Surg ; 163(2): 284-292, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32204653

RESUMO

OBJECTIVES: The advent of endonasal endoscopic skull base surgery (ESBS) has redefined the management of pediatric sellar and suprasellar lesions. To date, the outcomes of these procedures have not been systematically reviewed. This study performed a systematic review with meta-analysis of surgical outcomes for pediatric patients undergoing ESBS for sellar and suprasellar lesions. DATA SOURCES: PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and Cochrane Library (Wiley). REVIEW METHODS: Articles reporting on pediatric patients undergoing ESBS for craniopharyngiomas, pituitary adenomas, and Rathke's cleft cysts were reviewed. The primary outcome was postoperative cerebrospinal fluid (CSF) leak. Secondary outcomes included endocrine, visual, and other complications. RESULTS: Twenty-five articles reporting on 554 patients were included. Overall postoperative CSF leak rate was 8.6%, with tumor-specific rates of 10.6% in craniopharyngiomas, 6.5% in pituitary adenomas, and 7.2% in Rathke's cleft cysts (P > .05). Older studies demonstrate higher postoperative CSF leak rates as compared with more recent studies (12.5% vs 6.1%, P = .0082). Younger children (8.9-12.6 years old) experienced a higher rate of postoperative CSF leaks as compared with older children (13.0-16.6 years old; 12.9% vs 4.9%, P = .0016). Additional postoperative complications included diabetes insipidus (26.7%), hypopituitarism (46.6%), visual deficits (2.6%), meningitis (3.4%), and weight gain (3.4%). CONCLUSION: ESBS for pediatric sellar and suprasellar lesions is overall an effective management approach with an increasingly favorable risk-benefit profile. Younger children may be more susceptible to postoperative CSF leak as compared with older pediatric patients. Tumor type does not appear to be an independent risk factor for postoperative CSF leak in this population.


Assuntos
Adenoma/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Craniofaringioma/cirurgia , Cirurgia Endoscópica por Orifício Natural , Neoplasias Hipofisárias/cirurgia , Criança , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Nariz , Sela Túrcica
7.
Clin Imaging ; 64: 24-28, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32217423

RESUMO

PURPOSE: To systematically evaluate the sella morphology and pituitary gland height on brain MRI of Chiari II malformation (C2M) patients to understand the observed high incidence of apparent enlargement of the pituitary gland. METHODS: Brain MRIs of C2M patients at a single tertiary care adult institution were retrospectively reviewed. We also evaluated two age and gender-matched control groups-patients with normal brain MRI (C1 group) and chronic ventricular shunts (C2 group). The heights of tuberculum sella, dorsum sella, and pituitary gland were measured and compared. The presence or absence of dural thickening was noted. RESULTS: 21 patients were included in each group. In C2M group, a pituitary adenoma was suggested on 24% of the MRIs. The dorsum sella was significantly smaller in the C2M group (4.8 mm) compared to both the C1 group (7.4 mm, p < 0.001) and the C2 group (7.1 mm, p < 0.001). The pituitary gland was also larger in the cranial-caudal dimension in C2M group (8.6 mm) as compared to both the C1 group (6.6 mm, p < 0.01) and the C2 group (6.0 mm, p < 0.001). One C2M patient with a pituitary gland<10 mm was suggested to have a pituitary adenoma on outside MRI, although a normal pituitary gland was seen on pathology. CONCLUSION: C2M patients have shallow sella which can accentuate the pituitary gland height. The mean pituitary height was larger in C2M patients, but no functional pituitary pathology was present. It is important to consider sella morphology when evaluating the pituitary gland of C2M patients to avoid unnecessary medical and surgical interventions.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Hipófise/anatomia & histologia , Adulto , Feminino , Humanos , Hipertrofia/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Sela Túrcica/patologia , Adulto Jovem
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(2): 78-88, feb. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-187432

RESUMO

Introduction: Protocol for prescribing hormone replacement therapy in isolated growth hormone (GH) deficiency includes magnetic resonance imaging of the brain. There is controversy on the frequency of structural pituitary abnormalities and on the importance of abnormal MRI findings on prognosis and response to GH replacement. Methods: A descriptive, retrospective study of children of both sexes aged 0-14 years, who had undergone brain MRI, diagnosed with isolated GH deficiency at a tertiary hospital in the past 14 years, aimed at reporting the frequency of abnormal MRI findings in isolated GH deficiency, and to establish whether differences exist in height diagnosis and evolution according to MRI findings. MRI findings were also compared with the findings reported in healthy children in order to establish incidence. Results: 96 patients were studied, of whom 74/96 (77%) reached adult age. Abnormal MRI findings were seen in 11.5% of them (8/11 of pituitary origin). No brain or pituitary tumor was seen in any case. Patients with abnormal images had a mean age at treatment start of 8 years, a target height of -0.8SD, and a final height of 1.04SD, while patients with normal MRI findings had an age at treatment start of 10 years old, a target height of -1.44SD, and a final height of -1.75SD, with statistically significant differences. Conclusions: Patients with abnormal MRI findings show a more favorable response to GH replacement therapy


Introducción: El protocolo de prescripción de hormona sustitutiva en el déficit aislado de hormona del crecimiento (GH) incluye la realización de una resonancia cerebral. Hay controversia sobre la frecuencia de anomalías hipofisarias y la importancia de los hallazgos anormales de resonancia magnética en el pronóstico y la respuesta al tratamiento de GH. Métodos: Estudio descriptivo retrospectivo de niños de 0 a 14 años, de ambos sexos, con imágenes de resonancia magnética cerebral, que fueron diagnosticados de deficiencia aislada de GH en un hospital terciario en los últimos 14 años, para describir la frecuencia de las anomalías en la resonancia magnética y establecer si existen diferencias en el diagnóstico de talla y evolución de acuerdo con los hallazgos de la resonancia magnética. Además, comparamos los hallazgos en la resonancia con los hallazgos publicados en niños sanos, con el fin de establecer la incidencia. Resultados: Se estudiaron 96 pacientes, alcanzando 74/96 (77%) la edad adulta. El 11,5% tenía imágenes de resonancia magnética anormales (8/11 de origen hipofisario). En ningún caso se observó tumor cerebral o hipofisario. Los pacientes con imágenes anormales mostraron una edad media al inicio de tratamiento de 8 años, talla diana de -0,8 DE y una talla final de 1,04 DE; mientras que los pacientes con imágenes de resonancia magnética normal muestran una edad de inicio de tratamiento de 10 años, una talla diana de -1,44 DE y una talla final de -1,75 DE, con diferencias estadísticamente significativas. Conclusiones: Los pacientes con alteraciones en la resonancia magnética muestran una respuesta más favorable al tratamiento sustitutivo de GH


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Hormônio do Crescimento Humano/deficiência , Cérebro/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Índice de Gravidade de Doença , Hormônio do Crescimento Humano/análise , Estudos Retrospectivos , Estudos Longitudinais , Estatura , Sela Túrcica/diagnóstico por imagem
9.
Medicine (Baltimore) ; 99(8): e18572, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080071

RESUMO

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline.To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem.This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed.A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing.STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.


Assuntos
Neoplasias Encefálicas/patologia , Glândula Pineal/patologia , Sela Túrcica/patologia , Técnicas Estereotáxicas/efeitos adversos , Adolescente , Adulto , Biópsia/efeitos adversos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , China/epidemiologia , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Pineal/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Técnicas Estereotáxicas/mortalidade , Adulto Jovem
10.
J Clin Neurosci ; 73: 48-50, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32070673

RESUMO

Cerebral spinal fluid (CSF) leak is a significant complication in pituitary surgery, increasing both patient morbidity and mortality. In a recent publication, Campero et al. observed worse postoperative prognosis and increased risk of intraoperative CSF leak in patients with reduced sellar barrier thickness. The objective of this study was to analyze the association between sellar barrier thickness and intraoperative CSF leak in older individuals. A retrospective review was conducted of 44 transsphenoidal surgery resections for pituitary adenomas, 24 microscopic and 20 purely endoscopic procedures. Presence of intraoperative CSF fistula was significantly greater in patients with weak sellar barrier (thickness under 1 mm), compared to strong sellar barrier (52.94% vs 3.70% p < 0.0001, respectively). Application of this novel concept may help improve surgical technique selection as well as predict risk of intraoperative CSF leak and need for eventual use of flaps for reconstruction.


Assuntos
Adenoma/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Neuroendoscopia/efeitos adversos , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
11.
Clin Anat ; 33(3): 468-474, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31943393

RESUMO

BACKGROUND: The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. METHODS: We provided anatomical models in six fresh-frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. RESULTS: We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. CONCLUSION: We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.


Assuntos
Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Endoscopia , Modelos Anatômicos , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/anatomia & histologia , Adulto , Idoso , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Estudos Prospectivos
12.
J Craniofac Surg ; 31(1): 306-309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31449220

RESUMO

OBJECTIVE: The purpose of this study is to evaluate morphometric analysis of sella turcica using cone-beam computed tomography (CBCT) in patients with cleft lip and palate (CLP) and healthy controls. METHODS: Cone-beam computed tomography images of 68 patients (36 males, 32 females, age range 7-20 years) with CLP and 68 healthy individuals (36 males, 32 females, age range 8-19 years) were examined retrospectively. Sella turcica shapes were analyzed by 2 different methods in CLP and control groups. Length, depth, and diameter of sella turcica were measured in both groups. The data were statistically assessed by age, gender using Independent t-test and one-way analysis. RESULTS: Diameter of sella turcica was smaller in CLP group compared to healthy individuals (P < .05). Length and depth of sella turcica were lower than in control group, but not statistically significant (P > .05). Sella turcica shape significantly differed between groups (P < .05). The most common sella turcica types were flattened and irregular shapes in CLP group, whereas round and normal shapes were in control group. There was no significant difference between groups in any dimension of sella turcica by gender (P > .05). Sella turcica depth was significantly higher at age of 15 years and above in CLP group. CONCLUSION: This study showed that flattened and irregular shapes of sella turcica were the most common types in CLP group. Smaller sella turcica was detected in CLP group compared to healthy individuals. Cone-beam computed tomography can be useful for evaluation of sella turcica.


Assuntos
Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adolescente , Biometria , Criança , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
13.
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
14.
J Craniofac Surg ; 31(1): e68-e69, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31633667

RESUMO

Pituitary adenomas are a group of tumors arising from the anterior pituitary gland, and with the exception of prolactin-secreting adenomas, transsphenoidal resection is the cornerstone of treatment. Although most adenomas are located within the pituitary fossa, ectopic adenomas have been reported, primarily occurring along the route of embryologic development. In this article, we present the case of an ectopic pituitary adenoma in the nasolabial fold that likely resulted from seeding during transsphenoidal resection via sublabial approach.


Assuntos
Síndrome de Nelson/cirurgia , Prolactinoma/cirurgia , Idoso , Feminino , Humanos , Síndrome de Nelson/diagnóstico por imagem , Prolactinoma/diagnóstico por imagem , Recidiva , Sela Túrcica/patologia
15.
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
16.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
17.
J Clin Neurosci ; 71: 234-244, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31843433

RESUMO

This study aimed to determine the anatomical and histological features of diaphragma sellae that affect the suprasellar extension of intrasellar tumours. Twenty-four fresh adult cadavers were dissected for the study. Diaphragma sellae and pituitary capsules with sellar structures were resected. The diaphragma sellae was anatomically reviewed in detail. Immunohistochemical staining was performed for collagen types I, II, III, and IV. We examined the suprasellar growth of 13 sellar tumours extending superiorly through the diaphragma sellae by performing a series of 2704 endoscopic transnasal operations to analyse the anatomic and histologic results of the study. The diameter of the foramen of diaphragma sellae varied between specimens. Of 24 specimens, the diaphragma sellae in five (21%) had a tight-type foramen and those in 19 (79%) were more spacious. An increased expression of collagen types I and IV was observed in the pituitary capsule and the diaphragma sellae. In this clinical series, we observed that all types of sellar tumours could expand through the foramen. We observed radiologically and intraoperatively that the diaphragma sellae was displaced laterally and formed a dome in two cases with an adenoma extending to the suprasellar area. Two types of suprasellar extension through the diaphragma sellae are possible: 1) The collagen structure of diaphragma sellae can be destroyed by invasive tumours; 2) The morphology of the foramen of the diaphragma sellae facilitates suprasellar tumoural extension. All sellar tumours, including non-invasive cystic tumours, may invade the suprasellar area by expanding through the foramen of the diaphragma sellae.


Assuntos
Dura-Máter/anatomia & histologia , Hipófise/anatomia & histologia , Neoplasias Hipofisárias/patologia , Sela Túrcica/anatomia & histologia , Adulto , Cadáver , Feminino , Humanos
18.
Ideggyogy Sz ; 72(11-12): 427-431, 2019 Nov 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31834687

RESUMO

Among tumours found in the suprasellar region metastases are very rare and the most frequent primary tumours are lung and breast cancer. Data of a patient with clear cell renal carcinoma with intra-suprasellar metastasis will be discussed. As in most of the tumours in the sellar region, the first symptom was visual deterioration with visual field defect. A transsphenoidal debulking of the tumour was performed and the residual tumor was treated by CyberKnife hypofractionated stereotactic radiotherapy. Both our patient's visual acuity and visual field impairment improved after the surgery and CyberKnife treatment. At 6-month after irradiation, MR of the sella showed a complete remission of the tumour. This was the first treatment with CyberKnife in our country in case of a tumour close to the optic chiasm. According to our best knowledge, there are 21 cases in the literature with renal cell carcinoma metastasis in the suprasellar region.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nervo Óptico/cirurgia , Radiocirurgia/métodos , Sela Túrcica/cirurgia , Carcinoma de Células Renais/patologia , Humanos , Neoplasias Renais/patologia , Metástase Neoplásica , Nervo Óptico/patologia , Neoplasias Hipofisárias , Radiocirurgia/instrumentação , Resultado do Tratamento , Transtornos da Visão/etiologia
19.
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
20.
Pan Afr Med J ; 34: 55, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762921

RESUMO

Intrasellar arachnoid cysts are benign malformations. They are extremely rare (approximately 3% of cases). Their pathophysiology is still poorly elucidated. We here report a case of intrasellar arachnoid cyst with suprasellar extension whose treatment was based on endoscopic transsphenoidal fenestration. The epidemiological, clinical, pathophysiological, radiological, therapeutic and evolutionary features have been analyzed. Neuroendoscopic procedures are performed with increasing frequency in surgery. Prognosis is good and recurrences are frequent, even after several years of evolution.


Assuntos
Cistos Aracnóideos/diagnóstico , Endoscopia/métodos , Sela Túrcica/patologia , Adulto , Cistos Aracnóideos/cirurgia , Feminino , Humanos , Prognóstico , Sela Túrcica/cirurgia
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