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1.
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
2.
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
3.
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
4.
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
5.
World Neurosurg ; 132: e5-e13, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521751

RESUMO

BACKGROUND: The use of the recent concept of sellar barrier revealed that a specific group of patients were difficult to categorize. For this reason, we propose to add a new subtype: the mixed sellar barrier. The aim of this work was to define the new mixed barrier subtype and analyze this in a series of operated patients. METHODS: A retrospective study was carried out. From January to December 2018, 72 patients with pituitary adenomas underwent surgery by transsphenoidal approach. Patients with more than 1 surgery were excluded. Each patient's magnetic resonance imaging (MRI) was analyzed and classified using the following criteria: strong barrier (>1 mm), weak barrier (<1 mm), and mixed barrier (<1 mm in one region and >1 mm in another part). RESULTS: Mixed sellar barrier is the coexistence of 2 types of sellar barrier (strong and weak). The presence of a mixed sellar barrier on MRI was associated with the presence of a mixed sellar barrier intraoperatively (P < 0.0001). By using the new MRI classification that includes the mixed sellar barrier, we found a stronger statistically significant association regarding the risk of cerebrospinal fluid leak (for the extreme categories; i.e., strong and weak) compared to the original work. CONCLUSIONS: The new mixed sellar barrier subtype was precisely defined and illustrated. The correlation between MRI and intraoperative findings for this new subtype has been demonstrated in this study. A prospective study with a larger series of patients is required for validation.


Assuntos
Sela Túrcica/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Seio Esfenoidal/cirurgia
6.
World Neurosurg ; 132: 1-3, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442637

RESUMO

BACKGROUND: This report presents a rare presentation of a ganglioglioma in the sellar/suprasellar region. On the basis of the patient's presentation and imaging characteristics, the initial diagnosis was craniopharyngioma. While gangliogliomas are already rare brain tumors that are usually found in the frontal and temporal lobes of young patients, the presentation of this tumor in the sellar region is exceedingly rare. CASE DESCRIPTION: A 25-year-old male presented to the emergency department with headache, agitation, and combativeness. A head computed tomography scan showed a sellar/suprasellar mass with mixed solid and cystic components and peripheral calcifications. The mass compressed the third ventricle and cerebral aqueduct, resulting in obstructive hydrocephalus. The patient was intubated for decline in mental status and combativeness. A ventricular drain was placed emergently. A pituitary function panel did not show endocrine dysfunction. Magnetic resonance imaging showed a 3.6 cm × 4.2 cm solid mass in the sellar/suprasellar region with a cystic component. The mass displaced the adenohypophysis and extended into the prepontine and interpedicular cisterns. The clinical presentation and radiologic characteristics led to an initial diagnosis of craniopharyngioma. The patient underwent a right pterional craniotomy and transsylvian approach for resection of mass without complication, although a subtotal resection was achieved due to adherence of the tumor to optic nerves and carotid arteries. The resected specimen was diagnosed as ganglioglioma. CONCLUSIONS: This case is a reminder of how much the field of neurosurgery relies on imaging modalities but also emphasizes the importance of histopathology in the field of brain tumors.


Assuntos
Neoplasias Encefálicas/cirurgia , Ganglioglioma/cirurgia , Sela Túrcica/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Craniofaringioma/diagnóstico , Craniotomia , Diagnóstico Diferencial , Ganglioglioma/complicações , Ganglioglioma/diagnóstico por imagem , Ganglioglioma/patologia , Humanos , Hidrocefalia/etiologia , Imagem por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/diagnóstico , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Ventriculostomia
7.
World Neurosurg ; 127: 469-477, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30995554

RESUMO

BACKGROUND: Chondrosarcoma is a malignant tumor that originates from mesenchymal cells that have differentiated into chondrocytes, often growing laterally, rarely seen in the cranium, and seldom seen in the saddle area. We believe that only a few cases have been reported in the literature. We report a case of pituitary fossa chondrosarcoma, which was completely resected by an extended endoscopic endonasal approach, and a literature review. CASE DESCRIPTION: A 20-year-old man was admitted to hospital with bilateral temporal headache and blurred vision, without any history of sexual dysfunction or diabetes insipidus. Endocrine function was normal. Computed tomography of the head showed calcified sellar lesions and sellar bone destruction, which were closely associated with the right cavernous sinus. Magnetic resonance imaging showed saddle area space-occupying lesions, with low signal on the T1-weighted image and high signal on the T2-weighted image, uneven enhancement by enhanced scanning, and unclear pituitary display. The tumor was completely resected by an extended endoscopic endonasal approach and confirmed by magnetic resonance imaging. Postoperative pathology revealed conventional chondrosarcoma (World Health Organization grade II). Postsurgical visual acuity also improved. The patient did not receive radiotherapy or chemotherapy. No recurrence was found at 10-month follow-up. CONCLUSIONS: Sellar region chondrosarcoma is rare. For space-occupying lesions in this area, chondrosarcoma should be considered and not necessarily pituitary adenoma, craniopharyngioma, meningioma, and chordoma. The extended endoscopic endonasal approach represents a good treatment option for sellar area chondrosarcoma.


Assuntos
Condrossarcoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Neoplasias Cranianas/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Cavidade Nasal/cirurgia , Neuroendoscopia/métodos , Sela Túrcica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
World Neurosurg ; 126: e953-e958, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877013

RESUMO

BACKGROUND: Empty sella is an anatomic finding that is usually asymptomatic. However, when patients with empty sella finding present with visual deficits, surgical treatment may be necessary. The main goal of surgery is to elevate sellar content through a transsphenoidal approach. The aim of this study was to demonstrate a new technique for precise reconstruction of the sellar floor using a heterologous bone block to restore the anatomic elements of the sella turcica. METHODS: Three patients with primary empty sella who presented with visual field defects were prospectively included. Surgery was performed through a microsurgical transsphenoidal approach and involved elevating the sellar content by using a tricortical heterologous bone graft, the dimensions of which were obtained considering the exact dimensions of each patient's sella turcica. The graft was premodeled outside the surgical bed and carefully introduced into the sella turcica to achieve the required elevation (chiasmapexy). RESULTS: Vision of all 3 patients improved, and the improvement persisted throughout the follow-up period. 2 patients, this improvement was noted immediately after surgery, and in the third patient, this change in vision occurred 1 week later. Long-term imaging studies showed the persistence of the bone graft in the sella turcica and the exact elevation of the sellar content at the end of the follow-up period. There were no complications in the present series. CONCLUSIONS: The technique presented here is simple and reproducible and allows an almost exact and persistent elevation of the sellar content.


Assuntos
Síndrome da Sela Vazia/cirurgia , Quiasma Óptico/cirurgia , Sela Túrcica/cirurgia , Transtornos da Visão/cirurgia , Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Quiasma Óptico/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Resultado do Tratamento , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/etiologia
9.
Neurosurg Rev ; 42(2): 593-598, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30825013

RESUMO

Transsphenoidal surgery (TSS) has become a well-established standard surgical technique, but the cerebrospinal fluid leakage remains controversial. Direct suturing of the dura, which is a routine procedure within transcranial surgery, can be applied for closure of the sella turcica within TSS. However, as the dura is not accessible by the index finger, knot tying in the narrow and deep surgical corridor following dural suturing is extremely difficult, cumbersome, and time-consuming in TSS. Here, we present a new, simple, and effective technique for knot tying using our newly developed instrument the "knot tightener" (UC-6603: Medical U & A, Inc., Osaka, Japan) to solve this challenge. The knot tightener has a total length of 235 mm and is bayonet shaped. The tip is 5 × 10 mm in diameter and has one long arm and two short curved arms. The long arm has a dimple which can hook and hold a thread, fulfilling the role of an index finger. Together the two short curved arms make a half circle and are able to hook a thread easily. From the 28th of March 2011 to August 2018, we used the knot-tightener device for 566 patients who underwent endonasal TSS, to deliver and tie knots following stitching of the dura using 6-0 nylon. The device was able to easily deliver a knot from outside of the nostril to the sella turcica through the nasal cavity and successfully tighten it firmly. No complications were observed, confirming the safety of the newly designed instrument. The knot tightener can be considered to be an optimal tool for the challenging surgical procedure of knot tying following dural suturing in TSS. Its potential future applications may extend to include other neurosurgical procedures in anatomically restricted areas.


Assuntos
Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Técnicas de Sutura/instrumentação , Humanos , Japão , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Sela Túrcica/cirurgia , Suturas
10.
World Neurosurg ; 126: 21-23, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30825621

RESUMO

BACKGROUND: Penetrating injuries are dangerous because they can damage intracranial structures. Removal of the object carries this same risk of injury, so neurosurgeons often visualize the injury via craniotomy during removal. CASE DESCRIPTION: This report illustrates the case of a 41-year-old man who had a penetrating injury with a knife that started in the left nasal passage and extended to the parasellar region. Computed tomography angiography revealed an associated sphenoid fracture and showed the tip of the knife within the parasellar space with preservation of the internal carotid artery, ophthalmic artery, optic nerve, and pituitary gland. The patient was taken to the operating room for a right pterional craniotomy and the knife was removed in the operating room in a combined effort between neurosurgery and otorhinolaryngology. CONCLUSIONS: The patient progressed well without complications postoperatively and was discharged 5 days later. We provide a report with video showing our surgical approach for removal of a penetrating object through the tuberculum sellae.


Assuntos
Craniotomia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Sela Túrcica/cirurgia , Adulto , Artéria Carótida Interna/cirurgia , Angiografia Cerebral/métodos , Craniotomia/métodos , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Procedimentos Neurocirúrgicos/métodos
11.
J Neurooncol ; 142(3): 545-555, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30796744

RESUMO

BACKGROUND: Approach selection paradigm for tuberculum sellae meningiomas (TSMs) is still a point of discussion. The trans-eyebrow supraorbital keyhole approach (TSKA) is a minimally invasive transcranial approach and has been used for the treatment of TSMs during recent years. In this study, we presented a series of 30 cases of TSMs treated via TSKA with a long-term follow-up. METHOD: Thirty patients with TSMs underwent surgery via TSKA between December 2006 and August 2018. The medical data and follow-up results were retrospectively analyzed. RESULTS: A total of 5 males and 25 females were included in this study. Three patients presented with recurrent TSMs. The mean tumor size was 25.3 ± 7.3 mm (range, 10-48 mm). The mean follow-up period was 58.0 months (interquartile range, 33.5-86.3 months). Gross total resection (GTR) was achieved in 27 patients (90.0%). One recurrence (3.3%) occurred 9 years after surgery. Out of 29 patients with preoperative visual impairment, 17 (58.6%) improved, eight (27.6%) remained stable, and four (13.8%) deteriorated. No peri-operative death, CSF rhinorrhea, or permanent endocrine dysfunction occurred. All patients exhibited satisfactory cosmetic results. At the last follow-up, the glasgow outcome scale score was five in 27 patients (90.0%). CONCLUSION: The TSKA is characterized by minimal invasion with a satisfactory cosmetic outcome. Based on the tumor characteristics and surgeon's experience, this approach can be employed as an alternative minimally invasive approach for the treatment of TSMs.


Assuntos
Testa/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva Local de Neoplasia/patologia , Sela Túrcica/cirurgia , Neoplasias da Base do Crânio/cirurgia , Acuidade Visual , Adulto , Idoso , Craniotomia , Feminino , Seguimentos , Testa/patologia , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Órbita , Prognóstico , Estudos Retrospectivos , Sela Túrcica/patologia , Neoplasias da Base do Crânio/patologia
12.
World Neurosurg ; 125: 32-36, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703592

RESUMO

BACKGROUND: Differential diagnosis of sellar masses includes adenoma, meningioma, craniopharyngioma, and metastasis. Primary paraganglioma is seldom considered. We present a case of this unique pathology, review the relevant literature, and compile a compendium of immunohistochemical characteristics for use as a resource. CASE DESCRIPTION: A 73-year-old woman presented to the hospital with visual changes in her left hemifield. Noncontrast head computed tomography demonstrated a large sellar mass with suprasellar extension and displacement of the optic chiasm (diameter of 3.1 cm). Magnetic resonance imaging was unobtainable owing to an incompatible pacemaker. Computed tomography characterization was most consistent with a macroadenoma. Given the acute visual decline, surgical decompression via an endonasal transsphenoidal route was performed without complication. A diagnosis of paraganglioma was made based on histopathology. Following resection, the patient's visual field deficit improved. Computed tomography body imaging was negative for a metastatic origin. CONCLUSIONS: Paraganglioma is a rare but potential differential diagnosis to consider when evaluating sellar masses.


Assuntos
Adenoma/diagnóstico por imagem , Quiasma Óptico/diagnóstico por imagem , Paraganglioma/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Quiasma Óptico/química , Quiasma Óptico/cirurgia , Paraganglioma/cirurgia , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/química , Sela Túrcica/cirurgia
13.
Neurosurgery ; 84(3): 599-606, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29618106

RESUMO

BACKGROUND: Headache frequently occurs in patients with pituitary adenoma and is reported in large as well as small adenomas. However, the exact mechanism of headache derived from pituitary adenoma remains unknown. OBJECTIVE: To evaluate the contribution of intrasellar pressure (ISP) to headache manifestation by using intraoperative ISP measurement. METHODS: The records of 108 patients who had first-time transsphenoidal surgery for pituitary adenoma were reviewed retrospectively. Measurement of intraoperative ISP was undergone using intracranial pressure monitoring sensors and compared with radiological assessment. RESULTS: Among 30 patients with headache, 29 (96.7%) presented with significant headache (Headache Impact Score-6, 50 or greater). Intraoperative ISP measurement was conducted successfully in all cases, and revealed higher ISP in patients with headache (35.6 ± 9.2 mm Hg) than in those without headache (15.8 ± 5.2 mm Hg). The ISP reduction after sella floor decompression was greater in patients with headache than that in patients without headache. In patients with headache, the frequency of invasion into the cavernous sinus or sphenoid sinus was significantly lower, and the diameter of the foramen at the diaphragm sellae was narrower. In addition, intratumoral cyst or hematoma was more common in patients with headache. Postoperatively, headache was either diminished or improved in 28 patients (93.3%). CONCLUSION: Headache in patients with pituitary adenomas associated with ISP elevation, results from compromised dural integrity at the sella and intratumoral hemorrhage. The increased stretch force of the sella dura may be a notable etiology of headache in patients with pituitary adenoma.


Assuntos
Adenoma/diagnóstico por imagem , Cefaleia/diagnóstico por imagem , Pressão Intracraniana/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adenoma/complicações , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , Cefaleia/etiologia , Cefaleia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Sela Túrcica/cirurgia , Adulto Jovem
14.
World Neurosurg ; 122: e472-e479, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30366141

RESUMO

BACKGROUND: Sellar germ cell tumors (GCTs) occur more frequently in childhood. Some will present as malignancy with infiltration and metastasis. However, the association between the timeliness of diagnosis and outcome has been controversial. We investigated the clinical risk factors associated with a diagnostic delay in patients with sellar GCTs in China. METHODS: The data from 53 patients aged <18 years with histologically confirmed sellar GCTs at Peking Union Medical College Hospital treated from January 2008 to December 2016 were reviewed retrospectively. RESULTS: The median interval between symptom onset and diagnosis was 25 months. Of the 53 patients, 44 (83%) had a delayed diagnosis. Most patients (86%) with a delayed diagnosis presented with polyuria or polydipsia. Of the 53 patients, 48 (91%) exhibited changes in the pituitary stalk. Patients with a germinoma (odds ratio, 4.1; 95% confidence interval, 2.4-6.9) and slow growth (odds ratio, 5.3; 95% confidence interval, 1.2-24.5) were more likely to have a delayed diagnosis. The overwhelming majority of patients with a delayed diagnosis (96%) had been seen by >1 doctor. No statistically significant differences were found in the mean survival time (P = 0.21) or mean progression-free survival time (P = 0.36) between patients with and without delay in diagnosis, respectively. CONCLUSIONS: A significant proportion of patients with sellar GCTs will experience a delay in the time to diagnosis. Although a delay in diagnosis did not reduce the survival time or progression-free survival time for patients with sellar GCTs, it might increase the risk of short stature. Thus, a detailed medical history and an immediate radiological examination are important for the early diagnosis of sellar GCTs in childhood.


Assuntos
Diagnóstico Tardio/tendências , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Diagnóstico Tardio/mortalidade , Feminino , Seguimentos , Humanos , Lactente , Masculino , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Hipofisárias/mortalidade , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Fatores de Risco , Sela Túrcica/cirurgia
15.
J Neurosurg Sci ; 63(1): 83-87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28869375

RESUMO

Craniopharyniomas arise from the sellar region and are particularly challenging because of their close proximity to critical neurovascular structures, including cranial nerves, brainstem, internal carotid arteries, posterior cerebral arteries, hypothalamus, and the pituitary gland. The tumors are benign on histology but can cause serious symptoms by compression of surrounding vital structures. While radical surgery and gross total resection (GTR) remains the first line treatment, choosing the optimal surgical approach is critical for the minimization of complications and postoperative morbidity. The extended endoscopic endonasal approach (EEEA) offers a direct route towards the sellar and suprasellar regions and has proven to be a safe and effective for GTR, with lower rates of complications and postoperative morbidity than open transcranial approaches. However, traditional transcranial approaches remain relevant in tumors with significant lateral extension. Radiotherapy can be considered in cases of subtotal resection (STR) or if surgery is not possible, although progressive growth of cysts with neurological deterioration has been demonstrated no infrequently. Newly developed chemotherapy for papillary craniopharygniomas might expand treatment options in the future.


Assuntos
Craniofaringioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/cirurgia , Craniofaringioma/tratamento farmacológico , Craniofaringioma/radioterapia , Humanos , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/radioterapia
16.
World Neurosurg ; 123: e781-e786, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30579017

RESUMO

OBJECTIVE: The Medpor porous polyethylene implant is reported to be safe and effective for sellar reconstruction after transsphenoidal surgery (TSS). However, we have observed several cases of delayed chronic sphenoid sinusitis related to the implant. The purpose of this study is to describe the presentation and management of implant-related sphenoid sinusitis after sellar reconstruction. METHODS: This is a retrospective study of patients who underwent endonasal TSS with Medpor sellar reconstruction between December 2008 and January 2013 at a tertiary care institution. Patient demographics, initial surgical management, sinonasal symptoms, postoperative imaging, sinusitis management, and resulting outcomes were analyzed. RESULTS: From 2008-2013, 139 patients underwent sellar reconstruction using Medpor. Five patients (3.6%) presented between 8 and 60 months after surgery with chronic sphenoid sinusitis that required surgical management. All 5 patients presented as outpatients for management of headaches and nasal drainage, 4 patients experienced chronic nasal congestion, and 3 patients noted recurrent sinusitis. At the time of revision surgery, all 5 patients were found to have mucosal inflammation and edema surrounding the implant, and 4 of the 5 had an exposed or partially extruded implant that was removed. CONCLUSIONS: Reconstruction of the sellar floor may be performed after TSS to prevent postoperative complications. Although porous polyethylene implants have previously been described as safe and effective for this purpose, surgeons should be aware of the risk of subsequent implant extrusion and chronic sphenoid sinusitis that can occur in a delayed manner.


Assuntos
Adenoma/cirurgia , Materiais Biocompatíveis/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Polietilenos/administração & dosagem , Próteses e Implantes/efeitos adversos , Sela Túrcica/cirurgia , Sinusite Esfenoidal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
17.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(2): 131-134, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30366871

RESUMO

Pituitary surgery is performed via a transsphenoidal approach in the vast majority of cases according to various methods that have changed over the years. A microscopic transseptal approach via a sublabial mucosal incision or a nasal mucosal incision has also been extensively used. An endoscopic transnasal approach was first described in the 1990's, followed by the concept of a microscopic transseptal approach and an endoscopic strictly endonasal approach. We use an entirely endoscopic transseptal transsphenoidal approach via an incision in the nasal mucosa for both access and tumour resection. This procedure has a number of advantages: strictly midline approach to the sella turcica, large operative field, no interference between instruments and a low rate of nasal complications.


Assuntos
Adenoma/cirurgia , Septo Nasal/cirurgia , Neoplasias Hipofisárias/cirurgia , Cirurgia Endoscópica Transanal/métodos , Pontos de Referência Anatômicos , Humanos , Posicionamento do Paciente/métodos , Sela Túrcica/cirurgia , Seio Esfenoidal/cirurgia , Técnicas de Sutura , Cirurgia Endoscópica Transanal/instrumentação
18.
J Neurosurg ; 131(6): 1829-1834, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30579273

RESUMO

Maffucci syndrome (MS) and Ollier disease (OD) are nonhereditary congenital diseases characterized by multiple enchondromas and/or chondrosarcomas. Recent studies have implicated somatic mosaic mutations of isocitrate dehydrogenase 1 or 2 (IDH1/2) as contributing to the pathogenesis of MS and OD. Occasionally, patients with these disorders may also present with central nervous system (CNS) tumors; however, detailed genetic analyses are limited. In this article, the authors report on a male patient with MS, harboring three CNS tumors that share a common genetic alteration. Over a 9-year period, three separate tumor resections were conducted for sellar, intraparenchymal brainstem, and osseous clival tumors. The histopathological diagnoses were pituitary adenoma, diffuse astrocytoma, and chondrosarcoma, respectively. Sanger sequencing revealed a common IDH1 R132C mutation among all three CNS tumors but not in blood DNA. Administering chemotherapy (nimustine) and subsequent radiation therapy to the brainstem glioma and the residual lesion in the clivus have kept the patient progression free for 18 months. This is the first report demonstrating an IDH1 mutation shared among three different CNS tumors in a single patient with MS. The findings support the hypothesis that in MS and OD, a single common IDH1 mutation triggers tumorigenesis in cells of different origins and locations in a somatic mosaic fashion.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Encondromatose/cirurgia , Isocitrato Desidrogenase , Mutação , Sela Túrcica/cirurgia , Neoplasias da Base do Crânio/cirurgia , Adulto , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/genética , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/cirurgia , Encondromatose/diagnóstico por imagem , Encondromatose/genética , Humanos , Isocitrato Desidrogenase/genética , Masculino , Mutação/genética , Sela Túrcica/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/genética
19.
J Neurosurg ; 131(2): 526-531, 2018 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-30485192

RESUMO

OBJECTIVE: The endoscopic endonasal approach has been proposed as a primary surgical strategy for select craniopharyngiomas. However, those tumors that arise from the sella have not been classified with the other craniopharyngioma subtypes in terms of surgical nuances, intraoperative findings, and postoperative outcomes. The authors describe their experience with a select subtype of craniopharyngioma arising within the sella subjacent to the diaphragma sellae and refer to these tumors as type 0. METHODS: After obtaining IRB approval, three institutions retrospectively reviewed their data collected from 2005 to 2017. Patients eligible for inclusion in the study were those who had tumors that originated from the sella inferior to the diaphragma sellae. Demographic, clinical, radiological, surgical, and follow-up data were examined and analyzed. RESULTS: Twenty-eight patients (average age 19.3 years, range 3-60 years) were included in this study. Sixteen patients (57%) were younger than 18 years of age. All patients had characteristic imaging features of an expanded sella. Seventy-five percent of the patients presented with some form of visual field deficit (89% had radiographic optic apparatus compression) and 39% with hypopituitarism. The average maximal tumor diameter in the axial, coronal, or sagittal plane was 3.1 cm. Gross-total resection was achieved in 82% of the patients. Twenty-one percent of patients experienced an iatrogenic complication, and there were only two cases (7%) of postoperative cerebrospinal fluid (CSF) leakage. Only two patients (7%) required the use of a nasoseptal flap as part of their original reconstruction. Pathology was uniformly the adamantinomatous subtype. Postoperative objective visual outcomes were improved in 71% of the patients with visual symptoms or visual field deficits on presentation and stable in 24%. Mean follow-up was 45.1 months (range 3-120 months) with an 18% recurrence rate at a mean of 44.4 months (range 10-84 months). One patient was lost to follow-up. Thirty-six percent of patients received postoperative radiation to treat recurrence or residual tumor. Endocrine data are also presented. CONCLUSIONS: Craniopharyngiomas that originate within the sella below the diaphragma sellae are a select subtype characterized by 1) an enlarged sella, 2) an intact diaphragma sellae at surgery, and 3) an adamantinomatous pathology. These tumors can be treated transnasally without the absolute need for neurovascular flap reconstruction, as there is a low risk of CSF leakage.


Assuntos
Craniofaringioma/diagnóstico por imagem , Craniofaringioma/cirurgia , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Medicine (Baltimore) ; 97(47): e13376, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30461658

RESUMO

RATIONALE: Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC). PATIENT CONCERNS: A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision. DIAGNOSES: Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC. INTERVENTIONS: The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy. OUTCOMES: No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis. LESSON: Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.


Assuntos
Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Sela Túrcica/patologia , Adulto , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirurgia , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Imagem por Ressonância Magnética , Cirurgia Endoscópica por Orifício Natural/métodos , Nefrectomia , Sela Túrcica/cirurgia
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