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1.
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
2.
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
3.
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
4.
Medicine (Baltimore) ; 98(27): e16089, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277105

RESUMO

To establish magnetic resonance imaging (MRI) features that differentiate residual tumors from postoperative surgical changes following the transsphenoidal approach of a pituitary adenoma.We analyzed residual enhancements at the tumor bed in 52 patients who underwent dynamic contrast-enhanced sella MRI within 48 hours after surgery and at 6 to 28 months. Patients were divided into 2 groups defined by either peripheral or nodular enhancement patterns. For each group, we measured the maximum thickness of the residual enhancing portion and compared differences in the residual tumor and postoperative changes.Among the tumors examined in the 52 patients, 19 residual tumors showed nodular (n = 16) and peripheral (n = 3) enhancement patterns, and 33 postoperative changes showed nodular (n = 3) and peripheral (n = 30) enhancement patterns. The mean residual tumor thickness was 7.1 mm (range, 2.9-16.8 mm) and 1.9 mm (range, 1.0-7.4 mm) in the postoperative change. Receiver operating characteristic curve analysis revealed that a 3.9-mm thickness was associated with 89% sensitivity, 97% specificity, and 94% accuracy for diagnosis of residual tumor.On immediate postoperative MRI, residual enhancement with greater than 3.9-mm thickness and nodular pattern suggest residual pituitary adenoma tumor.


Assuntos
Adenoma/patologia , Neoplasia Residual/patologia , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Adulto Jovem
5.
World Neurosurg ; 130: e150-e159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203060

RESUMO

BACKGROUND: Xanthogranuloma is a chronic inflammatory mass characterized by cholesterol crystal deposition, which is rarely seen in the sellar region. The objective of this study is to identify the clinical features and cause of sellar xanthogranulomas. METHODS: We retrospectively analyzed manifestation, radiographic, and endocrinologic presentation in 9 patients (7 women and 2 men) whom we had previously treated. RESULTS: The patients were between 26 and 73 years of age (median, 56 years). The chief symptoms were visual symptoms in 3, polyuria in 3, headache in 4, and tiredness in 4 patients. Perimetry found visual field deficit in 6 patients. Anterior pituitary provocation tests disclosed impairment of ≥1 hormone in all patients: growth hormone in 8 patients and adrenocorticotropic hormone-cortisol axis in 8 patients. The lesions were suprasellar in 2 patients, intrasellar in 2 patients, and intrasuprasellar region in 5 patients. Three of the lesions were solid and 6 were single cystic to multicystic. Very low intensity area on T2-weighted magnetic resonance imaging was observed in 4 lesions. Postcontrast study performed in 7 lesions showed enhancement in solid parts or cyst walls. Surgical decompression improved visual disturbance in half of the patients but rarely improved hormonal deficits. Follow-up (median, 47 months) found no recurrence of the lesion. In addition to these 9 cases, we found 2 xanthogranulomatous lesions pathologically associated with ciliated epithelia, which also presented with severe hypopituitarism. CONCLUSIONS: Xanthogranuloma seems to be the last stage of the chronic inflammation affecting Rathke cleft cyst or craniopharyngioma presenting with severe anterior pituitary insufficiency.


Assuntos
Granuloma/complicações , Granuloma/patologia , Hipopituitarismo/complicações , Neoplasias Hipofisárias/complicações , Sela Túrcica/patologia , Xantomatose/complicações , Xantomatose/patologia , Adulto , Idoso , Feminino , Granuloma/diagnóstico por imagem , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/patologia , Masculino , Pessoa de Meia-Idade , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
6.
J Clin Neurosci ; 66: 275-277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101584

RESUMO

We report the case of a 59 year old woman who presented with a six week history of worsening bifrontal headache. On CT brain the only abnormal finding was a partially empty sella potentially indicative of increased intracranial pressure. MRI found a large cerebral venous sinus thrombosis in the superior sagittal sinus. Blood tests and a bone marrow biopsy revealed a diagnosis of JAK2 positive primary polycythaemia rubra vera. The lack of sensitivity and specificity of CT in the diagnosis of CVST should engender a low threshold for MRI in patients with risk factors and/or non-diagnostic abnormalities on initial CT. Management of this dual pathology involves both the immediate treatment of the thrombus with heparin bridging to warfarin and the long treatment for polycythaemia involving repeat venesections and cytoreductive therapy.


Assuntos
Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/diagnóstico por imagem , Policitemia Vera/complicações , Policitemia Vera/diagnóstico por imagem , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Diagnóstico Diferencial , Síndrome da Sela Vazia/terapia , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico por imagem , Cefaleia/terapia , Heparina/administração & dosagem , Humanos , Pessoa de Meia-Idade , Policitemia Vera/terapia , Sela Túrcica/diagnóstico por imagem , Trombose dos Seios Intracranianos/terapia , Varfarina/administração & dosagem
7.
J Ayub Med Coll Abbottabad ; 31(2): 172-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094110

RESUMO

BACKGROUND: The growth of sella turcica is completed early in life, therefore it can be used as a stable landmark for the prediction of future skeletal malocclusions. This early diagnosis may help in planning less complicated treatment modalities. Therefore, this study aimed to evaluate the relationship between sella turcica dimensions and morphology with various skeletal patterns. METHODS: A cross sectional study was conducted using the pre-treatment cephalograms of 180 subjects aged 13-19 years. The subjects were divided into two groups based on skeletal patterns. The dimensions of sella turcica and skeletal patterns were digitally measured using View Pro-X software. One-way ANOVA was applied to compare sella turcica dimensions among skeletal patterns. Sella dimensions and vertical growth patterns were compared using Post-hoc Tukey test. Chi-square test was applied to compare sella morphology among malocclusion groups. Results were taken as statistically significant at p-value of ≤0.05. RESULTS: Sella dimensions showed insignificant differences among sagittal groups whereas, significant differences were found for sella length (p≤0.02) and depth (p≤0.03) among the vertical groups. Multiple comparisons showed significant differences between sella length (p≤0.03) and diameter (p≤0.04) between normodivergent versus hyperdivergent groups. Moreover, significant differences were found in the sella turcica morphology among sagittal malocclusion (p≤0.03). CONCLUSIONS: Increased dimensions of sella turcica were associated with hyperdivergent growth pattern. Bridging of the sella turcica was found to be prevalent in class III malocclusion.


Assuntos
Má Oclusão , Sela Túrcica , Adolescente , Adulto , Cefalometria , Estudos Transversais , Humanos , Má Oclusão/diagnóstico por imagem , Má Oclusão/epidemiologia , Má Oclusão/patologia , Sela Túrcica/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Adulto Jovem
8.
World Neurosurg ; 128: 527-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048046

RESUMO

BACKGROUND: Diffuse midline glioma H3 K27M mutant is a new tumor entity described in the revised 2016 World Health Organization classification. It is most frequently observed in children and develops in midline structures, including the brainstem, thalamus, and spine. We describe a rare diffuse midline glioma with an H3 K27M mutation arising in the hypothalamus of an adult. CASE DESCRIPTION: A 27-year-old woman was admitted to our department complaining of amenorrhea, polydipsia, and diuresis for the previous 3 months, and headache and lethargy for approximately 10 days. Computed tomography scan showed an oval isodense solid mass extending from the pituitary toward the suprasellar cistern. A gadolinium-enhanced magnetic resonance imaging (MRI) showed a strongly heterogeneous enhanced solid lesion and nonenhanced cystic lesion. The patient underwent surgery and chemoradiotherapy with temozolomide. Histologic and immunohistochemical analyses revealed H3 K27M-mutant diffuse midline glioma. The patient underwent another resection for a recurrent tumor 5 months after the first surgery. Three months after the second operation, the patient relapsed, with MRI revealing spinal cord and meningeal metastases; she died shortly afterward. CONCLUSIONS: Diffuse midline glioma with an H3 K27M mutation occurring in the hypothalamus of an adult is rare but should be considered in differential diagnoses. Because histone H3 K27M mutations are associated with aggressive clinical behavior and poor prognosis, molecular analyses should be used to determine the clinical and histopathologic features of such tumors. This will contribute to developing targeted drugs and gene therapy going forward.


Assuntos
Glioma/cirurgia , Neoplasias Hipotalâmicas/cirurgia , Adenoma/diagnóstico , Adulto , Amenorreia/etiologia , Diagnóstico Diferencial , Diurese , Feminino , Glioma/complicações , Glioma/diagnóstico por imagem , Glioma/genética , Histonas/genética , Humanos , Hipopituitarismo/etiologia , Neoplasias Hipotalâmicas/complicações , Neoplasias Hipotalâmicas/diagnóstico por imagem , Neoplasias Hipotalâmicas/genética , Neoplasias Hipofisárias/diagnóstico , Polidipsia/etiologia , Sela Túrcica/diagnóstico por imagem
9.
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
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.
Surg Radiol Anat ; 41(5): 529-534, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30652212

RESUMO

PURPOSE: Few studies have explored the detailed morphology of the diaphragma sellae (DS), diaphragm opening (DO) or stoma, and subdiaphragmatic cistern (SDC) using neuroimages. The aim of the present study was to characterize these structures using magnetic resonance imaging. METHODS: Thin-sliced, sagittal and coronal T2-weighted imaging was performed for a total of 84 outpatients. RESULTS: The DS, DO, SDC, and relevant structures were consistently delineated in all patients. In 66% of patients, all three structures appeared to be highly variable, and were classifiable as six distinct morphological types. In 4% of patients, the DS presented as a complete sheet lacking a discernible DO. In addition, 30% of the patients presented with undiscernible SDCs. In the coronal sections of 11% of patients, the pituitary glands extended laterally, reaching or extending beyond the center line on the sectional image of the cavernous internal carotid artery. CONCLUSIONS: Thin-sliced, sagittal, and coronal T2-weighted sequences are useful for delineating the DS, DO, and SDC. Morphological variation of these structures among individuals may considerably influence the direction of pituitary tumor expansion.


Assuntos
Seio Cavernoso/anatomia & histologia , Seio Cavernoso/diagnóstico por imagem , Dura-Máter/anatomia & histologia , Dura-Máter/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Sela Túrcica/anatomia & histologia , Sela Túrcica/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
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
15.
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
16.
Endocrine ; 63(1): 36-43, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30276594

RESUMO

PURPOSE: In 2017, the WHO established that pituicytoma, granular cell tumour (GCT) and spindle cell oncocytoma (SCO) are posterior pituitary tumours (PPT). Recent data suggests that these tumours probably arise from the pituicytes and may constitute a spectrum of a unique histopathological entity. Our aim is to report the clinical findings and surgical outcomes of 16 patients with PPT. We also evaluated the tissue specimens available in light of current knowledge. METHOD: Cross-sectional study with retrospective data. RESULTS: PPT were 7 pituicytomas, 3 GCT and 6 SCO. Patients mean age was 55 years old and 75% were female. Basal hormonal study showed hyperprolactinemia (43.7%) and hypopituitarism (37.5%). There was no case of diabetes insipidus (DI). MRI showed sellar/suprasellar masses with mean size of 19.7mm. PPT was not suspected in any patient. Fifteen patients underwent surgery and complications were common: 20% had perioperative bleeding (one patient died because of a massive haemorrhage), 57.1% hypopituitarism, 35.7% permanent DI and 21.4% underwent a second surgery. Pathological findings shown positivity for thyroid transcription factor 1, vimentin and negativity for cytokeratin and chromogranin A in all specimens evaluated. S100 protein was positive in 88.8% of tumours. Ki67 was ≥ 3% in 66.6% and ranged from 4-7% in SCO. CONCLUSION: PPT have similar histology, clinical features and are frequently misdiagnosed as nonfunctioning pituitary tumours. However, post-surgical complications including haemorrhage are common. A high clinical suspicion is needed to presume the diagnosis prior surgery and diminish the high morbidity of these tumours.


Assuntos
Adenoma Oxífilo/cirurgia , Tumor de Células Granulares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neuro-Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Adenoma Oxífilo/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Tumor de Células Granulares/patologia , Humanos , Hiperprolactinemia/etiologia , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Neuro-Hipófise/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Resultado do Tratamento
17.
World Neurosurg ; 122: e130-e138, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30266706

RESUMO

OBJECTIVE: Pituitary macroadenomas extend into the extrasellar space, such as the sphenoid sinus, cavernous sinuses, and suprasellar region. However, factors that regulate the direction of their extensions into the surrounding anatomical structures remain unknown. METHODS: This retrospective study included 162 patients who were treated for pituitary adenomas that had maximum diameters greater than 20 mm. According to the direction of adenoma extension, patients were divided into 4 groups: group A, inferior into the sphenoid sinus; group B, lateral into the cavernous sinus; group C, suprasellar region with enlarged sella turcica; and group D, supraellar region without enlarged sella turcica. Several anatomical structures surrounding the sella turcica were evaluated statistically, and multivariate logistic regression analysis was performed if the structures met the determining factors of adenomas extensions. RESULTS: The maximum diameter of adenomas was significantly larger in groups A and D. The maximum diameter of the diaphragmatic foramen was largest in group C (19.3 mm) and was significantly narrower in groups B (12.7 mm) and D (12.5 mm). Intrasphenoid septation, attached on the midline of the sella turcica, was observed most frequently in group D (78.6%) and was not detectable in group A (0%). Extension into the cavernous sinus, classified as dural discontinuity, was highly prevalent in group B (80.0%) and was uncommon in group C (12.3%). Erosion of the posterior clinoid process was most apparent in group B (92.0%). CONCLUSIONS: The integrity of the sella dura and the intrasphenoid septation can regulate adenoma extension by encouraging their growth towards paths of least resistance.


Assuntos
Adenoma/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/patologia , Adenoma/fisiopatologia , Progressão da Doença , Dura-Máter/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Carga Tumoral
18.
Folia Morphol (Warsz) ; 78(3): 517-523, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30444524

RESUMO

BACKGROUND: The aim of the study was to assess the dimensions and volume of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: CBCT images of 80 Caucasian adult patients (40 males, 40 females) with normal facial appearance and occlusion taken previously for diagnostic purposes were evaluated. Two groups were constructed in accordance to gender. The volume, length, diameter, and depth of the sella turcica were measured by Romexis software programme. Mann-Whitney U test and Independent t-tests were used for statistical analysis. RESULTS: The mean lengths of the sella were 9.9 mm and 10.2 mm, depths were 9.2 mm and 8.8 mm and diameters were 12.3 mm and 12.1 mm in female and male groups, respectively. Between the genders, no statistically significant differences were found for any of the measurements. There were significantly higher values for the volume of sella turcica in males than in females (1102 ± 285.3 mm3 and 951.3 ± 278.5 mm3, respectively). CONCLUSIONS: The dimensions of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance revealed nonsignificant differences between the genders. Individual variability in dimensions and gender differences in the volume are of importance in comparison of patients with craniofacial syndromes and aberrations. Knowledge concerning the dimensions and volume of sella turcica will be clinically relevant for a guidance to consciously realize pituitary disorders.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imagem Tridimensional , Doenças da Hipófise/patologia , Sela Túrcica/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Padrões de Referência , Sela Túrcica/patologia
19.
Am J Clin Pathol ; 151(3): 241-254, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30551183

RESUMO

Objectives: The list of tumors involving the pituitary gland has been expanded to include a variety of neuronal and paraneuronal tumors in the 2017 World Health Organization tumor classification of endocrine organs. All the entities included in this category are distinctly rare, with limited case reports in the literature. Methods: We illustrate two extraordinary sellar tumors with neuronal differentiation: a sellar paraganglioma and a sellar neurocytoma, with thorough literature review and comparison of the clinicopathologic features of these entities. Results: Both entities are exceptionally rare and tend to be misdiagnosed as pituitary adenoma preoperatively. Both entities demonstrate frequent clinical recurrence compared with pituitary adenoma, as well as the rare occurrence of metastatic disease. Conclusions: In evaluating a sellar tumor with an uncommon morphology and neuroendocrine differentiation, an increased awareness of the unusual entities that may involve the sellar region and a judicious panel of immunohistochemical studies should improve the diagnosis.


Assuntos
Adenoma/patologia , Tumores Neuroendócrinos/patologia , Paraganglioma/patologia , Neoplasias Hipofisárias/patologia , Adenoma/classificação , Adenoma/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tumores Neuroendócrinos/classificação , Tumores Neuroendócrinos/diagnóstico por imagem , Paraganglioma/classificação , Paraganglioma/diagnóstico por imagem , Neoplasias Hipofisárias/classificação , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Organização Mundial da Saúde
20.
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
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