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Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes.

OBJECTIVE: To analyze functioning and nonfunctioning pituitary adenomas (PAs)>3 cm, with special emphasis on preoperative and postoperative visual functions. METHODS: The cases consisted of 49 women and 54 men with mean age of 43.2 years (range 19-66 years). All cases had a macroadenoma >3 cm in diameter. The transsphenoidal approach was performed in 117 procedures, and the transcranial approach was performed in 8 procedures. Radical tumor excision was achieved in 50 of 103 patients. Postoperative evaluation was done in 88 patients. Preoperative and postoperative visual acuity, visual field,

Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission.

We retrospectively analyzed 90 patients who underwent transsphenoidal surgery (performed by three surgeons) in our center as initial therapy for acromegaly. We used a combination of modern, evidence-based remission criteria including mean day curve GH less than 2.5 micro g/liter (5 mU/liter), a nadir GH less than 1.0 micro g/liter (2 mU/liter) after an oral glucose tolerance test, and normal age-related IGF-I levels (where available). Fifty-seven of 90 (63%) patients remained in remission after surgery. Seventy-nine percent of patients with microadenomas but only 56% of patients with macroaden

Pathophysiology of hyponatremia after transsphenoidal pituitary surgery.

Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery

Case series: non vascular considerations in trigeminal neuralgia.

An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs a

Reduced intercarotid artery distance in acromegaly: pathophysiologic considerations and implications for transsphenoidal surgery.

BACKGROUND: The objective of this study is to evaluate the significance of reduced intercarotid artery distance in the C5 segment in acromegalic patients and the implications for transsphenoidal surgery. METHODS: The skull base with the carotid canal was examined with a helical CT scan in 45 patients with acromegaly and 45 age group-matched controls. The distances between the inner walls (IWs) of the carotid sulcus (CS), the outer walls (OWs) of the CS, and the diameter of the ICA at the C5 segment were assessed. Preoperative IGF-1 and growth hormone levels and concomitant diseases were evalu

Intraoperative MRI for transphenoidal procedures: short-term outcome for 100 consecutive cases.

BACKGROUND: The majority of pituitary lesions are benign and can be cured with complete surgical resection. However, the transsphenoidal technique (the most common approach for pathology in this region) is limited by poor visualization and anatomical constraints. This can lead to incomplete tumor resection and thus increased recurrence rates. The use of iMRI during these procedures offers the advantage of radiographic confirmation during the procedure and may improve extent of resection. We reviewed our experience with this technology in 100 consecutive cases and compared the outcomes to publi

Surgical outcome in 90 patients with craniopharyngioma: an evaluation of transsphenoidal surgery.

OBJECTIVE: To analyze surgical outcomes in 90 patients with craniopharyngioma treated by standard transsphenoidal surgery (TSS) or extended transsphenoidal surgery (eTSS). METHODS: From 1990-2008, 90 patients (64 adults and 26 children) underwent TSS for craniopharyngioma (34 subdiaphragmatic and 56 supradiaphragmatic). TSS was performed as the initial surgery in 62 patients and as the second procedure in 28 patients. RESULTS: Total tumor removal was achieved in 70 (77.8%) patients, subtotal removal was achieved in 17 (18.9%), and partial removal was achieved in 3 (3.3%). Total removal was m

Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases.

OBJECTIVE: The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region. METHODS: From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar reg

Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly.

OBJECT: The results of surgical therapy for acromegaly were assessed using carefully conducted endocrinological testing in 115 patients who underwent transsphenoidal surgery from 1981 to 1995. METHODS: Ninety-nine of the 115 patients could be contacted for follow-up review; in 57 of the patients an endocrinological assessment was performed by the authors. Biochemical cure was strictly defined as a normalization of the insulin-like growth factor(IGF)-I level (obtained in 100 patients) and/or a basal or glucose-suppressed growth hormone (GH) level of 2 ng/ml or less. The mean length of follow u

Budget Impact of a Steroid-Eluting Sinus Implant Versus Sinus Surgery for Adult Chronic Sinusitis Patients with Nasal Polyps.

BACKGROUND: A corticosteroid-eluting sinus implant was recently approved by the FDA as a drug to treat adult patients with nasal polyps who have undergone previous endoscopic sinus surgery (ESS) of the ethmoid sinuses. ESS is performed in an operating room under general anesthesia, whereby diseased tissue and bone are removed to provide improved drainage. ESS typically involves dissection of 1 or more of the 4 paired sinus cavities (maxillary, ethmoid, sphenoid, or frontal). The implant, containing 1,350 mcg of mometasone furoate, is inserted by a physician in an office setting and offers cont

Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery.

PURPOSE: Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS and the predictors of endocrine function before and after ETSS are scarce. This study is purposed to analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS: A retrospective review of 601 consecutive patients who underwent ETSS between 2010 an

Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note.

Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction. Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningio

Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome.

OBJECTIVE: To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. METHODS: A retrospective analysis was done on 53 patients (40 female) with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. The standard surgical approach consisted of pterional craniotomy. Sixteen meningiomas extended posteriorly onto the diaphragma sella, 29 anteriorly to the planum sphenoidale, and 19 to the anterior clinoid process. Thirty seven tumours involved the optic canal,

Сфеноидный грибковый носорогсинусит по всему спектру заболеваний: серия неинвазивных грибковых шариков и смертельный острый инвазивный грибковый носорогсинусит.

ВВЕДЕНИЕ: Сфеноидный грибковый носорогсинит является необычным, но клинически важным субъектом, начиная от неинвазивного грибкового шара и заканчивая быстро фатальным острым инвазивным грибковым носорогом. ПРЕДОСТАВЛЕНИЕ КИСЛОТА: Мы сообщаем о двух противоположных случаях грибкового заболевания сфеноида. Во-первых, 28-летняя иммунокомпетентная женщина с хронической односторонней головной болью, вызванной изолированным феноидным грибком, который успешно лечился эндоскопической феноидотомией и расчисткой. Вторым был 49-летний мужчина с сахарным диабетом, который подавался с орбитальным участием,

Case Report: Cavernous Sinus Syndrome as the Initial Presentation of Multiple Myeloma.

Multiple myeloma (MM) is the second most common hematologic malignancy and most common primary bone malignancy. Ocular manifestations of MM are extremely rare and may be the first presentation leading to diagnosis. Ophthalmologists routinely encounter cavernous sinus syndrome, and there is a wide range of possible etiologies. Here, we present a case of a patient presenting with diplopia, ptosis, and ophthalmoplegia found to have a cavernous sinus plasmacytoma with systemic workup consistent with MM. MM is a rare cause of cavernous sinus syndrome and should be considered in the setting of a sku

An unusual case of aggressive endometrial adenocarcinoma metastasis to the clivus: illustrative case.

BackgroundThough endometrial carcinomas are a relatively common cancer of the female genitourinary tract, they rarely metastasize. Similarly, clival metastases make up a tiny fraction of all brain metastases. To the authors' knowledge, an endometrial carcinoma clival metastasis has never been described in the literature; therefore, the authors present the following unusual case of a 69-year-old female with a history of an initially grade 2 endometrial adenocarcinoma that metastasized to her clivus.ObservationsEndometrial carcinoma has the potential to metastasize to the clivus.LessonsEndometri

Совпадение в полном тексте источника
… Lessons The majority of symptomatic clival lesions present with headache and diplopia attributable to an abducens nerve palsy. 1 , 4 The petrosal process of the sphenoid bone is the superolateral portion of the clivus, which comprises the inferomedial portion of Dorello’s canal, where this nerve traverses … Microsurgical anatomy and the importance of the petrosal process of the sphenoid bone in endonasal surgery . J Neurosurg . 2022 ; 137 ( 5 ): 1431 - 1442 . 35276642 10.3171/2021.12.JNS212024 10. Vellutini A Balsalobre L Hermann DR Stamm AC . …

Nuances in the treatment of malignant tumors of the clival and petroclival region.

Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnost

Совпадение в полном тексте источника
… The clivus has a unique anatomical relationship with the sphenoid bone in that it lies posterior and extends inferior to the sphenoid sinus, making it surgically accessible through transsphenoidal and nasopharyngeal approaches. … The petrous portion of the temporal bone is wedged in the middle of the skull base bordered anteriorly by the squamous part of the temporal bone and sphenoid bone and bordered posteriorly by the occipital bone. …

Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension.

Giant pituitary adenomas are considered a surgical challenge. Their invasiveness, irregular growth, and extensions make this surgery critical. Because of this reason, the radical resection rate is low in such pathology. The endoscopic endonasal approach pushes its limits to get successful results in skull base lesions. Irregular shape, cavernous sinus invasion, and extensions are being successfully resected during the last decades. Lateral extension, especially posterolateral extension, of this tumor makes them impossible to radical resection. In this video case, we try to present an expanded

Decision-Making in Clival Mass Lesions: Risk Factors for Malignant Disease and an Illustrative Case Example.

Introduction  Clival tumors are rare and heterogeneous. Although some benign prototypical sellar lesions may present as clival tumors, the likelihood of malignant disease is higher. Here we define a novel algorithm for the workup and management of clival masses through an illustrative case of colorectal adenocarcinoma metastasis to the clivus. Methods  In this case report, the best practice guidelines for managing clival masses are described through a literature review and refined by senior author consensus. We conducted a focused systematic review to characterize the present case in the conte

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base.

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformati