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Endocrine Imaging
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Pituitary adenomas can be macroadenomas (>1 cm) or microadenomas (<1 cm), and they account for 10–15% of all intracranial tumours. They usually originate from the anterior pituitary, and macroadenomas often extend through the diaphragma sellae.
Craniopharyngioma
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Hermann L. Müller, Claire Alapetite, Jeffrey Wisoff
Although most craniopharyngiomas of childhood arise in the region of the tuber cinereum, a small percentage originates from more caudal craniopharyngeal duct cell rests within the sella turcica.118 As these tumors grow, the diaphragma sellae stretches over the dorsal aspect, separating it from suprasellar structures and preventing tumor adherence to the optic apparatus, hypothalamus, and vessels of the circle of Willis. This feature of the pathological anatomy allows a radical removal of solid intrasellar tumors and large infradiaphragmatic cystic tumors (Puget grade 0 and 1), through a transsphenoidal/transnasal approach.110,114,118,119 In centers with appropriate clinical experience and a coordinated ear, nose, and throat–pediatric neurosurgical team, endoscopic endonasal and extended endonasal approaches achieve a high rate of resection of not only sellar, but some suprasellar, tumors.120–122 In pediatric craniopharyngiomas, up to 80% of the tumors may be amenable to transsphenoidal/transnasal resection.100,102,119
The Basal Cell Nevus Syndrome
Published in Roger M. Browne, Investigative Pathology of the Odontogenic Cysts, 2019
Julia A. Woolgar, J. W. Rippin
Calcification of the falx cerebri is present in at least 85% of adult patients.3 Using CT-scanning, Lindeberg et al.7 found calcification of the falx in eight out of nine patients; the one case in which it was absent was the youngest patient in the series (8 years old), so it is conceivable that it would have developed later in life. Calcification of the falx has a quite distinctive lamellar pattern and can be present in even the youngest patients. This contrasts with the spotty, focal calcification seen in about 5% of the general population as a consequence of aging. Calcification of the diaphragma sellae and of the tentorium cerebelli is seen in 60 to 80% and 40% of patients, respectively. There are also reports of calcifications in the choroid plexus and basal ganglia in some patients, and it has been suggested, though without substantiation, that this may be the cause of the mental retardation often quoted as a feature of the syndrome.8 Agenesis of the corpus callosum has been noted, but it is not yet clear if this is other than a chance occurrence.9,10
Arachnoid prolapse in endoscopic transsphenoidal surgery of pituitary adenoma, technical note
Published in British Journal of Neurosurgery, 2023
Guive Sharifi, Nader Akbari Dilmaghani, Seyed Mousa Sadrhosseini, Shima Arastou
Prolapse of the suprasellar cistern arachnoid into the sellar fossa rapidly occurs after removal of a large cystic or soft tumor during transsphenoidal surgery. According to the flaccid diaphragma sellae theory, ‘suprasellar extension from large sellar tumors or any pathology that could cause pressure on the diaphragm sellae leading to produce a long flaccid diaphragm resulted from a decrease of its thickness strength and increase its length that could easily be prolapsed due to CSF pressure and drag the adhered structures by itself’ [1]. However, it has been mentioned that prolapse of the suprasellar cistern toward the sellar floor may require some type of reconstruction [12]. Acute dropping of the elongated optic nerves and chiasm into the sellae may also be present; however, severe postoperative visual deterioration is rarely found in this situation [13]. Previously, we used some maneuvers to decrease intra cranial pressure such as hyperventilation or the administration of a lumbar drain or other similar apparatus to reduce intracranial pressure, so prolapsed arachnoid get smaller then reconstruct sellar ploor. However, these are costly maneuvers which are expensive and not so effective. Therefore, we have used a simple method-cauterization of the arachnoid, which significantly reduces the size of the prolapsed arachnoid with upward movement into the intrasellar space through the sellar floor defect.
Post-operative vision loss: analysis of 587 patients undergoing endoscopic surgery for pituitary macroadenoma
Published in British Journal of Neurosurgery, 2022
John W. Rutland, Jonathan T. Dullea, Eric K. Oermann, Rui Feng, Dillan F. Villavisanis, Shivee Gilja, William Shuman, Travis Lander, Satish Govindaraj, Alfred M. C. Iloreta, James Chelnis, Kalmon Post, Joshua B. Bederson, Raj K. Shrivastava
Six patients presented with a primary pituitary adenoma, and five had received previous surgical resection at an outside institution. Grafts were used for 10 patients during surgical reconstruction. Graft materials included abdominal fat (45.5%), fascia lata (27.3%), and a combination of abdominal fat and fascia lata (18.2%). The diaphragma sellae was opened in nine out of the 11 surgeries. A preventative graft was placed in one patient without diaphragma opening due to interoperative identification of thinning of the diaphragma. All 11 tumours were subtotally resected with an average resection rate of 87.4%. Four patients had a hematoma and six patients had pneumocephalus identified on post-operative imaging. The average systolic blood pressure measured in the post-anaesthesia care unit was 141.5 ± 18.2 mm Hg. Seven patients returned to the operating room within 24 h of initial surgery. The average time to return to the operating room was 33.5 ± 40.5 h. Surgical factors are shown in Table 2.
Pediatric pituitary adenoma with mixed FSH and TSH immunostaining and FSH hypersecretion in a 6 year-old girl with precocious puberty: case report and multidisciplinary management
Published in International Journal of Neuroscience, 2022
Marco Ceraudo, Diego Criminelli Rossi, Natascia Di Iorgi, Armando Cama, Gianluca Piatelli, Alessandro Consales
The patient successfully underwent transsphenoidal endoscopic resection of the pituitary macroadenoma (Figure 3). After local decongestion of the nasal mucosa, a paraseptal dissection up to the rostrum and sphenoid sinus ostium was performed. Anterior sphenoidectomy allowed the exposure of a large sellar floor. Using high speed drill, sphenoid septa and a thin sellar floor bone layer were removed. Once the dura was incised, a soft and fluffy yellow mass came out. There was no evidence of intralesional hemorrhages or cavernous sinus wall invasion. Using different types of endoscopic curette, complete resection was achieved. Modified endoscopic diving technique hydrodissection [14] was performed in order to remove any tumor residual, check grade of resection and control the integrity of diaphragma sellae and cavernous sinus walls. No CSF leaks were found and skull base reconstruction was performed using heterologous dural substitute, fibrin glue and other haemostatic agents. Nasal swabs were left in both nostrils for the subsequent five days.