Pituitary surgery
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The nasal cavity provides access to this space, because the sphenoid bone connects it to the pituitary gland above. The carotid arteries are in close relationship to the sphenoid bone, creating an impression in the lateral wall of the sphenoid sinus. Also, both cavernous sinuses lie laterally to the sphenoid bone. The pituitary gland rests in the center of the bone, the sella turcica, limited anteriorly by the tuberculum sellae and posteriorly by the dorsum sellae. The sphenoid sinus is an air cavity inside the sphenoid body. It separates the cavernous sinuses, the cavernous segments of the carotid arteries, the optic, extraocular, and trigeminal nerves, and the pituitary gland from the nasal cavity (Figure 37.4). The sella turcica is separated from the rest of the brain by the diaphragma sellae, a membrane that covers the pituitary gland, except for a small opening in its center for the pituitary stalk.
Pituitary Tumors and Their Management
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
Transsphenoidal surgery is unique in neurosurgery in that the operating surgical corridor is narrow, limiting the surgeon’s view. In addition, during tumor removal only a fraction of the tumor can be visualized, which makes the confirmation of complete tumor removal often difficult. The indications for the use of endoscopic transsphenoidal surgery are essentially the same as for the standard approach. Endoscopic surgery through use of the short focal length offers the advantages of enhanced illumination and a wider angle of viewing than the microscope. The tumor morphology often dictates the approach in each case. Tumors with extensive suprasellar extension may require a craniotomy rather than a transsphenoidal resection. In addition to a detailed history, physical, and endocrinological workup, the use of high-resolution MRI with and without contrast is imperative before surgery. Special coronal sella windows help delineate the sella anatomy, especially the location of the carotid arteries and the optic chiasm. The extent of sphenoid sinus pneumatization is also important when planning the appropriate surgical approach. Many endoscopic surgeons also favor high-resolution computed tomography of the sphenoid and sella to better assess the bony anatomy of the sphenoid.
Head and neck
Dave Maudgil, Anthony Watkinson in The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Are the following statements regarding juvenile angiofibroma true or false? Although benign it often invades the sphenoid sinus.Widening of the pterygopalatine fossa is a typical sign.It is generally of high signal intensity on T1-weighted magnetic resonance imaging (MRI).CT-guided biopsy is a good means of investigation.Arterial supply is usually via the facial artery.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2018
David Bellows, Noel Chan, John Chen, Hui-Chen Cheng, Peter MacIntosh, John H. Pula, Michael Vaphiades, Konrad P Weber
The authors report a retrospective evaluation spanning ten years. They describe cases of sphenoid sinus disease having neuro-ophthalmologic manifestations. They excluded describing non-inflammatory cases such as malignancy, and they excluded any cases wher pathology was localized anywhere outside the sphenoid sinus. In all, they found 67 cases of isolated sphenoid sinus disease, although only 23 were included in the report. It would have been helpful if they reported why the other cases were not included, but it is possible these were the non-inflammatory cases. The authors noted that neuro-ophthalmologic manifestations are non-specific, and include optic neuropathy, third nerve, and sixth nerve palsy. Fungal sinusitis was the most common diagnosis where post-operative pathology differed from preliminary radiographic diagnosis. Sphenoidotomy with drainage was the main treatment in all patients, and the authors recommend NOT treating with steroids until the infectious lesion is cleared. They found patients with diplopia responded much better to treatment than patients with optic neuropathy.
In-silico investigation of airflow and micro-particle deposition in human nasal airway pre- and post-virtual transnasal sphenoidotomy surgery
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Khashayar Moshksayan, Hojat Bahmanzadeh, Mohammad Faramarzi, Sasan Sadrizadeh, Goodarz Ahmadi, Omid Abouali
The endoscopic direct transnasal sphenoidotomy (TNS) is one such surgery that is currently performed for sphenoid sinus disease and pituitary surgery. In TNS surgery, only the posterior portion of the superior turbinate, close to the sphenoid wall, is removed and an area of the anterior sphenoid sinus wall is cauterized (Har-El 2003). TNS has several advantages over its alternative, transethmoidal sphenoidotomy (TES), because it does not require the ethmoidectomy procedure, and thus avoids any of its subsequent side effects (Bahmanzadeh et al. 2015). Furthermore, TNS is minimally invasive, as it does not involve removing the uncinate process nor the basal lamella dissection (Schlosser and Bolger 2003). Therefore, TNS is a suitable alternative to other methods of sphenoid sinus surgery.
Pituitary metastasis from renal cell carcinoma: case report and review of the literature
Published in International Journal of Neuroscience, 2021
Bin Li, Jian-Hua Cheng, Hai-Bo Zhu, Chu-Zhong Li, Ya-Zhuo Zhang, Peng Zhao
Lin [8] reported a similar case of pituitary metastases from a renal cell carcinoma. In his case, transsphenoidal surgery revealed a vascular tumor that invaded the sellar floor and the normal pituitary gland. In another case, a trans-sphenoidal surgical approach was performed by Magnoli [9], and upon exposure of the sphenoid sinus extensive bone erosion was noted. Complete removal of all evident lesion was accomplished despite moderate tumor bleeding in his case. In a case of a pituitary metastasis of renal cell carcinoma reported by Weber [10], only a biopsy was possible because the surgical procedure was complicated by profuse tumor bleeding. These results were similar with our case. We reviewed some of the literature related to pituitary metastasis from renal cell carcinoma. The results summarized are shown in Table 3 [4, 8–25].
Related Knowledge Centers
- Maxillary Nerve
- Ophthalmic Nerve
- Paranasal Sinuses
- Sphenoid Bone
- Nasal Cavity
- Sella Turcica
- Body of Sphenoid Bone
- Sphenoethmoidal Recess
- Choana
- Posterior Ethmoidal Nerve