Topographic variations of the optic chiasm and the pituitary stalk: a morphometric study based on midsagittal T2-weighted MR images

2014 ◽  
Vol 36 (8) ◽  
pp. 775-781 ◽  
Author(s):  
Hao Long ◽  
Song-tao Qi ◽  
Ye Song ◽  
Jun Pan ◽  
Xi-an Zhang ◽  
...  
Keyword(s):  
Optic Chiasm ◽  
Pituitary Stalk ◽  
Morphometric Study ◽  
Mr Images

Pre- and Postoperative MR Imaging of Craniopharyngiomas

1996 ◽  
Vol 37 (3P2) ◽  
pp. 806-812 ◽  
Author(s):  
J. K. Hald ◽  
O. P. Eldevik ◽  
D. J. Quint ◽  
W. F. Chandler ◽  
T. Kollevold
Keyword(s):  
Mr Imaging ◽  
Pituitary Gland ◽  
Third Ventricle ◽  
Optic Chiasm ◽  
Tumour Volume ◽  
Volume Reduction ◽  
Pituitary Stalk ◽  
Residual Tumour ◽  
Mr Images ◽  
The Third

Purpose: To compare the pre- and postoperative MR appearance of craniopharyngiomas with respect to lesion size, tumour morphology and identification of surrounding normal structures. Material and Methods: MR images obtained prior to and following craniopharyngioma resection were evaluated retrospectively in 10 patients. Tumour signal characteristics, size and extension with particular reference to the optic chiasm, the pituitary gland, the pituitary stalk and the third ventricle were evaluated. Results: Following surgery, tumour volume was reduced in all patients. In 6 patients there was further tumour volume reduction between the first and second postoperative images. Two of these patients received radiation therapy between the 2 postoperative studies, while 4 had no adjuvant treatment to the surgical intervention. There was improved visualization of the optic chiasm in 3, the pituitary stalk in one, and the third ventricle in 9 of the 10 patients. The pituitary gland was identified preoperatively only in one patient, postoperatively only in another, pre- and postoperatively in 5, and neither pre- nor postoperatively in 3 patients. In 3 patients MR imaging 0–7 days postoperatively identified tumour remnants not seen at the end of the surgical procedure. The signal intensities of solid and cystic tumour components were stable from pre- to the first postoperative MR images. Optic tract increased signal prior to surgery was gone 28 days postoperatively in one patient, but persisted on the left side for 197 days after surgery in another. Conclusion: Postoperative MR imaging of craniopharyngiomas demonstrated tumour volume reduction and tumour remnants not seen at surgery. Early postoperative MR imaging of craniopharyngiomas may overestimate the size of residual tumour. Improved visualization of peritumoral structures may be achieved.

scholarly journals Damage to the Optic Chiasm in Myelin Oligodendrocyte Glycoprotein–Experimental Autoimmune Encephalomyelitis Mice

2014 ◽  
Vol 7 ◽  
pp. MRI.S19750 ◽  
Author(s):  
Sheryl L. Herrera ◽  
Vanessa L. Palmer ◽  
Heather Whittaker ◽  
Blair Cardigan Smith ◽  
Annie Kim ◽  
...  
Keyword(s):  
Experimental Autoimmune Encephalomyelitis ◽  
Disease Onset ◽  
Optic Chiasm ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Mr Images ◽  
Autoimmune Encephalomyelitis ◽  
Apparent Diffusion ◽  
Hematoxylin And Eosin ◽  
Magnetic Resonance Imaging Mri ◽  
Experimental Autoimmune

Optic chiasm lesions in myelin oligodendrocyte glycoprotein (MOG)–experimental autoimmune encephalomyelitis (EAE) mice were characterized using magnetic resonance imaging (MRI) and validated using electron microscopy (EM). MR images were collected from 3 days after induction to remission, approximately 20 days after induction. Hematoxylin and eosin, solochrome cyanin–stained sections, and EM images were obtained from the optic chiasms of some mice approximately 4 days after disease onset when their scores were thought to be the highest. T2-weighted imaging and apparent diffusion coefficient map hyperintensities corresponded to abnormalities in the optic chiasms of EAE mice. Mixed inflammation was concentrated at the lateral surface. Degeneration of oligodendrocytes, myelin, and early axonal damage were also apparent. A marked increase in chiasm thickness was observed. T2-weighted and diffusion-weighted MRI can detect abnormalities in the optic chiasms of MOG-EAE mice. MRI is an important method in the study of this model toward understanding optic neuritis.

scholarly journals Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function

1997 ◽  
Vol 3 (1) ◽  
pp. E1
Author(s):  
R. Bryan Mason ◽  
Lynnette K. Nieman ◽  
John L. Doppman ◽  
Edward H. Oldfield
Keyword(s):  
Postoperative Period ◽  
Cushing’S Disease ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Anterior Lobe ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Cushing's Disease ◽  
Suprasellar Cistern ◽  
Transsphenoidal Resection

When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.

scholarly journals A Case of IgG4-Related Hypophysitis Presented with Hypopituitarism and Diabetes Insipidus

2015 ◽  
Vol 8 ◽  
pp. CCRep.S15352 ◽  
Author(s):  
Yumi Harano ◽  
Kazufumi Honda ◽  
Yurika Akiyama ◽  
Lisa Kotajima ◽  
Hiroko Arioka
Keyword(s):  
Diabetes Insipidus ◽  
Laboratory Tests ◽  
Plasma Cells ◽  
Elevated Serum ◽  
Pituitary Stalk ◽  
Mr Images ◽  
Abdominal Ct ◽  
Serum Igg4 ◽  
Almost All

Immunoglobulin (Ig) G4-related systemic syndrome is a recently described entity characterized by elevated serum IgG4 and tissue infiltration of IgG4-positive plasma cells. Pituitary gland can be involved as hypophysitis. We report a case of a 72-year-old man, who presented with general fatigue and weakness. Laboratory tests revealed diabetes insipidus as well as hypopituitarism including adrenal insufficiency, hypogonadism, and hypothyroidism. His serum IgG4 was elevated. MR images showed enlargement of the pituitary stalk. Multiple nodules in bilateral kidneys were pointed out in the abdominal CT. Histological examination of the nodules showed increased IgG4-positive plasma cells. We diagnosed him with IgG4-related kidney disease and hypophysitis. After treatment with hydrocortisone, his symptoms improved. The follow-up images showed that almost all renal nodules disappeared and his pituitary stalk was shrinking. Our case appears to be very sensitive to glucocorticoid and suggests the possibility of treating IgG4-related hypophysitis successfully with a lower dose of glucocorticoid.

Complete Microsurgical Resection of Large Retrochiasmatic Hypothalamic Craniopharyngioma by Transpetrosal Approach: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Nina T Yoh ◽  
Laligam N Sekhar
Keyword(s):  
Frozen Section ◽  
Brain Magnetic Resonance Imaging ◽  
Optic Chiasm ◽  
Pituitary Stalk ◽  
Excessive Sleepiness ◽  
Microsurgical Resection ◽  
Magnetic Resonance Imaging Mri ◽  
Prefixed Chiasm ◽  
The Right ◽  
Retrochiasmatic Region

Abstract This two-dimensional video shows the technical nuances of complete microsurgical resection of a hypothalamic craniopharyngioma located in the retrochiasmatic region by the transpetrosal approach.  This 49-yr-old man presented with progressive fatigue, excessive sleepiness, and difficulty in vision in both eyes. He was found to have right CN 3 paralysis and bitemporal hemianopsia on neurological examination. Further workup revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) demonstrated a large solid retrochiasmatic hypothalamic lesion with homogeneous contrast enhancement, measuring 2.1 × 2.6 × 2.4 cm. Optic chiasm was prefixed, and the tumor was just posterior to the pituitary stalk area. The preoperative differential diagnosis included hypothalamic astrocytoma, craniopharyngioma, germinoma, and histiocytosis. Because of the prefixed chiasm, a presigmoid, transpetrosal approach was performed. Our initial plan was a large biopsy, but based on frozen section histology, we decided to excise the tumor completely. The tumor had a pseudocapsule, which was firm and yellowish. It was debulked, dissected from the surrounding hypothalamus, and removed completely. The pituitary stalk was found at the anterior and inferior ends of the tumor and was preserved.  Postoperatively, the patient developed diabetes insipidus and requires desmopressin replacement, which was gradually tapered. For panhypopituitarism, he is receiving thyroxine, hydrocortisone, and testosterone.  Postoperatively, patient had an improvement in vision in his left eye and ptosis was improving in the right eye with mRs 1- at 10-wk follow-up.  An informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function

1997 ◽  
Vol 87 (3) ◽  
pp. 343-351 ◽  
Author(s):  
R. Bryan Mason ◽  
Lynnette K. Nieman ◽  
John L. Doppman ◽  
Edward H. Oldfield
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Anterior Lobe ◽  
Pituitary Function ◽  
Pituitary Stalk ◽  
Cushing's Disease ◽  
Content Type ◽  
Suprasellar Cistern ◽  
Fine Print

✓ When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.

Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus

2008 ◽  
Vol 108 (5) ◽  
pp. 930-933 ◽  
Author(s):  
Christopher R. P. Lind ◽  
Amy M. C. Tsai ◽  
Andrew J. J. Law ◽  
Hui Lau ◽  
Kavitha Muthiah
Keyword(s):  
Sagittal Plane ◽  
Statistical Significance ◽  
Catheter Insertion ◽  
Adult Patients ◽  
Patient Specific ◽  
Morphometric Study ◽  
Ventricular Catheter ◽  
Mr Images ◽  
Frontal Horn ◽  
Margin Of Error

Object The purpose of this study was to compare the margins of error of different shunt catheter approaches to the lateral ventricle and assess surface anatomical aiming landmarks for free-hand ventricular catheter insertion in adult patients with hydrocephalus. Methods Four adults who had undergone stereotactic brain magnetic resonance (MR) imaging and had normal ventricles, and 7 prospectively recruited adult patients with acute hydrocephalus were selected for inclusion in this study. Reconstructed MR images obtained prior to surgical intervention were geometrically analyzed with regard to frontal, parietal, and parietooccipital (occipital) approaches in both hemispheres. Results The ventricular target zones were as follows: the frontal horn for frontal and occipital approaches, and the atrium/ posterior horn for parietal approaches. The range of possible angles for successful catheter insertion was smallest for the occipital approach (8° in the sagittal plane and 11° in the coronal plane), greater for parietal catheters (23 and 36°), and greatest for the frontal approach in models of hydrocephalic brains (42 and 30°; p < 0.001 for all comparisons except frontal vs parietal, which did not reach statistical significance). There was no single landmark for aiming occipital or parietal catheters that achieved ventricular target cannulation in every case. Success was achieved in only 86% of procedures using occipital trajectories and in 66% of those using parietal trajectories. Conclusions The occipital approach to ventricular catheter insertion provides the narrowest margin of error with regard to trajectory but has less aiming point variability than the parietal approach. The use of patient-specific stereotaxy rather than generic guides is required for totally reliable, first-pass ventricular catheterization via a posterior approach to shunt placement surgery in adults.

The Superior Hypophyseal Arteries: Anatomical Study with an Endoscopic Endonasal Perspective

2019 ◽  
Vol 17 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Francesco Doglietto ◽  
Daniel Monte-Serrat Prevedello ◽  
Francesco Belotti ◽  
Marco Ferrari ◽  
Davide Lancini ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Optic Tract ◽  
Anatomical Study ◽  
Optic Chiasm ◽  
Pituitary Stalk ◽  
High Definition ◽  
Endoscopic Endonasal ◽  
Almost All ◽  
Internal Carotid Arteries ◽  
Number Of Branches

AbstractBACKGROUNDThe use of high-definition endoscopes in extended transsphenoidal approaches to the suprasellar area has significantly improved visualization of its vascularization.OBJECTIVETo systematically examine the superior hypophyseal arteries (SHAs) anatomy from an endonasal endoscopic perspective.METHODSThe endoscopic endonasal transsphenoidal trans-tuberculum approach was performed in 19 adult, fresh and latex injected specimens. Dissections recordings were reviewed to analyze SHAs type, number, and branches, as well as internal carotid arteries (ICA) branches that vascularized optic nerves and chiasm.RESULTSIdentification of SHAs was possible in all specimens (37/38 sides). The number of SHAs varied from 1 to 3 per side (mean: 1.7). The anterior superior hypophyseal artery was visible in almost all cases (35/37 sides) and originated at the level of the carotid cave in 18/35 specimens; number of branches ranged from 1 to 6 (mean: 3.5), directed to the optic nerve (86%), chiasm (57%), infundibulum (86%), and/or parallel to the pituitary stalk (74%). The 4 main branches and patterns, originally described by McConnell in 1953, were confirmed. The posterior superior hypophyseal artery was evident in 28/37 sides with number of branches ranging from 0 to 4 (mean: 2.1), directed to the optic chiasm (50%), optic tract (32%), infundibulum (79%), and/or pituitary stalk (36%). The surgical implications of this study, together with anatomical and clinical videos, are also briefly discussed.CONCLUSIONSHAs constitute a complex of anterior and posterior branches that stem from the medial ICA with different patterns, vascularizing the optic apparatus and pituitary stalk.

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