Visualization of the normal pituitary gland during the endoscopic endonasal removal of pituitary adenoma by narrow band imaging

2016 ◽  
Vol 158 (10) ◽  
pp. 1977-1981 ◽  
Author(s):  
Nobuyuki Akutsu ◽  
Masaaki Taniguchi ◽  
Eiji Kohmura
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Endoscopic Endonasal ◽  
Normal Pituitary Gland

scholarly journals Contact endoscopy as a novel technique for intra-operative identification of normal pituitary gland and adenoma

2022 ◽  
Vol 6 (1) ◽  
pp. V17
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Thin Section ◽  
Tumor Resection ◽  
Noninvasive Technique ◽  
Endoscopic Endonasal ◽  
Novel Technique ◽  
Normal Gland ◽  
Normal Pituitary Gland

Intraoperative distinction of pituitary adenoma from normal gland is critical in maximizing tumor resection without compromising pituitary function. Contact endoscopy provides a noninvasive technique that allows for real-time in vivo visualization of differences in tissue vascularity. Two illustrative cases of endoscopic endonasal approaches (EEAs) for resection of pituitary adenoma illustrate the use of contact endoscopy in identifying tumor from gland and differentiating a thin section of normal gland draped over the underlying tumor, thereby allowing for safe extracapsular tumor resection. Contact endoscopy may be used as an adjunct for intraoperative, in vivo differentiation of pituitary gland and adenoma. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21199

scholarly journals Infrasellar Endoscopic Endonasal Approach for a Pituitary Adenoma Extending into the Third Ventricle, with Anterior Displacement of the Pituitary Gland

2018 ◽  
Vol 79 (S 02) ◽  
pp. S233-S234
Author(s):  
Georgios Zenonos ◽  
Eric Wang ◽  
Juan Fernandez-Miranda
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Outcome Measures ◽  
Third Ventricle ◽  
Visual Fields ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Anterior Displacement ◽  
The Third

Objectives The current video presents the nuances of the infrasellar endoscopic endonasal approach for a pituitary adenoma extending into the third ventricle, with anterior displacement of the pituitary gland. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon at a teaching academic institution. Participants The case refers to 73-year-old female patient who was found to have a sellar mass after failure of vision to improve with cataract surgery. She also reported a several-month history of progressive loss of vision along with daily retro-orbital headaches. The adenoma extended into the clivus as well as in the retrosellar and suprasellar regions, eroding into the floor of the third ventricle. The normal gland was displaced anteriorly. Main Outcome Measures The main outcome measures consisted of reversal of patient symptoms (headaches and visual disturbance), recurrence-free survival based on imaging, as well as absence of any complications. Results The patient's headaches and visual fields improved. There was no evidence of recurrence. Conclusion The infrasellar endoscopic endonasal approach is safe and effective for pituitary adenomas extending into the third ventricle, with anterior displacement of the pituitary gland.The link to the video can be found at: https://youtu.be/zp_06mEyRvY.

Narrow band imaging in giant pituitary adenoma surgery

2016 ◽  
Vol 158 (8) ◽  
pp. 1621-1623 ◽  
Author(s):  
F. Prada ◽  
C. Pipolo ◽  
M. Del Bene ◽  
A. Maccari ◽  
A. M. Saibene
Keyword(s):  
Pituitary Adenoma ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Giant Pituitary Adenoma

Growth Patterns of the Normal Pituitary Gland and in Pituitary Adenoma

2008 ◽  
Vol 32 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Yukuo Konishi ◽  
Masanori Kuriyama ◽  
Masakatsu Sudo ◽  
Katsumi Hayakawa ◽  
Kaoru Konishi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Growth Patterns ◽  
Normal Pituitary Gland

Hypophysial transposition (hypophysopexy) for radiosurgical treatment of pituitary tumors involving the cavernous sinus

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Meic H. Schmidt ◽  
Joel D. Macdonald ◽  
Randy L. Jensen ◽  
William T. Couldwell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Radiation Exposure ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Residual Tumor ◽  
Normal Pituitary Gland ◽  
Fascia Graft ◽  
Normal Functional

Stereotactic radiosurgery (SRS) is performed with increasing frequency in the treatment of residual or recurrent pituitary adenomas. Its major associated risk in these cases of residual or recurrent pituitary tumor adjacent to normal functional pituitary gland is radiation exposure to the pituitary, which frequently leads to the development of hypopituitarism. The authors describe a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual pituitary adenoma within the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and a fat and fascia graft is interposed between the normal pituitary gland and the residual tumor in the cavernous sinus. The residual tumor may then be treated with SRS. The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery and reduces radiation exposure to the normal pituitary gland.

scholarly journals The role of indocyanine green fluorescence in endoscopic endonasal skull base surgery and its imaging correlations

2020 ◽  
pp. 1-11
Author(s):  
Mostafa Shahein ◽  
Daniel M. Prevedello ◽  
Thomas L. Beaumont ◽  
Khalid Ismail ◽  
Radwan Nouby ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Indocyanine Green ◽  
Pituitary Gland ◽  
Skull Base ◽  
Contrast Enhancement ◽  
Strong Correlation ◽  
Skull Base Surgery ◽  
Blue Color ◽  
Endoscopic Endonasal ◽  
Mri Contrast

OBJECTIVEThe use of endoscope-integrated indocyanine green (E-ICG) has recently been introduced in skull base surgery. The quantitative correlation between E-ICG and T1-weighted gadolinium-enhanced (T1WGd) images for skull base tumors has not been previously assessed, to the authors’ knowledge. In this study, the authors investigated the indications for use and the limitations of E-ICG and sought to correlate the endoscopic fluorescence pattern with MRI contrast enhancement.METHODSFollowing IRB approval, 20 patients undergoing endoscopic endonasal skull base surgery between June 2017 and August 2018 were enrolled in the study. Tumor fluorescence was measured using a blue color value and blood fluorescence as a control. Signal intensities (SIs) of tumor T1WGd images were measured and the internal carotid artery (ICA) SI was used as a control. For pituitary adenoma, the pituitary gland fluorescence was also measured. The relationships between ICG fluorescence and MRI enhancement measurements were analyzed.RESULTSData showed that in pituitary adenoma there was a strong correlation between the ratios of gland/blood fluorescence to gland/ICA SI (n = 8; r = 0.92; p = 0.001) and tumor/blood fluorescence to tumor/ICA SI (n = 9; r = 0.82; p = 0.006). In other pathologies there was a strong correlation between the ratios of tumor/blood fluorescence and tumor/ICA SI (n = 9; r = 0.74; p = 0.022). The ICG fluorescence allowed perfusion assessment of the pituitary gland as well as of the nasoseptal flaps. Visualization of the surrounding vasculature was also feasible.CONCLUSIONSDefining the indications and understanding the limitations are critical for the effective use of E-ICG. Tumor fluorescence seems to correlate with preoperative MRI contrast enhancement.

scholarly journals Magnetic resonance imaging of cavernous sinus invasion by pituitary adenoma diagnostic criteria and surgical findings

2004 ◽  
Vol 62 (2b) ◽  
pp. 437-443 ◽  
Author(s):  
Joaquim O. Vieira Jr. ◽  
Arthur Cukiert ◽  
Bernardo Liberman
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Cavernous Sinus ◽  
Predictive Value ◽  
Lateral Wall ◽  
Preoperative Imaging ◽  
Cavernous Sinus Invasion ◽  
Normal Pituitary Gland ◽  
Sensitivity Specificity ◽  
Dural Wall

This study used MRI to define preoperative imaging criteria for cavernous sinus invasion (CSI) by pituitary adenoma (PA). MR images of 103 patients with PA submitted to surgery (48 with CSI) were retrospectively reviewed. The following MR signs were studied and compared to intraoperative findings (the latter were considered the gold standard for CSI detection): presence of normal pituitary gland between the adenoma and CS, status of the CS venous compartments, CS size, CS lateral wall bulging, displacement of the intracavernous internal carotid artery (ICA) by adenoma, grade of parasellar extension (Knosp-Steiner classification) and percentage of intracavernous ICA encased by the tumor. Statistical analysis was performed using qui-square testing and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for each MR finding. The following signs have been found to represent accurate criteria for non-invasion of the CS: 1- normal pituitary gland interposed between the adenoma and the CS (PPV, 100%); 2- intact medial venous compartment (PPV, 100%); 3- percentage of encasement of the intracavernous ICA lower than 25% (NPV, 100%) and 4- medial intercarotid line not crossed by the tumor (NPV, 100%). Criteria for CSI were: 1- percentage of encasement of the intracavernous ICA higher than 45%; 2- occlusion of three or more CS venous compartments and 3- occlusion of the CS lateral venous compartment. The CS was very likely to be invaded if the inferior venous compartment was not detected (PPV. 92,8%), if the lateral intercarotid line was crossed (PPV. 96,1%) or if a bulging lateral dural wall of the CS was seen (PPV, 92,3%). The preoperative diagnosis of CSI by PA is extremely important since endocrinological remission is rarely obtained after microsurgery alone in patients with invasive tumors. The above mentioned MR imaging criteria may be useful in advising most of the patients preoperatively on the potential need for complimentary therapy after surgery.

NARROW BAND IMAGING COMO MÉTODO ALTERNATIVO PARA LA DETECCIÓN Y CARACTERIZACIÓN DE LOS FOCOS DE CRIPTAS ABERRANTES

Endoscopy ◽  
2011 ◽  
Vol 43 (12) ◽  
Author(s):  
M López-Cerón ◽  
M Jimeno ◽  
C Rodríguez de Miguel ◽  
M Zabalza ◽  
V Alonso-Espinaco ◽  
...  
Keyword(s):  
Narrow Band ◽  
Narrow Band Imaging
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