Comparison between extended transsphenoidal and transcranial surgery for craniopharyngioma: focus on hypothalamic function and obesity

Pituitary ◽  
2021 ◽  
Author(s):  
Alberto Luigi Gallotti ◽  
Lina Raffaella Barzaghi ◽  
Luigi Albano ◽  
Marzia Medone ◽  
Filippo Gagliardi ◽  
...  
Keyword(s):  
Transcranial Surgery ◽  
Hypothalamic Function

Central Retinal Artery Occlusion Following Prone Transcranial Surgery for Craniosynostosis and Discussion of Risk Factors

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Grayson Roumeliotis ◽  
Stewart Campbell ◽  
Sumit Das ◽  
Goran Darius Hildebrand ◽  
Peter Charbel Issa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Artery ◽  
Transcranial Surgery

A propensity-adjusted comparison of endoscopic endonasal surgery versus transcranial microsurgery for pediatric craniopharyngioma: a single-center study

2021 ◽  
pp. 1-10
Keyword(s):  
Perioperative Complications ◽  
Single Center ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Adjusted Analysis ◽  
Significant Difference ◽  
Csf Leakage ◽  
Hypothalamic Function

OBJECTIVE When comparing endoscopic endonasal surgery (EES) and transcranial microsurgery (TCM) for adult and mixed-age population craniopharyngiomas, EES has become an alternative to TCM. To date, studies comparing EES and TCM for pediatric craniopharyngiomas are sparse. In this study, the authors aimed to compare postoperative complications and surgical outcomes between EES and TCM for pediatric craniopharyngiomas. METHODS The data of pediatric patients with craniopharyngiomas who underwent surgery between February 2009 and June 2021 at a single center were retrospectively reviewed. All included cases were divided into EES and TCM groups according to the treatment modality received. The baseline characteristics of patients were compared between the groups, as well as surgical results, perioperative complications, and long-term outcomes. To control for confounding factors, propensity-adjusted analysis was performed. RESULTS Overall, 51 pediatric craniopharyngioma surgeries were identified in 49 patients, among which 35 were treated with EES and 16 were treated with TCM. The proportion of gross-total resection (GTR) was similar between the groups (94.3% for EES vs 75% for TCM, p = 0.130). TCM was associated with a lower rate of hypogonadism (33.3% vs 64.7%, p = 0.042) and a higher rate of growth hormone deficiency (73.3% vs 26.5%, p = 0.002), permanent diabetes insipidus (DI) (60.0% vs 29.4%, p = 0.043), and panhypopituitarism (80.0% vs 47.1%, p = 0.032) at the last follow-up. CSF leakage only occurred in the EES group, with no significant difference observed between the groups (p > 0.99). TCM significantly increased the risk of worsened visual outcomes (25.0% vs 0.0%, p = 0.012). However, TCM was associated with a significantly longer median duration of follow-up (66.0 vs 40.5 months, p = 0.007) and a significantly lower rate of preoperative hypogonadism (18.8% vs 60.0%, p = 0.006). The propensity-adjusted analysis revealed no difference in the rate of recurrence, hypogonadism, or permanent DI. Additionally, EES was associated with a lower median gain in BMI (1.5 kg/m2 vs 7.5 kg/m2, p = 0.046) and better hypothalamic function (58.3% vs 8.3%, p = 0.027) at the last follow-up. CONCLUSIONS Compared with TCM, EES was associated with a superior visual outcome, better endocrinological and hypothalamic function, and less BMI gain, but comparable rates of GTR, recurrence, and perioperative complications. These findings have indicated that EES is a safe and effective surgical modality and can be a viable alternative to TCM for pediatric midline craniopharyngiomas.

The current role of transcranial surgery in the management of pituitary adenomas

Pituitary ◽  
2012 ◽  
Vol 16 (4) ◽  
pp. 419-434 ◽  
Author(s):  
Ravindran Pratheesh ◽  
Simon Rajaratnam ◽  
Krishna Prabhu ◽  
Sunithi E. Mani ◽  
Geeta Chacko ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Current Role ◽  
Transcranial Surgery

Immortalized neurons for the study of hypothalamic function

2011 ◽  
Vol 300 (5) ◽  
pp. R1030-R1052 ◽  
Author(s):  
Prasad S. Dalvi ◽  
Anaies Nazarians-Armavil ◽  
Stephanie Tung ◽  
Denise D. Belsham
Keyword(s):  
Neuronal Cell ◽  
Glucose Sensing ◽  
T Antigen ◽  
Molecular Techniques ◽  
Cell Models ◽  
Hypothalamic Neurons ◽  
In Vivo Models ◽  
Wide Range ◽  
Hypothalamic Function

The hypothalamus is a vital part of the central nervous system: it harbors control systems implicated in regulation of a wide range of homeostatic processes, including energy balance and reproduction. Structurally, the hypothalamus is a complex neuroendocrine tissue composed of a multitude of unique neuronal cell types that express a number of neuromodulators, including hormones, classical neurotransmitters, and specific neuropeptides that play a critical role in mediating hypothalamic function. However, neuropeptide and receptor gene expression, second messenger activation, and electrophysiological and secretory properties of these hypothalamic neurons are not yet fully defined, primarily because the heterogeneity and complex neuronal architecture of the neuroendocrine hypothalamus make such studies challenging to perform in vivo. To circumvent this problem, our research group recently generated embryonic- and adult-derived hypothalamic neuronal cell models by utilizing the novel molecular techniques of ciliary neurotrophic factor-induced neurogenesis and SV40 T antigen transfer to primary hypothalamic neuronal cell cultures. Significant research with these cell lines has demonstrated their value as a potential tool for use in molecular genetic analysis of hypothalamic neuronal function. Insights gained from hypothalamic immortalized cells used in conjunction with in vivo models will enhance our understanding of hypothalamic functions such as neurogenesis, neuronal plasticity, glucose sensing, energy homeostasis, circadian rhythms, and reproduction. This review discusses the generation and use of hypothalamic cell models to study mechanisms underlying the function of individual hypothalamic neurons and to gain a more complete understanding of the overall physiology of the hypothalamus.

Headache mechanisms

2020 ◽  
pp. 34-44
Author(s):  
Andrew Charles
Keyword(s):  
Critical Role ◽  
Primary Headaches ◽  
Vascular Activity ◽  
Electrophysiological Studies ◽  
Broad Array ◽  
Upper Cervical ◽  
Nervous System Function ◽  
Hypothalamic Function ◽  
Headache Pain ◽  
Trigeminal Nerves

Headache disorders involve widespread disturbances in nervous system function, resulting in a broad array of symptoms in addition to head pain. A general understanding of these disorders requires not only an understanding of the mechanisms underlying the pain, but also of those causing symptoms that may precede, accompany, or follow the pain. Imaging and clinical electrophysiological studies provide strong evidence that rather than being primarily vascular disorders, the major primary headaches disorders are fundamentally disorders of brain excitability. Changes in the activity of the thalamus and cortex appear to be particularly important in migraine, and alterations in hypothalamic function likely play a critical role in both migraine and cluster headache. Migraine aura involves propagated waves of activity in the cortex; cortical spreading depression (CSD) in animal models provides insight in the mechanisms of these waves. Elevations of extracellular potassium and release of the excitatory transmitter glutamate appear to be critical in the initiation of CSD, whereas sustained uncoupling of the normal relationship between neural and vascular activity occurs in the wake of CSD. Headache pain may be transmitted not only by trigeminal nerves, but also by the upper cervical nerves. The trigeminal nucleus caudalis, dorsolateral pons and midbrain, periaqueductal gray, thalamus, and sensory cortex may all play important roles in headache. Increasing evidence implicates the release of neuropeptides, particularly calcitonin gene-related peptide as a primary mediator of headache. Each of these and other basic mechanisms of headache may represent distinct therapeutic targets

Kisspeptin-54 accurately identifies hypothalamic GnRH neuronal dysfunction in men with congenital hypogonadotropic hypogonadism

2020 ◽  
Author(s):  
Ali Abbara ◽  
Pei Chia Eng ◽  
Maria Phylactou ◽  
Sophie A. Clarke ◽  
Edouard Mills ◽  
...  
Keyword(s):  
Neuronal Migration ◽  
Hypogonadotropic Hypogonadism ◽  
Neuronal Function ◽  
Specific Test ◽  
Healthy Men ◽  
Pituitary Dysfunction ◽  
Pathogenic Variants ◽  
Congenital Hypogonadotropic Hypogonadism ◽  
Gnrh Release ◽  
Hypothalamic Function

Background: Hypogonadotropic hypogonadism is hypogonadism due to either hypothalamic or pituitary dysfunction. Whilst gonadotropin releasing hormone (GnRH) can directly test pituitary function, no specific test of hypothalamic function exists. Kisspeptin-54 (KP54) is a neuropeptide that directly stimulates hypothalamic GnRH-release and thus could be used to specifically interrogate hypothalamic function. Congenital Hypogonadotropic Hypogonadism (CHH) is typically due to variants in genes that control hypothalamic GnRH neuronal migration of function. Thus, we investigated whether KP54 could accurately identify hypothalamic dysfunction in men with CHH. Methods: Men with CHH (n=21) and healthy eugonadal men (n=21) received an intravenous bolus of either GnRH (100mcg), or KP54 (6.4nmol/kg), on two occasions, and were monitored for 6hrs after administration of each neuropeptide. Results: Maximal LH-rise after KP54 was significantly greater in healthy men (12.5 iU/L) than in men with CHH (0.4 iU/L; P<0.0001). KP54 more accurately differentiated CHH men from healthy men than GnRH (auROC curve KP54: 1.0, 95%CI 1.0-1.0; GnRH: 0.88, 95%CI 0.76-0.99). Indeed, all CHH men had an LH-rise <2.0 iU/L following KP54, whereas all healthy men had an LH-rise >4.0 iU/L. Anosmic men with CHH (i.e. Kallmann syndrome) had even lower LH-rises after KP54 than did normosmic men with CHH (P=0.017). Likewise, men identified to have pathogenic/likely pathogenic variants in CHH genes had even lower LH-rises after KP54 than other men with CHH (P=0.035). Conclusion: KP54 fully discriminated men with CHH from healthy men. Thus, KP54 could be used to specifically interrogate hypothalamic GnRH neuronal function in patients with congenital hypogonadotropic hypogonadism.

scholarly journals Adipsic diabetes insipidus secondary to craniopharyngioma resection

2019 ◽  
Vol 12 (1) ◽  
pp. e225903 ◽  
Author(s):  
María Alejandra Pérez ◽  
Henry Augusto Millán ◽  
Julián Alberto Naranjo ◽  
Andrés Flórez Romero
Keyword(s):  
Visual Acuity ◽  
Diabetes Insipidus ◽  
Brain Mri ◽  
Warning Signs ◽  
Delayed Puberty ◽  
Histopathological Findings ◽  
History Of ◽  
Transcranial Surgery

Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour’s extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.

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