Safety of endoscopic endonasal biopsy for the pituitary stalk-hypothalamic lesions

LOCALIZATION OF HYPOTHALAMIC LESIONS INHIBITING ADRENAL WEIGHT MAINTENANCE IN THE RAT

Acta Endocrinologica ◽

10.1530/acta.0.xxxiv0019 ◽

1960 ◽

Vol XXXIV (I) ◽

pp. 19-26 ◽

Cited By ~ 4

Author(s):

Johannes Moll

Keyword(s):

Median Eminence ◽

Weight Maintenance ◽

Brain Lesions ◽

Pituitary Stalk ◽

Adrenal Weight ◽

Hypothalamic Lesions ◽

Electrolytic Lesions ◽

The Right

ABSTRACT Electrolytic lesions, approximately 1 mm in diameter, were placed at 20 regularly distributed points in the midline of the hypothalamus of rats. Eighteen days later the left adrenals were removed and weighed. Six days after this operation the animals were sacrificed and the right adrenals weighed. Animals without brain lesions but otherwise similarly treated, served as controls. The brains of all lesioned animals were studied histologically. Following lesions in the antero-basal and mid-basal hypothalamus the weights of both adrenals were subnormal. Compensatory adrenal hypertrophy was only slightly inhibited by the lesions. Lesions destroying the pituitary stalk and lesions in the median eminence, had no effect on adrenal weight.

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Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report

Journal of Neurosurgery ◽

10.3171/2016.11.jns161605 ◽

2018 ◽

Vol 128 (2) ◽

pp. 437-443 ◽

Cited By ~ 2

Author(s):

Ana C. I. Nakassa ◽

Joseph D. Chabot ◽

Carl H. Snyderman ◽

Eric W. Wang ◽

Paul A. Gardner ◽

...

Keyword(s):

Diabetes Insipidus ◽

Epidermoid Cyst ◽

Residual Tumor ◽

Mass Effect ◽

Visual Disturbance ◽

Primary Hypothyroidism ◽

Complete Resection ◽

High Rate ◽

Pituitary Stalk ◽

Endoscopic Endonasal

Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.

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

Operative Neurosurgery ◽

10.1093/ons/opy393 ◽

2019 ◽

Vol 17 (3) ◽

pp. 321-331 ◽

Cited By ~ 3

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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Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas

Frontiers in Neurology ◽

10.3389/fneur.2021.753944 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhengyuan Chen ◽

Zengyi Ma ◽

Wenqiang He ◽

Xuefei Shou ◽

Zhao Ye ◽

...

Keyword(s):

Diabetes Insipidus ◽

Tumor Recurrence ◽

Progression Free Survival ◽

Pituitary Stalk ◽

Endoscopic Endonasal ◽

Central Type ◽

Kaplan Meier ◽

Peripheral Type ◽

The Impact ◽

Surgically Induced

Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging.Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081–0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48–59) and 39 (95% CI 28–50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05).Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.

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Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09292 ◽

2010 ◽

Vol 28 (4) ◽

pp. E8 ◽

Cited By ~ 58

Author(s):

Peter G. Campbell ◽

Brian McGettigan ◽

Adam Luginbuhl ◽

Sanjay Yadla ◽

Marc Rosen ◽

...

Keyword(s):

Visual Field ◽

English Literature ◽

Endoscopic Approach ◽

Pituitary Stalk ◽

Gross Total Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Csf Leaks

Object The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. Methods Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. Results Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. Conclusions The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

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Endoscopic endonasal approach for craniopharyngioma: the importance of the relationship between pituitary stalk and tumor

Journal of Neurosurgery ◽

10.3171/2017.4.jns162143 ◽

2018 ◽

Vol 129 (3) ◽

pp. 611-619 ◽

Cited By ~ 8

Author(s):

Yun-Sik Dho ◽

Yong Hwy Kim ◽

Young-Bem Se ◽

Doo Hee Han ◽

Jung Hee Kim ◽

...

Keyword(s):

Tumor Invasion ◽

Pituitary Stalk ◽

Primary Group ◽

Endoscopic Endonasal Approach ◽

Endoscopic Endonasal ◽

Primary Tumors ◽

Recurrent Group ◽

Csf Leakage ◽

The Mean ◽

The Relationship

OBJECTIVEThe endoscopic endonasal approach (EEA) is commonly used for the treatment of craniopharyngioma; therefore, it is essential to analyze outcomes in order to understand the benefits and drawbacks. The goal of this paper was to evaluate the clinical features and outcomes associated with this treatment approach.METHODSFrom July 2010 to March 2016, 82 adult craniopharyngioma patients underwent an EEA at the authors’ institution. Of these cases, intraoperative records and immediate postoperative MR images were available for 68 patients. The patients underwent systemized endocrinological evaluation. Eighteen of 68 patients who underwent EEA for recurrence or regrowth of residual lesions after previous surgical management were excluded in the analysis of the anatomical tumor classification. The authors retrospectively analyzed preoperative clinical features and previous anatomical classifications, focusing on the relationship of the pituitary stalk and tumor, to determine predictive factors for the clinical outcome, such as the extent of resection, visual function, endocrinological function, recurrence rate, and complications.RESULTSThe mean tumor size was 2.5 cm (3.1 cm for primary tumors and 1.9 cm for recurrent lesions). Gross-total resection (GTR) was achieved in 62 (91.1%) patients (48 [96.0%] patients with primary tumors and 14 [77.8%] patients with recurrent tumors). The rate of GTR was higher in the primary group than in the group with recurrence (p = 0.038). The overall pre- and postoperative visual impairment scale (VIS) scores were 40.8 and 22.1, respectively (50.9 and 14.3 in the primary group and 30.7 and 29.9 in patients with recurrence, respectively). The improvement rate in VIS score was higher in the primary group than in the recurrent group (p = 0.001). Endocrinological function was improved in 4 patients (5.9%) and deteriorated in 32 of 68 patients (47.1%). Tumor invasion into the center of the pituitary stalk affected the postoperative outcomes most significantly. Cognitive dysfunction was observed in 22 patients before surgery and improved in 20 patients (90.9%) after surgery. Hydrocephalus was found in 7 patients and resolved after surgery in all cases. CSF leakage occurred in 2 (2.9%) of 68 patients and was repaired by revision surgery in both patients. Ten patients without CSF leakage also received antibiotics for the treatment of meningitis. The infection rate was higher in the recurrent group. Postoperative endocrinological evaluation showed no deficits in 12 patients and panhypopituitarism in 55 patients. The remaining patient had growth hormone deficiency. Forty-three patients had new-onset diabetes insipidus, and 1 patient had persistent diabetes insipidus after surgery. There were 2 (2.9%) cases of recurrence during the mean 30.7-month follow-up period; one patient underwent radiosurgery and the other underwent reoperation.CONCLUSIONSThe EEA resulted in excellent surgical outcomes and acceptable morbidity rates, regardless of the anatomical location of the tumor. Invasion of the craniopharyngioma into the center of the pituitary stalk has strong predictive power for postoperative endocrinological outcome.

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An Elongated Pituitary Stalk Resembling the Lining of a Dermoid Cyst during Endoscopic Endonasal Approach

Otolaryngology ◽

10.1177/0194599815585509 ◽

2015 ◽

Vol 153 (1) ◽

pp. 150-151 ◽

Cited By ~ 2

Author(s):

Devin Mistry ◽

Bryan Figueroa

Keyword(s):

Dermoid Cyst ◽

Pituitary Stalk ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

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Fine Structural Changes in the Adenohypophyses of Rats Following Destruction of the Pituitary Stalk

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079917 ◽

1977 ◽

Vol 35 ◽

pp. 496-497

Author(s):

K. Kovacs ◽

E. Horvath ◽

J. M. Bilbao ◽

F. A. Laszlo ◽

I. Domokos

Keyword(s):

Structural Changes ◽

Tissue Injury ◽

Anterior Lobe ◽

Uranyl Acetate ◽

Male Rats ◽

Pituitary Stalk ◽

Sequence Of Events ◽

Pituitary Glands ◽

Electrolytic Lesions ◽

Ultrathin Sections

Electrolytic lesions of the pituitary stalk in rats interrupt adenohypophysial blood flow and result in massive infarction of the anterior lobe. In order to obtain a deeper insight into the morphogenesis of tissue injury and to reveal the sequence of events, a fine structural investigation was undertaken on adenohypophyses of rats at various intervals following destruction of the pituitary stalk.The pituitary stalk was destroyed electrolytically, with a Horsley-Clarke apparatus on 27 male rats of the R-Amsterdam strain, weighing 180-200 g. Thirty minutes, 1,2,4,6 and 24 hours after surgery the animals were perfused with a glutaraldehyde-formalin solution. The skulls were then opened and the pituitary glands removed. The anterior lobes were fixed in glutaraldehyde-formalin solution, postfixed in osmium tetroxide and embedded in Durcupan. Ultrathin sections were stained with uranyl acetate and lead citrate and investigated with a Philips 300 electron microscope.

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