Transsphenoidal Surgery for Cushing's Disease: Outcome in Patients with a Normal Magnetic Resonance Imaging Scan

Neurosurgery ◽  
2000 ◽  
Vol 46 (3) ◽  
pp. 553-559 ◽  
Author(s):  
Patrick Lyle Semple ◽  
Mary Lee Vance ◽  
James Findling ◽  
Edward R. Laws
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Disease Outcome ◽  
Cushing's Disease ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Resonance Imaging Scan

Surgical Treatment of Recurrent Cushing's Disease

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1108-1118 ◽  
Author(s):  
Bernd M. Hofmann ◽  
Michal Hlavac ◽  
Jürgen Kreutzer ◽  
Gerd Grabenbauer ◽  
Rudolf Fahlbusch
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Adjuvant Therapy ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Magnetic Resonance Imaging Scan ◽  
Inferior Petrosal Sinus ◽  
Resonance Imaging ◽  
Inferior Petrosal Sinus Sampling ◽  
Resonance Imaging Scan

Abstract OBJECTIVE: The aim of this study was to evaluate the role of transsphenoidal selective adenomectomy alone or in combination with adjuvant therapy in treatment of recurrent Cushing's disease. METHODS: A total of 16 patients with recurrent Cushing's disease underwent reoperation, 15 via a transsphenoidal approach and one via a combined transsphenoidal/transcranial approach. Selective adenomectomies were performed in 13 patients and hemihypophysectomies were performed in three patients. Endocrinologically, recurrence was diagnosed by an overnight 2-mg dexamethasone suppression test. All patients underwent a 1.5-T magnetic resonance imaging scan, and eight patients underwent inferior petrosal sinus sampling. RESULTS: After selective adenomectomy, six of the 13 patients went into remission. Recurrence always occurred at the localization of the original tumor. In three patients without intraoperative tumor detection, hypophysectomy did not lead to remission. In 10 patients with persistent disease, adjuvant therapy (radiotherapy, adrenalectomy) led to normalization of basal cortisol levels in eight patients and clinical remission in one patient. One patient was lost to follow-up. In 10 patients, no evidence of an adenoma was visible on the preoperative magnetic resonance imaging scan. Inferior petrosal sinus sampling allowed correct prediction of the tumor localization in two of eight patients. CONCLUSION: By performing repeated selective adenomectomy, patients with recurrent Cushing's disease can be cured without the risk of endocrine deficits or major complications. Dynamic endocrine tests are of paramount importance for surgical decision making. Imaging and inferior petrosal sinus sampling are not helpful in locating the recurrent tumor. If normalization can not be achieved, adjuvant therapy is mandatory.

Cushing's Disease in Children and Adolescents: 20 Years of Experience in a Single Neurosurgical Center

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 281-285 ◽  
Author(s):  
Shabin M. Joshi ◽  
Richard Jonathan David Hewitt ◽  
Helen L. Storr ◽  
Kia Rezajooi ◽  
Habib Ellamushi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Postoperative Complications ◽  
Children And Adolescents ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Cushing's Disease ◽  
Surgical Removal ◽  
Resonance Imaging

ABSTRACT OBJECTIVE: This is a retrospective analysis of 25 consecutive pediatric patients with Cushing's disease who underwent transsphenoidal surgery performed by a single neurosurgeon in a specialist center during a 20-year period. This article discusses the presentation of Cushing's disease, the endocrinological investigation with particular reference to bilateral inferior petrosal sinus sampling (BIPSS), the operative management with reference to specific pediatric difficulties of the transsphenoidal approach and the use of intraoperative image guidance, and the analysis of these cases as regards postoperative complications and outcomes of this rare condition in young patients. METHODS: All patients underwent detailed endocrine investigation and imaging in the form of computed tomography and/or magnetic resonance imaging. BIPSS was performed in 19 patients (76%), with successful lateralization of the side of the microadenoma in 14 (74%) and prediction of a central tumor in four (94% total prediction rate). Surgical removal was via the sublabial, paraseptal, transsphenoidal route. RESULTS: There were 15 male and 10 female patients, with a mean age of 13.4 years (range, 6.6–17.8 yr). Weight gain was the most common presentation (100%), and then growth impairment (96%), fatigue and skin changes (64%), and hypertension (32%). Postoperative complications included growth hormone deficiency (36%), transient diabetes insipidus (12%), panhypopituitarism (4%), and transient cerebrospinal fluid rhinorrhea (4%). The median follow-up period was 59.5 months (range, 6–126 mo). Overall, 15 patients (60%) achieved surgical cure or remission, of which 14 outcomes were obtained using the results of BIPSS. Ten patients (40%) required postoperative radiotherapy to achieve “remission.” There were no cases of meningitis, no neurological deficits, no reoperations, and no mortality. CONCLUSION: Cushing's disease in children and adolescents is a rare illness. The accurate preoperative localization of the adenoma is essential for achieving good results. In this series, BIPSS was far more accurate in localizing the adenoma than computed tomography or magnetic resonance imaging. Imaging, however, is useful for the exclusion of other intracranial problems. Transsphenoidal surgery was safe and efficacious in achieving cure in the majority of cases. The challenge of transsphenoidal surgery in this age group is the small pituitary fossa and the absence of sphenoid sinus aeration in some cases. We found the use of intraoperative neuronavigation to be an excellent aid in overcoming such anatomic difficulties.

Radiation Necrosis of the Optic Chiasm, Optic Tract, Hypothalamus, and Upper Pons after Radiotherapy for Pituitary Adenoma, Detected by Gadolinium-Enhanced, T1-Weighted Magnetic Resonance Imaging: Case Report

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 640-643 ◽  
Author(s):  
Osamu Tachibana ◽  
Narihito Yamaguchi ◽  
Tetsumori Yamashima ◽  
Junkoh Yamashita
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Radiation Necrosis ◽  
Optic Tract ◽  
Optic Chiasm ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Weighted Magnetic Resonance Imaging ◽  
Resonance Imaging Scan

Abstract A 26-year-old woman was treated for a prolactin secreting pituitary adenoma by surgery and radiotherapy (5860 rads). Fourteen months later, she developed right hemiparesis and dysarthria. A T1-weighted magnetic resonance imaging scan using gadolinium contrast showed a small, enhanced lesion in the upper pons. Seven months later, she had a sudden onset of loss of vision, and radiation optic neuropathy was diagnosed. A T1-weighted magnetic resonance imaging scan showed widespread gadolinium-enhanced lesions in the optic chiasm, optic tract, and hypothalamus. Magnetic resonance imaging is indispensable for the early diagnosis of radiation necrosis, which is not visualized by radiography or computed tomography.

Mobile Schwannoma of the Cauda Equina Diagnosed by Magnetic Resonance Imaging

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 968-971 ◽  
Author(s):  
Toyohiko Isu ◽  
Yoshinobu Iwasaki ◽  
Minoru Akino ◽  
Masafumi Nagashima ◽  
Hiroshi Abe
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cauda Equina ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Resonance Imaging Scan

Abstract Three cases of a mobile cauda equina schwannoma, preoperatively diagnosed by magnetic resonance imaging, are described. When dealing with tumors of the cauda equina, it is important to carry out a second magnetic resonance imaging scan after changes in posture, bearing in mind the possibility of mobility of the tumor.

Lipoma of the parapharyngeal space

2006 ◽  
Vol 120 (2) ◽  
pp. 1-3 ◽  
Author(s):  
E J M McNeill ◽  
P R Samuel ◽  
S England
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Examination ◽  
Parapharyngeal Space ◽  
Diagnostic Radiology ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Nocturnal Cough ◽  
Resonance Imaging Scan

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.

An Ancient Cause of Muscle Spasm…and an Unhelpful Magnetic Resonance Imaging Scan

2014 ◽  
Vol 81 (3-4) ◽  
pp. e23-e25
Author(s):  
Shawn Agius ◽  
David P. Breen ◽  
Nikolaos Haliasos ◽  
Jonathan Benjamin ◽  
Rajith de Silva
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Muscle Spasm ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Resonance Imaging Scan
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