scholarly journals Endoscopic Endonasal Transsphenoidal Resection for Pituitary Apoplexy during the Third Trimester of Pregnancy

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Adesh Tandon ◽  
Juan Alzate ◽  
Patrick LaSala ◽  
Marvin P. Fried
Keyword(s):  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Third Trimester ◽  
Endoscopic Endonasal ◽  
Acute Hemorrhage ◽  
The Third ◽  
Vascular Insufficiency ◽  
The Brain ◽  
Transsphenoidal Resection

Pituitary apoplexy is an uncommon phenomenon typically characterized by vascular insufficiency or acute hemorrhage into a pituitary adenoma. The overall incidence of pituitary apoplexy ranges between 1 and 25% of all pituitary adenomas. With the widespread use of MRI technology, the diagnosis of asymptomatic intratumoral hemorrhage is closer to 10%. The authors report a case of a 27-year-old female in her 36th week of pregnancy who presented with severe onset headache and acute left-sided vision loss. MRI of the brain revealed a large hemorrhagic mass occupying the sella turcica. The patient underwent an emergent endoscopic endonasal transsphenoidal resection for pituitary apoplexy. Postoperatively, the patient’s neurologic deficit resolved. Minimally invasive endoscopic endonasal transsphenoidal resection of pituitary apoplexy can be safely utilized in third trimester pregnant women presenting with acute severe neurologic deficits.

scholarly journals Sinusitis Independently Predicts the Presence of Headache Following Endoscopic Transsphenoidal Resection for Pituitary Adenomas

2021 ◽  
Author(s):  
Jiayu Gu ◽  
Xiaoqun Chen ◽  
Yunzhi Zou ◽  
Shuo Yang ◽  
Siyu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Meta Analysis ◽  
Confidential Interval ◽  
Endoscopic Endonasal ◽  
Postoperative Headache ◽  
The One ◽  
Headache Impact ◽  
Transsphenoidal Resection

Abstract Purpose Headache is common among patients with pituitary adenomas undergone endoscopic endonasal surgery (EES), but was seldomly concerned before. The present study aims to investigate the incidence and profile of risk factors of headache after EES.Methods A meta-analysis was performed to evaluate the occurrence proportions of postoperative headache in patients with pituitary adenomas. Then, a cohort of 101 patients undergone EES were enrolled for analyzing risk factors of headache. The Headache Impact Test (HIT-6) was used to score the headache preoperatively, 1 month and 3 months postoperatively. Results A total of 18 studies and 4442 participants were included for meta-analysis. The pooled occurrence proportion of postoperative headache was 29% (95% confidential interval: 20-38%). For the 101 patients enrolled in the present study, 26 (25.74%) of them had a HIT-6 scores of > 55 preoperatively, but decreased to 22 (21.78%) at 1 month, and 6 (5.94%) at 3 months, postoperatively. Multivariate analysis showed that pituitary apoplexy (OR=3.591, 95%CI 1.219-10.575, p=0.020) and Hardy's grade C-D (OR=21.06, 95%CI 2.25-197.02, p=0.008) were independently risk factors for preoperative headache. In contrast, postoperative sinusitis (OR=3.88, 95%CI 1.16-13.03, P=0.028) and Hardy's grade C-D (OR=10.53, 95%CI 1.02-109.19, P=0.049) independently predicted the presence of postoperative headache at 1 month. At 3 months postoperatively, the proportion of sinusitis tended to be higher in the headache group than the one in non-headache group (100% vs. 30.0%, p=0.070). Conclusion Headache is very common following EES for pituitary adenomas. Prophylactic management of postoperative sinusitis may help to alleviate postoperative headache.

scholarly journals Isoflurane-induced Apoptosis of Neurons and Oligodendrocytes in the Fetal Rhesus Macaque Brain

2014 ◽  
Vol 120 (3) ◽  
pp. 626-638 ◽  
Author(s):  
Catherine E. Creeley ◽  
Krikor T. Dikranian ◽  
Gregory A. Dissen ◽  
Stephen A. Back ◽  
John W. Olney ◽  
...  
Keyword(s):  
White Matter ◽  
Neonatal Period ◽  
Rhesus Macaques ◽  
Fetal Brain ◽  
Third Trimester ◽  
The Third ◽  
Isoflurane Anesthesia ◽  
Drug Naïve ◽  
Induced Apoptosis ◽  
The Brain

Abstract Background: The authors have previously shown that exposure of the neonatal nonhuman primate (NHP) brain to isoflurane for 5 h causes widespread acute apoptotic degeneration of neurons and oligodendrocyte. The current study explored the potential apoptogenic action of isoflurane in the fetal NHP brain. Methods: Fetal rhesus macaques at gestational age of 120 days (G120) were exposed in utero for 5 h to isoflurane anesthesia (n = 5) or to no anesthesia (control condition; n = 4), and all regions of the brain were systematically evaluated 3 h later for evidence of apoptotic degeneration of neurons or glia. Results: Exposure of the G120 fetal NHP brain to isoflurane caused a significant increase in apoptosis of neurons and of oligodendrocytes at a stage when oligodendrocytes were just beginning to myelinate axons. The neuroapoptosis response was most prominent in the cerebellum, caudate, putamen, amygdala, and several cerebrocortical regions. Oligodendrocyte apoptosis was diffusely distributed over many white matter regions. The total number of apoptotic profiles (neurons + oligodendrocytes) in the isoflurane-exposed brains was increased 4.1-fold, compared with the brains from drug-naive controls. The total number of oligodendrocytes deleted by isoflurane was higher than the number of neurons deleted. Conclusions: Isoflurane anesthesia for 5 h causes death of neurons and oligodendrocytes in the G120 fetal NHP brain. In the fetal brain, as the authors previously found in the neonatal NHP brain, oligodendrocytes become vulnerable when they are just achieving myelination competence. The neurotoxic potential of isoflurane increases between the third trimester (G120) and the neonatal period in the NHP brain.

scholarly journals Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma

2018 ◽  
Vol 79 (S 03) ◽  
pp. S237-S238 ◽  
Author(s):  
Alexandre Todeschini ◽  
Alaa Montaser ◽  
Mostafa Shahein ◽  
Juan Revuelta ◽  
Bradley Otto ◽  
...  
Keyword(s):  
Vision Loss ◽  
Third Ventricle ◽  
Collagen Matrix ◽  
Endoscopic Endonasal ◽  
Stereotactic Radiation ◽  
The Third ◽  
Head Clamp ◽  
The Right ◽  
Adamantinomatous Craniopharyngioma

AbstractWe present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible.Hormonal panel showed no hormonal deficits. The initial diagnosis was of a type II transinfundibular craniopharyngioma (as classified by Kassam et al).An endoscopic endonasal transplanum transtuberculum approach was done using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. The tumor was carefully dissected away from the optic apparatus while preserving the vessels, mainly the superior hypophyseal artery. The stalk was identified around the tumor and preserved. The third ventricle was entered and inspected at the end of the procedure and a near-total resection (a small residual in the right hypothalamus) with decompression of the optic apparatus was achieved. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap. Patient had an uneventful postoperative stay and was discharged on POD 4, neurologically stable with no hormonal deficits. Pathology confirmed an adamantinomatous craniopharyngioma. Due to a small growth of the residual, patient underwent fractionated stereotactic radiation (50.4Gy in 28 sessions). He presented with panhypopituitarism 2 years after radiation therapy. At 3-month follow-up, his vision was back to normal and 6-year postoperative magnetic resonance imaging showed no signs of recurrence.The link to the video can be found at: https://youtu.be/chG7XIz7a_A.

scholarly journals Prenatal Ambient Air Pollutants Influence Fetal Blood Flow and Shunting to the Brain in the Third Trimester

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
C.V. Breton ◽  
A. Peterson ◽  
R. Habre ◽  
F. Lurmann ◽  
M. Amin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Air Pollutants ◽  
Ambient Air ◽  
Fetal Blood ◽  
Third Trimester ◽  
The Third ◽  
Ambient Air Pollutants ◽  
The Brain

The influence of the pituitary gland on the functions and development of the organism

1927 ◽  
Vol 23 (2) ◽  
pp. 239-243
Author(s):  
A. A. Sukhov
Keyword(s):  
Pituitary Gland ◽  
Dura Mater ◽  
Animal Species ◽  
Third Ventricle ◽  
Sella Turcica ◽  
Posterior Lobe ◽  
Posterior Pituitary ◽  
The Third ◽  
The Brain ◽  
Posterior Pituitary Lobe

The pituitary gland or gl. pituitaria is an organ lying at the base of the brain in a cavity formed by the sella turcica at the front, back, and bottom, and by the sinus venosus cavernosus dex. et sin. This entire cavity is lined by the dura mater, which covers it from above in the form of diaphragma sellae turcicae. Through its opening passes the infundibulum, which connects the pituitary gland in its posterior lobe with the brain. The cavity infundibuli, which is a recess of the bottom of the third ventricle, in some animal species (e.g., in dogs) passes as recessus infundibuli into the cavity of the posterior pituitary lobe (in humans this lobe has no cavity).

Giant Olfactory Groove Meningioma—2-Staged Approach: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. 115-116 ◽  
Author(s):  
Alexandre B Todeschini ◽  
Mostafa Shahein ◽  
Alaa S Montaser ◽  
Douglas Hardesty ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Skull Base ◽  
Vision Loss ◽  
Tumor Stage ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Simpson Grade ◽  
Staged Approach ◽  
Olfactory Groove Meningioma ◽  
The Right ◽  
The Brain

Abstract A 42-yr-old female presented with an olfactory groove meningioma causing progressive vision loss and anosmia. Given the size of the tumor, we opted for a 2-stage surgery: endoscopic endonasal approach (EEA) followed by a craniotomy. Stage I surgery was a transcribriform transplanum EEA using a binostril 4-hand/2 surgeons (ENT and neuro) technique, with the patient positioned supine with the head slightly turned to the right side and tilted to the left, fixed in a 3-pin head clamp, under imaging guidance, in which we drilled out all the affected skull base bone, devascularized and debulked the tumor. Stage II surgery was done through a right frontotemporal craniotomy 2 mo later. The surgery and postoperative period was uneventful with no complications and no need for further reconstruction of the skull base. The patient's vision was normalized. Postoperative magnetic resonance imaging (MRI) confirmed a Simpson Grade 1 resection.  The rationale behind this staged approach is that we have found when using a transcranial 1-stage approach the brain edema and necessary retraction required for resection leads to brain injury, oftentimes readily identified in the diffusion-weighted imaging MRI which are associated with different degrees of cognitive impairment. The skull base bone involved is usually not removed via transcranial approaches.  Despite requiring a second surgery, this staged approach allows a true total resection (including the affected bone) and in the transcranial stage the brain is more relaxed, with less edema, reducing the need for retraction, which may lead to a better outcome.  The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.

Endoscopic Endonasal Transsphenoidal Resection of Pituitary Apoplexy: Assessment of Visual and Endocrine Outcomes

2020 ◽  
Author(s):  
Rosemary T. Behmer Hansen ◽  
Kevin Zhao ◽  
Christine Yen ◽  
Grant Arzumanov ◽  
Wayne D. Hsueh ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Endoscopic Endonasal ◽  
Transsphenoidal Resection

Fetal biometry: size and configuration of the third ventricle

2005 ◽  
Vol 46 (6) ◽  
pp. 631-635 ◽  
Author(s):  
A. Sari ◽  
A. Ahmetoglu ◽  
H. Dinc ◽  
A. Saglam ◽  
U. Kurtoglu ◽  
...  
Keyword(s):  
Gestational Age ◽  
Normal Population ◽  
Third Ventricle ◽  
Third Trimester ◽  
Fetal Biometry ◽  
The Third ◽  
Antenatal Ultrasonography ◽  
Normal Configuration ◽  
The Mean ◽  
The Brain

Purpose: To evaluate the normal configuration and size of the third ventricle in second and third trimester fetuses in a normal population, and to compare our values with those of previously published studies. Material and Methods: Evaluation of fetal third ventricular width and configuration was obtained by antenatal ultrasonography in 474 fetuses with gestational age between 12 weeks and term (mean 28 weeks). Percentiles for third ventricle width were estimated by combining separate fractional polynominal regression models fitted to the mean and standard deviation, assuming that the measurements had a normal distribution at each gestational age. Appearance of the third ventricle was correlated with each gestational age. Results: The third ventricle could be visualized in 471 (99%) of 474 fetuses. The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. The third ventricle was seen as a single echogenic line in 153 (32.4%) of 474 fetuses. Two-hundred-and-ninety-nine (61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen. V-shaped third ventricular configuration was seen in only 28 (5.9%) of the fetuses. From 24 weeks to term, parallel echogenic lines were the most commonly (83.7% to 79.6%) encountered configuration for the third ventricle. Conclusion: The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. In the early second trimester, 77% of the fetuses had a single echogenic line appearance on ultrasonography. As the brain and ventricular structures mature, a parallel echogenic line becomes the prominent ultrasonography appearance (>80% of fetuses) in third trimester healthy fetuses.

scholarly journals Fetal MRI for characterising a variety of posterior fossa anomalies suspected on 3rd trimester ultrasound examination – a short series of four cases

2012 ◽  
Vol 16 (1) ◽  
pp. 27-29 ◽  
Author(s):  
Amaresh Indravadan Ranchod ◽  
Savvas Andronikou ◽  
Mala Modi
Keyword(s):  
Posterior Fossa ◽  
Ultrasound Examination ◽  
Fetal Mri ◽  
Third Trimester ◽  
The Third ◽  
Short Series ◽  
Screening Ultrasound ◽  
The Brain

Fetal MRI is increasingly being used to more accurately assess abnormalities detected on screening ultrasound. This procedure is more pertinent when the initial ultrasound is done late in the third trimester and when the abnormality involves the posterior fossa of the brain. Four cases with a variety of unusual posterior fossa anomalies are presented.

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