Reconstruction of the Pituitary Fossa in Transsphenoidal Surgery: An Experience of 140 Cases

Neurosurgery ◽  
1985 ◽  
Vol 17 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Renato Spaziante ◽  
Enrico de Divitiis ◽  
Paolo Cappabianca
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Empty Sella ◽  
Transsphenoidal Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Pituitary Fossa ◽  
Postoperative Course ◽  
Precise Method ◽  
Surgical Condition

Abstract Even though the main problems of transsphenoidal surgery are encountered during the intra- and suprasellar portions of the operation, proper reconstruction of the sella turcica plays an important role in the overall results, greatly influencing the final outcome. Improper measures may bring about a complicated postoperative course, whereas a wise and precise method allows one to control any surgical condition, preventing the more dangerous consequences of the transsphenoidal approach (i.e., empty sella, cerebrospinal fluid leakage, hemorrhage, infection, etc.). The authors review the different methods of sellar plugging and, on the basis of their own experience, indicate the most suitable one for each of the more usual situations. A good result is achievable if only natural materials are used and one avoids synthetic prostheses. Extradural packing is the technique of choice whenever a hermetic closure and a particularly effective intrasellar plug are required.

scholarly journals Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Soichi Oya ◽  
Junichiro Kumai ◽  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Wall ◽  
Rare Clinical Entity ◽  
Pituitary Abscess ◽  
Abscess Drainage ◽  
Postoperative Course ◽  
Fluid Leak

The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

Pituitary ◽  
2016 ◽  
Vol 19 (6) ◽  
pp. 565-572 ◽  
Author(s):  
Kazuhito Takeuchi ◽  
Tadashi Watanabe ◽  
Tetsuya Nagatani ◽  
Yuichi Nagata ◽  
Jonsu Chu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Transsphenoidal Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

Cerebrospinal Fluid Leakage During Transsphenoidal Surgery: Postoperative External Lumbar Drainage Reduces the Risk for Meningitis

Pituitary ◽  
2004 ◽  
Vol 7 (2) ◽  
pp. 89-93 ◽  
Author(s):  
M. O. van Aken ◽  
R. A. Feelders ◽  
S. de Marie ◽  
J. H. van de Berge ◽  
A.H.G. Dallenga ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Lumbar Drainage ◽  
Fluid Leakage ◽  
External Lumbar Drainage

scholarly journals Empty Sella Prevalence: Step By Step

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Victoria B. Sharavii ◽  
Natalya A. Shnayder ◽  
Lada K. Sharavii ◽  
Marina M. Petrova ◽  
Regina F. Nasyrova
Keyword(s):  
Pituitary Gland ◽  
Subarachnoid Space ◽  
Sella Turcica ◽  
Empty Sella ◽  
Systematic Search ◽  
Pituitary Fossa ◽  
The World

An empty sella (ES), also known as an empty sella turcica (empty pituitary fossa) is defined as an intrasellar herniation of subarachnoid space within the sella which leads to flattening of the pituitary gland towards the posteroinferior wall. Purpose — to analyze studies of ES prevalence in the world. Methods — We carried out a systematic search in both Russian and English databases (E-library, PubMed, GoogleScholar, OxfordPress, ClinicalKeys) using keywords “empty sella”, “empty sella turcica”, “empty pituitary fossa”, “prevalence” and their combinations. The period of search: 2000-2020. It is also worth noting that earlier publications of historical interest were included in the review. Results — We have analyzed 23 studies. They can be roughly devided into two groups: the first group – screening studies of ES, the second group – targeted studies of ES.

scholarly journals Risk Factors For Postoperative Cerebrospinal Fluid Leakage After Transsphenoidal Surgery For Pituitary Adenoma: A Meta-Analysis And Systematic Review

2021 ◽  
Author(s):  
Zhihuan Zhou ◽  
Feifei Zuo ◽  
Xiaoqun Chen ◽  
Qinqin Zhao ◽  
Mengna Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Cohort Studies ◽  
Transsphenoidal Surgery ◽  
Case Control ◽  
Cochrane Library ◽  
Cerebrospinal Fluid Leakage ◽  
Csf Leakage

Abstract Objective: Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).Methods: PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.Results: A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).Conclusions: This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

scholarly journals Intrasellar Cavernous Hemangioma: A Case Report and Literature Review

2017 ◽  
Vol 3 (2) ◽  
pp. 111-115
Author(s):  
Xinmin Wu ◽  
Hongquan Yu ◽  
Gang Zhao ◽  
Le Wang ◽  
Yang Liu ◽  
...  
Keyword(s):  
Literature Review ◽  
Cavernous Hemangioma ◽  
Sella Turcica ◽  
Mass Effect ◽  
Transsphenoidal Approach ◽  
Pituitary Fossa ◽  
Cavernous Hemangiomas ◽  
Suprasellar Cistern ◽  
Subtotal Removal ◽  
Specific Symptoms

Intrasellar cavernous hemangioma is rare. There are no specific symptoms and the mass effect often mimics pituitary macroadenoma. We present one case of intrasellar cavernous hemangioma that was misdiagnosed. Progressively decreasing vision was the main symptom in this case. The prolactin level was mildly increased but other biochemistry examinations were normal. Magnetic resonance imaging showed an enlarged pituitary fossa and an irregular solid tumor (33 mm × 22 mm × 22 mm) in the sella turcica and parasellar region. Subtotal removal in the case was performed through a transsphenoidal approach. Postoperatively, the patient's visual acuity improved. Through a literature review of 8 intrasellar cavernous hemangiomas, we found most lesions are likely to extend into the suprasellar cistern and cavernous sinus, and total resection is difficult. Transsphenoidal approach surgery should be applied for decompression of the optic nerve and biopsy, and stereotactic radiosurgery is preferable.

Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine

1981 ◽  
Vol 54 (6) ◽  
pp. 839-841 ◽  
Author(s):  
Angelita Ramos-Gabatin ◽  
Richard M. Jordan
Keyword(s):  
Cerebrospinal Fluid ◽  
Amphotericin B ◽  
Transsphenoidal Surgery ◽  
Combined Therapy ◽  
Sella Turcica ◽  
Single Patient ◽  
Pituitary Abscess ◽  
Content Type ◽  
Elevated Protein ◽  
Fine Print

✓ Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases have been of bacterial etiology; however, a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species has been reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. In the present case, a woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of cerebrospinal fluid. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis, or cerebrospinal fluid abnormalities, including pleocytosis, depressed glucose, and elevated protein.

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