scholarly journals Anatomical Considerations of the Endonasal Transsphenoidal Approach

2018 ◽  
Vol 19 (2) ◽  
pp. 48-53
Author(s):  
Alvaro Campero ◽  
Abraham Campero ◽  
Carolina Martins ◽  
Alexandre Yasuda ◽  
Albert Rhoton
Keyword(s):  
Pituitary Adenoma ◽  
Third Ventricle ◽  
The Other ◽  
Transsphenoidal Approach ◽  
Lateral Expansion ◽  
Sphenoidal Sinus ◽  
The Third ◽  
Lateral Distance ◽  
Sellar Floor ◽  
Diaphragm Sellae

The sellar contents are separated from the sphenoidal sinus by a tiny sheath of bone that compris es the sellar floor, making the transsphenoidal approach the most used surgical route to intrasellar lesions. The transsphenoidal approach can be initiated in three different ways: 1) cutting the mucosa over the alveolar part of maxilla (sublabial transsphenoidal), 2) cutting along the anterior nasal mucosa adjacent to the columella (transeptal transsphenoidal), and 3) cutting the mucosa over the sphenoidal rostrum (endonasal transsphenoidal). Each cavernous sinus has four dural walls. The lateral, superior and posterior walls are composed of endosteal and periosteal dura leaflets. Unlike the other dural walls, the medial wall is formed of a single, thin dural sheath, an anatomical fact that help explains the lateral expansion of a pituitary adenoma. In the center, the diaphragm sellae has an opening through which the infundibulum courses, linking the pituitary gland to the floor of the third ventricle. The morphology of this opening is quite variable among individuals. On average, the anteroposterior distance of the diaphragm opening was 7.26 mm + 1.99 mm, varying from 3.4 mm up to 10.7 mm. The lateral distance of the diaphragm opening was 7.33 mm + 2.79 mm, varying from 2.8 mm up to 14.1 mm.

Microsurgical removal of paraventricular cavernous angiomas

1981 ◽  
Vol 55 (2) ◽  
pp. 308-311 ◽  
Author(s):  
Eugenio Pozzati ◽  
Giulio Gaist ◽  
Massimo Poppi ◽  
Bernardino Morrone ◽  
Roberto Padovani
Keyword(s):  
Fourth Ventricle ◽  
Third Ventricle ◽  
Cavernous Angioma ◽  
The Other ◽  
Content Type ◽  
Cavernous Angiomas ◽  
The Third ◽  
Microsurgical Approach ◽  
The Right ◽  
Fine Print

✓ Two cases of paraventricular cavernous angiomas are presented. In one, the cavernous angioma was found in the right wall of the fourth ventricle, and in the other in the right thalamus encroaching upon the third ventricle. Both patients had onset of symptoms suggesting a tumor. Good results were obtained by the microsurgical approach to these malformations. The computerized tomography findings typical of cavernous angiomas are reviewed.

THE INFLUENCE OF THE CONCENTRATION OF SODIUM AND POTASSIUM IN THE CEREBROSPINAL FLUID ON THE SECRETION OF STEROIDS, INCLUDING ALDOSTERONE, FROM THE ADRENAL CORTEX

1961 ◽  
Vol 37 (4) ◽  
pp. 559-564 ◽  
Author(s):  
Nils Norman
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
The Other ◽  
Potassium Content ◽  
Fluid Mixtures ◽  
The Third ◽  
Artificial Cerebrospinal Fluid ◽  
The Right ◽  
Sodium And Potassium

ABSTRACT Two artificial cerebrospinal fluid mixtures, one having a higher than normal sodium, but lower than normal potassium content, the other having a lower than normal sodium, but higher than normal potassium content, were perfused alternately through the cerebral ventricular system of seven dogs, from the right lateral ventricle and down through the third ventricle, aqueduct and fourth ventricle. During this procedure blood was collected through the adrenal vein and the concentration of cortisol (11β, 17,12-trihydroxy-pregn-4-eme-3,20-dione), cortisone (17,21-dihydroxypregn-4-ene-3,11.20-trione), corticosterone (11β,21-dihydroxy-pregn-4-ene3,20-dione). compound S (11-dihydroxy-3,20-dioxo-pregn-4-en-18-al) and aldosterone (11β.21-dihydroxy-3,20-dioxo-pregn-4-en-18-al) determined. A gradual and marked increase in the secretion of all the cortical compounds was observed during the procedure. This pattern was not altered by changing from one of the artificial cerebrospinal fluid mixtures to the other.

scholarly journals Infrasellar Endoscopic Endonasal Approach for a Pituitary Adenoma Extending into the Third Ventricle, with Anterior Displacement of the Pituitary Gland

2018 ◽  
Vol 79 (S 02) ◽  
pp. S233-S234
Author(s):  
Georgios Zenonos ◽  
Eric Wang ◽  
Juan Fernandez-Miranda
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Outcome Measures ◽  
Third Ventricle ◽  
Visual Fields ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Anterior Displacement ◽  
The Third

Objectives The current video presents the nuances of the infrasellar endoscopic endonasal approach for a pituitary adenoma extending into the third ventricle, with anterior displacement of the pituitary gland. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon at a teaching academic institution. Participants The case refers to 73-year-old female patient who was found to have a sellar mass after failure of vision to improve with cataract surgery. She also reported a several-month history of progressive loss of vision along with daily retro-orbital headaches. The adenoma extended into the clivus as well as in the retrosellar and suprasellar regions, eroding into the floor of the third ventricle. The normal gland was displaced anteriorly. Main Outcome Measures The main outcome measures consisted of reversal of patient symptoms (headaches and visual disturbance), recurrence-free survival based on imaging, as well as absence of any complications. Results The patient's headaches and visual fields improved. There was no evidence of recurrence. Conclusion The infrasellar endoscopic endonasal approach is safe and effective for pituitary adenomas extending into the third ventricle, with anterior displacement of the pituitary gland.The link to the video can be found at: https://youtu.be/zp_06mEyRvY.

scholarly journals Combined simultaneous endoscopic endonasal and microscopic transventricular surgery using a port retractor system for giant pituitary adenoma: A technical case report

2021 ◽  
Vol 12 ◽  
pp. 90
Author(s):  
Erika Yamada ◽  
Hiroyoshi Akutsu ◽  
Hiroyoshi Kino ◽  
Shuho Tanaka ◽  
Hidetaka Miyamoto ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Tumor Resection ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Giant Pituitary Adenoma ◽  
The Third ◽  
Memory Disturbance

Background: We report a case of a giant pituitary adenoma with marked extension into the third ventricle that was successfully removed using combined simultaneous endoscopic endonasal surgery (EES) and microscopic transventricular port surgery. Case Description: A 47-year-old woman, who complained of memory disturbance, had a giant pituitary adenoma with marked extension into the third ventricle that was causing obstructive hydrocephalus. She underwent combined EES and microscopic transventricular surgery using a port retractor system. Most of the tumor was resected from the EES side with assistance from the transcranial side with minimum cortical trajectory damage. The tumor was completely excised without any complications. Conclusion: For giant pituitary adenoma with marked extension into the third ventricle, combined simultaneous EES and transventricular surgery using a port retractor system is effective to maximize the extent of tumor resection while also preventing complications. Using port surgery on the transcranial side, microscopic secure dissection is possible with minimum additional cortical damage.

scholarly journals Extended Endonasal Solo Endoscopic Approach for the Resection of Craniopharyngiomas

2013 ◽  
Vol 29 (2) ◽  
pp. 108-114
Author(s):  
Samsul Alam ◽  
A N Wakil Uddin ◽  
Anis Ahmed ◽  
Moshiur Rahman Mojumder ◽  
Kamrunnessa Hossain ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Diabetes Insipidus ◽  
Bacterial Infections ◽  
Third Ventricle ◽  
Endoscopic Approach ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Extended Transsphenoidal Approach

Background: Extended endonasal solo endoscopic approach for the non-pituitary lesions of the sellar and suprasellar regions are not new in the field of neurosurgery. Following endoscopic surgical approach of the pituitary adenoma, endoscopic neurosurgeon is eager to develop the skill for non-pituitary sellar & suprasellar lesions. Common sellar & suprasellar lesions are pituitary adenoma, craniopharyngioma, tuberculumselle meningioma and suprasellar germinoma. Objective: Traditional transsphenoidal approach gives exposure to the pituitary fossa, whereas extended approach provides exposure to the optic nerve, chiasm, acom complex and basal frontal lobe ,mammillary body, mid brain and laterally to the cavernous sinuses. Material & method: From November 2007 to March 2012, 12 cases of done by extended endonasal solo endoscopic approach among 12 cases of craniopharyngiomas. Patient’s history, clinical findings, pre-operative and post-operative visual acuity, visual field and radiological data were collected and analyzed. All patients underwent solo endoscopic extended transsphenoidal approach with or without nasoseptal flap technique for closure. Most of the patients were given lumbar drain as a treatment for CSF leak. Result: All patients were of age group of 10 to 60 years. Male were 8 (66.67%), female were 4 (33.33%) in number. Gross total removals were done in 7 cases out of 12 (58.33%) craniopharyngiomas and subtotal removal done in 5 (41.67%) cases. Visual acuity and field of vision were improved in all cases of craniopharyngiomas. One case (8.33%) of craniopharyngioma had prolong period of unconsciousness probably from hypothalamic disturbance. CSF leak developed in 2 (16.67%) cases. Patients with craniopharyngioma were required thyroxin and cortisol for replacement. Permanent diabetes insipidus developed in 5 cases (41.67%). Three patients required permanent CSF diversion via a ventriculoperitoneal shunt after documentation of postoperative HCP. There was one case of chemical meningitis, and two cases confirmed bacterial infections. Craniopharyngioma can be successfully resected via a purely endoscopic, endonasal approach. Craniopharyngioma have a higher rate of perioperative hydrocephalus and postoperative CSF leak compared with other tumor types in the same area. Conclusion: Extended transsphenoidal approach is an excellent alternative of skull base approach for the removal of most of the craniopharyngioma.The endoscopic endonasal route provides a good exposure, especially of the sub-chiasmatic and retro-chiasmatic areas, as well as of the stalk– infundibulum axis and the third ventricle chamber. It gives better visualization, improved postoperative visual outcome for less manipulation and low complication then craniotomy. However CSF leak and diabetes insipidus is common known complications which have to be manage promptly and appropriately. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 108-114

Further evidence implicating prostaglandin E2 in the genesis of pyrogen fever

1988 ◽  
Vol 254 (3) ◽  
pp. R463-R469 ◽  
Author(s):  
F. Coceani ◽  
J. Lees ◽  
I. Bishai
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Temperature ◽  
Latent Period ◽  
Third Ventricle ◽  
Interleukin 1 ◽  
Transport Processes ◽  
The Other ◽  
Causative Role ◽  
The Third ◽  
Pg E2

Conscious cats were used to study the effects of endotoxin and interleukin 1 (IL 1) on levels of prostaglandin (PG) E2 and thromboxane (TX) B2 (the stable TXA2 byproduct) in cerebrospinal fluid (CSF) from the third ventricle. Pyrogens were given intravenously or intraventricularly and prostanoids were measured by radioimmunoassay. PGE2 was normally less abundant than TXB2 (mean, 37 vs. 528 pg/ml), and its level increased severalfold during the sustained fever following intravenous endotoxin (bolus) or IL 1 (bolus plus infusion). PGE2 elevation preceded the fever and was maintained thereafter. Likewise, intraventricular pyrogens promoted PGE2 formation, and their effect was also manifest during the latent period of the fever. The PGE2 metabolite, 13,14-dihydro-15-keto-PGE2, was not measurable in CSF from either afebrile or febrile animals. Basal content of PGE2, on the other hand, was higher in animals pretreated with probenecid (30 mg/kg ip or iv; 50 or 100 micrograms ivt), confirming the importance of transport processes in removing prostanoids from brain. Unlike PGE2, TXB2 levels did not change during the fever to intravenous endotoxin. TXB2 rose instead in response to intraventricular endotoxin, although the elevation did not extend beyond fever uprise. Furthermore, a TXA2 analog (ONO-11113;2 or 4 micrograms ivt) had inconsistent effects on body temperature, while a TXA2 antagonist (ONO-11120;2 micrograms ivt) did not interfere with endotoxin fever. These findings strongly support a causative role for PGE2 in the onset and progression of pyrogen fever. No evidence of a similar role was obtained for TXA2.

Suprasellar Ectopic Pituitary Adenoma: Case Report and Review of the Literature

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 681-685 ◽  
Author(s):  
Akira Matsumura ◽  
Kotoo Meguro ◽  
Mikio Doi ◽  
Hideo Tsurushima ◽  
Yuji Tomono
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Immunohistochemical Staining ◽  
Adrenocorticotropic Hormone ◽  
Third Ventricle ◽  
Review Of The Literature ◽  
The Third ◽  
Ectopic Pituitary Adenoma ◽  
Large Numbers ◽  
Nuclear Polymorphism

Abstract The occurrence of a totally suprasellar ectopic pituitary adenoma in a 71-year-old man is described. The tumor was attached to the pituitary stalk, extending upward toward the third ventricle. No intrasellar lesion was observed. Histological examination revealed a pituitary adenoma with large numbers of eosinophilic cells with moderate nuclear polymorphism and rare mitosis. Immunohistochemical staining revealed that the tumor cells were strongly positive for anti-adrenocorticotropic hormone antibody. A review of five previously reported intracranial ectopic pituitary adenomas revealed that two were silent corticotropic tumors and two occurred with Cushing's syndrome.

Persisting embryonal infundibular recess

2009 ◽  
Vol 110 (2) ◽  
pp. 359-362 ◽  
Author(s):  
Andrej Šteňo ◽  
A. John Popp ◽  
Stefan Wolfsberger ◽  
Vít'azoslav Belan ◽  
Juraj Šteňo
Keyword(s):  
Distal Part ◽  
Third Ventricle ◽  
Sella Turcica ◽  
Empty Sella ◽  
Resonance Imaging ◽  
The Third ◽  
Rare Anomaly ◽  
Infundibular Recess ◽  
Sellar Floor

Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the third ventricular floor that has an unclear pathogenesis. In all 7 previously described cases, PEIR was present in adult patients and was invariably associated with hydrocephalus and, in 4 reported cases, with an empty sella. These associated findings led to speculations about the role of increased intraventricular pressure in the development of PEIR. In the present case, PEIR was found in a 24-year-old man without the presence of hydrocephalus or empty sella. Disorders of pituitary function had been present since childhood. Magnetic resonance imaging revealed a cystic expansion in an enlarged sella turcica. A communication between the third ventricle and the sellar cyst was suspected but not apparent. During transcranial surgery, the connection was confirmed. Later, higher-quality MR imaging investigations clearly showed a communication between the third ventricle and the sellar cyst through a channel in the tubular pituitary stalk. This observation and knowledge about the embryology of this region suggests that PEIR may be a developmental anomaly caused by failure of obliteration of the distal part of primary embryonal diencephalic evagination. Thus, PEIR is an extension of the third ventricular cavity into the sella. Although PEIR is a rare anomaly, it is important to identify when planning a procedure on cystic lesions of the sella. Because attempts at removal using the transsphenoidal approach would lead to a communication between the third ventricle and the nasal cavity, a watertight reconstruction of the sellar floor is necessary.

Ectopic pituitary adenoma of the third ventricle

1990 ◽  
Vol 72 (1) ◽  
pp. 139-142 ◽  
Author(s):  
B. K. Kleinschmidt-DeMasters ◽  
Ken R. Winston ◽  
David Rubinstein ◽  
Mary H. Samuels
Keyword(s):  
Pituitary Adenoma ◽  
Neurological Examination ◽  
Pituitary Adenomas ◽  
Sphenoid Sinus ◽  
Third Ventricle ◽  
Electron Microscopic ◽  
Content Type ◽  
The Third ◽  
Ectopic Pituitary Adenoma ◽  
Fine Print

✓ Ectopic pituitary adenomas without associated intrasellar adenomas are rare and are usually located in the sphenoid sinus. Most have been reported without modern radiological, endocrinological, or electron microscopic (EM) documentation. The case of a 47-year-old man with a third ventricular, ectopic, clinically non-secretory pituitary adenoma, which was shown to be a gonadotrophic adenoma by immunohistochemical and EM study, is reported. Neurological examination, extensive neurodiagnostic imaging, surgical anatomical observation, and endocrinological evaluation showed no evidence of neoplasia outside the third ventricle.

Surgical management of intraventricular lesions

2019 ◽  
pp. 411-424
Author(s):  
Guilherme Ribas ◽  
Eduardo Ribas ◽  
Ramez W. Kirollos
Keyword(s):  
White Matter ◽  
Potential Risk ◽  
Lateral Ventricle ◽  
Third Ventricle ◽  
Functional Anatomy ◽  
Deep Understanding ◽  
Neural Tissue ◽  
The Other ◽  
The Third ◽  
Shortest Route

Deep understanding of neuroanatomy is mandatory in planning and execution of surgery for intraventricular lesions. These operative procedures include both open and endoscopic approaches, and choosing the appropriate trajectory to the various parts of the ventricles can minimize the resulting morbidity of the approach, which may occur in addition to the potential risk to the surrounding structures during resection of the lesion itself. The use of the natural spaces provided by the cerebral fissures and sulci allows access to the ventricular cavities whenever possible, however, traversing neural tissue eventually is inevitable. The juxta-midline location of the frontal horns and body of the lateral ventricle and the third ventricle allows the use of interhemispheric approaches. On the other hand, transcortical/trans-sulcal approaches are necessary for lesions located within the atrium or temporal horns of the lateral ventricle. In planning these approaches not only exquisite knowledge of the functional anatomy of the cortex is required, but also understanding the subcortical architecture of the white matter fibres to choose the safest rather than just the shortest route. Furthermore, appreciating the potential morbidity from injuring the surrounding intra- and peri-ventricular structures and awareness of the blind spots related to the various trajectories cannot be underestimated. Surgery for fourth ventricular lesions is covered elsewhere.

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