Fluid-fluid level in pituitary tumors: analysis of management of 106 cases

2010 ◽  
Vol 112 (6) ◽  
pp. 1341-1346 ◽  
Author(s):  
Atul Goel ◽  
Abhidha Shah ◽  
Sukhdeep Singh Jhawar ◽  
Naina K. Goel
Keyword(s):  
Pituitary Tumors ◽  
Visual Outcome ◽  
Fluid Level ◽  
Recurrence Rates ◽  
Maximum Dimension ◽  
Visual Deficits ◽  
Time Of Presentation ◽  
Symptom Progression ◽  
Fluid Levels

Object The management issues of 106 cases of pituitary tumors with a fluid level within the fluid content of the cystic part of the tumor (a “fluid-fluid” level) were reviewed. Methods Between 2000 and March 2009, 1660 pituitary tumors were treated neurosurgically at K.E.M. Hospital. Investigations of 106 of these cases revealed a fluid-fluid level within the tumor. All patients underwent surgery via a transsphenoidal route. The mean follow-up duration was 46 months. Results The tumors varied in size: 31 were between 1 and 3 cm, and 75 were larger than 3 cm in maximum dimension (mean maximum dimension 3.4 cm). Fifty-two tumors had 1 fluid level, 11 had 2, and 43 had multiple fluid levels (≥ 3). The onset of symptoms was acute in 8 cases and insidious in 98 cases. In 16 cases, there was evidence of acute exacerbation of symptoms during the course of symptom progression. The symptoms were progressive in all cases. Ninety-seven percent of patients had visual deficits at the time of presentation. The solid portion of the tumor was relatively friable and vascular in most cases, and the fluid varied in color and in consistency, from a thin yellow to dark red liquid. Visual outcome was extremely gratifying in the majority of cases; of those presenting with visual dysfunction, 94% reported visual recovery in the immediate postoperative period. During the follow-up period, there was tumor recurrence in 21 cases; in 12 of these cases, the authors documented a fluid-fluid level. The histological features did not indicate malignancy in any case. Conclusions A fluid level within a fluid cavity in pituitary tumors is rarely reported but is not uncommon in large/giant tumors. The presence of such a feature suggests that surgery in these cases can be relatively straightforward despite the lesion's large size, and the visual outcome is gratifying. However, recurrence rates are relatively higher in such cases than in other pituitary tumors.

Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

2018 ◽  
Vol 32 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Amar Miglani ◽  
Joseph M. Hoxworth ◽  
Matthew A. Zarka ◽  
Devyani Lal
Keyword(s):  
Frozen Section ◽  
Standard Of Care ◽  
Inverted Papilloma ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Predictive Values ◽  
Endoscopic Techniques ◽  
Time Of Presentation ◽  
Very High

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

scholarly journals Visual outcome of cataract surgery with IOL implantation in traumatic cataract among 189 children: The Lahan experience

2017 ◽  
Vol 5 (3) ◽  
pp. 1-10
Author(s):  
L R Puri ◽  
G S Shrestha
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Anterior Segment ◽  
Visual Outcome ◽  
Traumatic Cataract ◽  
Eye Injuries ◽  
Iol Implantation ◽  
Wooden Stick ◽  
Time Of Presentation

Trauma is an important cause of monocular blindness in the developing world. This study aims to determine the demo­graphic profile and visual outcome of cataract surgery among the children with traumatic cataract. It was a prospective and longitudinal study of 189 consecutive children below 16 years who underwent cataract surgery with intra ocular lens (IOL) implantation for traumatic cataract at Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from October 2012 to March 2014. Assessment included visual acuity measurement in the Snellen’s chart or the Cardiff card, anterior segment examina­tion with slit lamp, dilated fundus examination with the help of +20D lens in indirect ophthalmoscope, B-scan ultrasonogra­phy of posterior segment and objective and subjective refraction. Follow up was scheduled at first post-operative day, at dis­charge, one month and three months. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Among 189, majority of them were males (73%) and the average age was 8.8±3.6 years. The time of presentation ranged from 3 days to 8 years (median age two months). Wooden stick was the most common cause of injury (34.4%). The average preoperative visual acuity in logMAR scale was 1.6. The average postoperative visual acuity in logMAR scale was 0.8. Eye injuries with traumatic cataract are associated with significant visual impairment. Cataract surgery with intraocular lens implantation restores vision significantly.

Management of surgical clinoidal meningiomas

2003 ◽  
Vol 14 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Samuel Tobias ◽  
Chang-Hyun Kim ◽  
Gregory Kosmorsky ◽  
Joung H. Lee
Keyword(s):  
Skull Base ◽  
Visual Function ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Total Resection ◽  
Visual Deficits ◽  
The Past ◽  
Optic Canal Unroofing ◽  
Base Technique

Object Clinoidal meningiomas remain a major neurosurgical challenge. Surgery-related outcome has been less than desirable in the past, and little attention has been directed toward improving visual deficits. The authors advocate a skull base technique for the removal of these difficult tumors and describe its advantages in terms of improving extent of resection and enhancing overall outcome, particularly visual function. Methods A retrospective analysis was performed on data obtained in 26 consecutive patients with clinoidal meningiomas (including one patient with hemangiopericytoma) who underwent resection between June 1995 and January 2003. In 24 cases the skull base procedure involved extradural anterior clinoidectomy, optic canal unroofing, and optic sheath opening; in two cases a standard pterional craniotomy was performed. Fourteen of the 26 patients suffered significant preoperative visual deficits. All patients underwent thorough pre- and postoperative ophthalmological evaluations. The follow-up period ranged from 3 to 91 months (mean 42.3 months). Total resection was achieved in 20 patients (77%), and the majority (76.9%) of patients with preoperative visual impairment experienced significant improvement. Conclusions With the use of the skull base technique, total resection and excellent visual outcome may be achieved with minimal morbidity in most patients with clinoidal meningiomas.

scholarly journals Profile of Open Globe Injury in Children at Lumbini Eye Institute

2015 ◽  
Vol 3 (1) ◽  
pp. 37-40
Author(s):  
Binita Bhattarai ◽  
Santosh Pokhrel ◽  
Bel Thapa ◽  
Prachand Gautam ◽  
Nanda Gurung
Keyword(s):  
Visual Acuity ◽  
Public Health Problem ◽  
Visual Outcome ◽  
Medical Sciences ◽  
Open Globe Injury ◽  
Open Globe ◽  
Male Preponderance ◽  
Time Of Presentation ◽  
Better Than

INTRODUCTION: Ocular trauma is preventable public health problem throughout the world that especially affects the young. During the last several decades the prognosis of open-globe injuries has significantly improved. The aim of this study was to describe the clinical profile of open globe injury in children and visual outcome after surgery.MATERIAL AND METHODS: It is a prospective hospital based study that included children aged 1-15 yrs presenting to Lumbini Eye Institute (LEI), Bhairahawa with open globe injury. Visual acuity and Anterior and Posterior Segment examination findings were recorded at the time of presentation, after surgery and in three subsequent follow up visits.RESULTS: Out of 26,538 pediatric patients, during the study period 0.26% (n=69) had open globe injury. The most common age group was 510 years comprising 43.5%, with a strong male preponderance of 74% and mean age of 8.06±3.6years. Playing was the most common mode of injury comprising 58%, where as stick was the most common agent causing trauma consisting 51%. Fifty two percent were visually impaired and 39% were blind at the time of presentation and only 9% children had visual acuity better than 6/18. Improved vision was found in 52%, same vision in 34% and deteriorated vision in 13% till third follow up visit. Anatomical integrity of the globe was maintained in 88.4% and only 11.6% had Phthisis bulbi.CONCLUSION: The incidence of open globe injury among children at Lumbini Eye Institute was 0.26%. Male children were more vulnerable. Stick was the most common traumatizing agent. There was a favorable outcome with improved vision in most children after surgery.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 37-40

Medial Sphenoid Wing Meningiomas: Clinical Outcome and Recurrence Rate

Neurosurgery ◽  
2006 ◽  
Vol 58 (4) ◽  
pp. 626-639 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Cornelius Jacobs ◽  
Peter Vorkapic ◽  
Madjid Samii
Keyword(s):  
Recurrence Rate ◽  
Cavernous Sinus ◽  
Visual Function ◽  
Visual Outcome ◽  
Recurrence Rates ◽  
Tumor Entity ◽  
Radical Removal ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE: To provide clinical data concerning the visual outcome and recurrence rate of medial sphenoid wing meningiomas in consideration of two different subgroups of this tumor entity. METHODS: Among 256 sphenoid wing meningiomas, there were 108 medial sphenoid wing meningiomas of globoid shape. They were classified into Group 1 (without cavernous sinus involvement) and Group 2 (with cavernous sinus involvement). En plaque meningiomas were excluded from the analysis. The charts of the patients including surgical records, discharge letters, follow-up records, and imaging studies were analyzed retrospectively. RESULTS: There were 39 Group 1 tumors and 69 Group 2 tumors. For microsurgical tumor removal, the frontolateral (15.7%) or the pterional approach (84.3%) was performed. Total resection was achieved in 92.3% of patients with Group 1 tumors and 14.5% of those with Group 2 tumors. Radiological recurrence was observed in 7.7% (Group 1 tumors) and 27.5% (Group 2 tumors). The mean follow-up time was 79.04 months (6.59 yr). Improvement of visual function (or stable visual function) was observed in 56% (44%) of patients with Group 1 tumors, in 30% (60%) with newly diagnosed Group 2 tumors, and 10% (70%) undergoing recurrent surgery for Group 2 tumors. CONCLUSION: Group 1 meningiomas present a more favorable subgroup with fortunate visual outcome. In Group 2 tumors, visual improvement was less favorable and radical removal is limited because of cavernous sinus infiltration, with consequential higher recurrence rates. Patients harboring recurrent Group 2 tumors with deteriorating visual function profit from microsurgery because vision can be preserved on the same preoperative level in the majority.

scholarly journals Long-term outcomes after an initial experience of computer-navigated resection of primary pelvic and sacral bone tumours

2019 ◽  
Vol 101-B (4) ◽  
pp. 484-490 ◽  
Author(s):  
R. Nandra ◽  
G. Matharu ◽  
J. Stevenson ◽  
M. Parry ◽  
R. Grimer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Computer Navigation ◽  
Wide Resection ◽  
Resection Margins ◽  
Recurrence Rates ◽  
Kaplan Meier ◽  
Cumulative Rate ◽  
Time Of Presentation

Aims The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. Patients and Methods This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, using computer navigation, between 2010 and 2012. The mean age of the patients at the time of presentation was 51 years (10 to 77). The rates of local recurrence and mortality were calculated using the Kaplan–Meier method. Results Bone resection margins were all clear and there were no bony recurrences. At a mean follow-up for all patients of 59 months (12 to 93), eight patients (34.8%) developed soft-tissue local recurrence, with a cumulative rate of local recurrence at six-years of 35.1% (95% confidence interval (CI) 19.3 to 58.1). The cumulative all-cause rate of mortality at six-years was 26.1% (95% CI 12.7 to 49.1). Conclusion Despite the positive early experience with navigated-assisted resection, local recurrence rates remain high. With increasing knowledge of the size of soft-tissue margins required to reduce local recurrence and the close proximity of native structures in the pelvis, we advise against compromising resection to preserve function, and encourage surgeons to reduce local recurrence by prioritizing wide resection margins of the tumour. Cite this article: Bone Joint J 2019;101-B:484–490.

Spectrum of Visual Deficits Associated with Pituitary Adenoma and Factors Determining Visual Outcome in More Than 2,000 Eyes

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Pinaki Dutta ◽  
Tenzin Gyurmey ◽  
Reema Bansal ◽  
Ashis Pathak ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Visual Outcome ◽  
Visual Deficits

scholarly journals Real-World Experience with Bezlotoxumab for Prevention of Recurrence of Clostridioides difficile Infection

2020 ◽  
Vol 10 (1) ◽  
pp. 2
Author(s):  
Rosa Escudero-Sánchez ◽  
María Ruíz-Ruizgómez ◽  
Jorge Fernández-Fradejas ◽  
Sergio García Fernández ◽  
María Olmedo Samperio ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Real World ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Clostridioides Difficile ◽  
Multicentre Cohort Study ◽  
Clostridioides Difficile Infection ◽  
Prevention Of Recurrence ◽  
Multicentre Cohort

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI.

scholarly journals Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3252
Author(s):  
Pier Paolo Mattogno ◽  
Quintino Giorgio D’Alessandris ◽  
Sabrina Chiloiro ◽  
Antonio Bianchi ◽  
Antonella Giampietro ◽  
...  
Keyword(s):  
Pituitary Tumors ◽  
Female Gender ◽  
Clinical History ◽  
Serum Prolactin ◽  
Cure Rate ◽  
Cross Sectional ◽  
Unique Challenge ◽  
Best Management ◽  
Pituitary Diseases

Background: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas. Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected by prolactinomas were enrolled if treated with a first-line treatment with a dopamine agonist (DA) or trans-sphenoidal surgery (TSS). Patients carried giant prolactinomas, and those with a follow-up <12 months were excluded. Results: Two hundred and fifty-nine patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. One hundred and forty-six of 249 patients (58.6%) needed a second therapy. The mean follow-up was 102.2 months (12–438 months). Surgery highly impacted on the cure rate—in particular, in females (p = 0.0021) and in microprolactinomas (p = 0.0020). Considering the multivariate analysis, the female gender and surgical treatment in the course of the clinical history were the only independent positive predictors of a cure at the end of 5 years follow-up (p = 0.0016, p = 0.0005). The evaluation of serum prolactin (24 hours after TSS) revealed that 86.4% of patients with postoperative prolactin (PRL) ≤10 ng/mL were cured at the end of the follow-up (p < 0.0001). Conclusions: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TSS for prolactinomas should be considered as a concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.

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