Modified orbitozygomatic craniotomy for craniopharyngioma resection in children

2009 ◽  
Vol 4 (4) ◽  
pp. 345-352 ◽  
Author(s):  
Kiarash J. Golshani ◽  
Kirk Lalwani ◽  
Johnny B. Delashaw ◽  
Nathan R. Selden
Keyword(s):  
Sella Turcica ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Neurological Deficits ◽  
Endocrine Dysfunction ◽  
Prepontine Cistern ◽  
Institutional Review ◽  
Suprasellar Region ◽  
Transsphenoidal Operation ◽  
Brain Retraction

Object In this study, the authors evaluated the efficacy and safety of modified orbitozygomatic craniotomy for resection of craniopharyngioma in children. Methods A prospective, institutional review board–approved database was retrospectively reviewed for pediatric patients undergoing craniopharyngioma resection performed by a single surgeon. Results Ten patients underwent craniopharyngioma resection surgery between July 2000 and January 2006 (4 girls and 6 boys, ages 1.5–17 years). Nine patients presented to the authors' institution, and 1 patient was referred after surgery and radiation therapy were administered elsewhere. Nine patients presented with visual field deficits (2 with unilateral or bilateral light perception only) and 5 with endocrine dysfunction. Eight patients had large tumors that significantly displaced the optic chiasm and hypothalamus. All patients underwent a modified frontotemporal orbitozygomatic osteotomy in a single piece. The lamina terminalis was opened in 4 patients with third ventricular extension. One patient required a staged transsphenoidal operation to remove residual tumor in the sella turcica, and 1 patient underwent a contralateral subtemporal approach to resect a daughter lesion in the prepontine cistern. Complete radiographic resection was achieved in all patients. Follow-up averaged 55 months (range 12–95 months). Vision was improved in 8 patients and remained stable in 2. All patients had postoperative endocrine dysfunction. One patient experienced transient cranial nerve IV palsy and 1 suffered a small caudate stroke 5 months after surgery without sequelae. Two patients experienced polyphagia and weight gain without other symptoms of hypothalamic dysfunction. There were no other new neurological deficits. Conclusions Modified orbitozygomatic craniotomy provides excellent exposure of the suprasellar region with minimal brain retraction, allowing complete resection of craniopharyngiomas with good visual and neurological results.

Resection of suprasellar tumors by using a modified transsphenoidal approach

2000 ◽  
Vol 92 (6) ◽  
pp. 1028-1035 ◽  
Author(s):  
Joshua G. Kouri ◽  
Michael Y. Chen ◽  
Joseph C. Watson ◽  
Edward H. Oldfield
Keyword(s):  
Third Ventricle ◽  
Sella Turcica ◽  
Transsphenoidal Approach ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Posterior Portion ◽  
Content Type ◽  
Suprasellar Region ◽  
Adjacent Structures ◽  
Fine Print

✓ Generally accepted contraindications to using a transsphenoidal approach for resection of tumors that arise in or extend into the suprasellar region include a normal-sized sella turcica, normal pituitary function, and adherence of tumor to vital intracranial structures. Thus, the transsphenoidal approach has traditionally been restricted to the removal of tumors involving the pituitary fossa and, occasionally, to suprasellar extensions of such tumors if the sella is enlarged. However, conventional transcranial approaches to the suprasellar region require significant brain retraction and offer limited visualization of contralateral tumor extension and the interface between the tumor and adjacent structures, such as the hypothalamus, third ventricle, optic apparatus, and major arteries. In this paper the authors describe successful removal of suprasellar tumors by using a modified transsphenoidal approach that circumvents some of the traditional contraindications to transsphenoidal surgery, while avoiding some of the disadvantages of transcranial surgery.Four patients harbored tumors (two craniopharyngiomas and two hemangioblastomas) that arose in the suprasellar region and were located either entirely (three patients) or primarily (one patient) within the suprasellar space. All patients had a normal-sized sella turcica. Preoperatively, three of the four patients had significant endocrinological deficits signifying involvement of the hypothalamus, pituitary stalk, or pituitary gland. Two patients exhibited preoperative visual field defects. For tumor excision, a recently described modification of the traditional transsphenoidal approach was used. Using this modification, one removes the posterior portion of the planum sphenoidale, allowing access to the suprasellar region. Total resection of tumor was achieved (including absence of residual tumor on follow-up imaging) in three of the four patients. In the remaining patient, total removal was not possible because of adherence of tumor to the hypothalamus and midbrain. One postoperative cerebrospinal fluid leak occurred. Postoperative endocrinological function was worse than preoperative function in one patient. No other new postoperative endocrinological or neurological deficits were encountered.This study demonstrates the feasibility of using a modified transsphenoidal approach for resection of certain suprasellar, nonpituitary tumors.

DYSPLASIA OF THE SELLA TURCICA: CLINICAL AND LABORATORY INVESTIGATIONS IN THREE CASES

1966 ◽  
Vol 52 (3) ◽  
pp. 478-488 ◽  
Author(s):  
P. O. Lundberg ◽  
Carl Gemzell
Keyword(s):  
Glucose Tolerance ◽  
Sella Turcica ◽  
Endocrine Dysfunction ◽  
The Third ◽  
First Case ◽  
Suprasellar Region ◽  
Laboratory Investigations ◽  
Air Encephalography

ABSTRACT Three cases are described with no actual sella turcica but only a shallow depression in its place. The name dysplasia is suggested for this as distinct from the term »a small sella« which is used by other authors to describe a clearly definable and normally-shaped sella turcica but which is smaller than average for the patient's age. Endocrine dysfunction was present in all cases to a varying extent. In the first case hypogonadism, dwarfism, obesity, fronto-temporal baldness, hypothermia and cataract were present. In the second case hypogonadism, slight obesity and a defective cortisol-ACTH feed-back mechanism were found. In the third case with the least pronounced dysplasia, the endocrinological investigations only showed frontal baldness and a decreased glucose tolerance. The EEG was pathological in all cases. Air-encephalography did not show any changes outside the suprasellar region. The patients were neurologically and mentally normal.

A rare case of primary sellar melanoma

2004 ◽  
Vol 100 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Jochen Tüttenberg ◽  
Wolfram Fink ◽  
Walter Back ◽  
Frederik Wenz ◽  
Dirk Schadendorf ◽  
...  
Keyword(s):  
Mr Imaging ◽  
S100 Protein ◽  
Sella Turcica ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
First Case ◽  
Fine Print

✓ The authors report on the case of a 37-year-old woman in whom a primary sellar malignant melanoma mimicking a hemorrhagic pituitary macroadenoma was treated. This entity is exceedingly rare; only five cases are described in the literature. The patient presented with rapid deterioration of vision within a 2-week period. After an ophthalmological diagnosis of chiasmal syndrome was made, magnetic resonance (MR) imaging of the head revealed an intra- and suprasellar mass that was elevating and compressing the optic chiasm. Because of the signal heterogeneity of the lesion a hemorrhagic pituitary macroadenoma was assumed; the lesion was transsphenoidally resected. Histological examination of the specimen showed a malignant melanocytic tumor with immunopositivity for S100 protein and HMB-45. Despite extensive staging no other primary melanotic tumor was found. Thus, a primary sellar melanoma was diagnosed. Postoperative MR images demonstrated no residual tumor. For adjuvant therapy the region around the sella turcica received 40.4 Gy stereotactically guided radiation. A 24-month follow-up examination revealed no tumor recurrence. This represents the sixth case of such a lesion reported in the literature, the third case evaluated using MR imaging, and the first case with a progression-free survival of 24 months. Thus, the authors advocate that management of primary sellar melanoma should include gross-total removal and postoperative stereotactic radiotherapy.

scholarly journals Pituitary apoplexy: clinical features, management and outcome. Clinical study and review of the literature

2015 ◽  
Vol 22 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Adriana Elena Solomon ◽  
Ligia Tataranu ◽  
Vasile Ciubotaru ◽  
Mircea Radu Gorgan
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Apoplexy ◽  
Cranial Nerves ◽  
Optic Chiasm ◽  
Clinical Syndrome ◽  
Rapid Expansion ◽  
Neurological Deficits ◽  
Suprasellar Region ◽  
Level Of Consciousness ◽  
Significant Compression

AbstractBackground: Pituitary apoplexy is a clinical syndrome secondary to rapid expansion of the content of the sella and extension to suprasellar region, cavernous sinus, sphenoid sinus secondary to a bleeding, ischemic or mixed episode taking place in a pituitary adenoma. This episode will determine a significant compression of the optic nerves, optic chiasm, cavernous sinus and hypothalamus, which translates clinically most often by headache, visual disturbances, deceased level of consciousness and ophthalmoplegia. Material and methods: This paper presents a retrospective study over a period of five years, from January 2009 to December 2013 and includes 98 patients diagnosed with pituitary apoplexy and treated in the Third Department of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni. Of the 98 patients, 62 were females (63.3 %) and 36 were males (36.7 %) with a ratio of female to male of 1.7:1. The patients were aged between 17 and 75 years old, average age being approximately 50 years. Follow-up period ranged from 2 months to 5 years. The main symptomsat presentation was sudden, intense headache, this symptom was encountered in 90 patients (91.83%), vomiting showed by 76 patients (77.55%), decreased visual acuity observed in 57 patients (58.16%), visual field deficits in 74 patients (75.51%), cranial nerves palsy (III, IV, VI) observed in 14 patients (14.28 %). Conclusions: Pituitary apoplexy is a disease that can endanger patients' lives. The clinical presentation may vary from minor symptoms to major neurological deficits and even death so early diagnosis and treatment are vital.

scholarly journals Recurrent Sphenocavernous Meningioma

2021 ◽  
Author(s):  
Mizuho Inoue ◽  
Mohamed Labib ◽  
Alexander Yang ◽  
A. Samy Youssef
Keyword(s):  
Tumor Resection ◽  
Intensity Modulated Radiotherapy ◽  
Residual Tumor ◽  
World Health ◽  
Neurological Deficits ◽  
Falciform Ligament ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Who Grade ◽  
Health Organization

AbstractA case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A magnetic resonance imaging (MRI) revealed a large left sphenocavernous meningioma. The patient underwent a frontotemporal craniotomy for tumor resection. Near total resection was achieved with minimal residual in the left cavernous sinus (CS) and orbital apex. The pathology was consistent with meningioma, World Health Organization (WHO) grade I. A follow-up MRI was done 9 months after surgery and showed a growth of the residual tumor, which was treated with intensity modulated radiotherapy. Tumor growth was detected on serial imaging over a 4-year period. Surgical resection was offered. A left frontotemporal craniotomy with pretemporal transcavernous approach was performed. The bone flap was reopened and the dura was opened in a Y-shaped fashion. The roof of the optic canal was drilled off, and the falciform ligament was opened to decompress the optic nerve. The tumor was disconnected from the anterior clinoid region (the anterior clinoid process was eroded by the tumor) and reflected off the wall of the lateral CS. Tumor was adherent to the V2 fascicles (the lateral CS wall was resected in the first surgery) and was sharply dissected off. Gross total resection was achieved. The pathology was consistent with meningioma, WHO grade I. The patient had an unremarkable postoperative course without any new neurological deficits.The link to the video can be found at: https://youtu.be/KVBVw_86JqM.

Rapid Deterioration of Latent HBV Hepatitis during Cushing Disease and Posttraumatic Stress Disorder after Earthquake

2017 ◽  
Vol 78 (04) ◽  
pp. 407-411 ◽  
Author(s):  
Ryosuke Tashiro ◽  
Teiji Tominaga ◽  
Yoshikazu Ogawa
Keyword(s):  
Hepatic Dysfunction ◽  
Residual Tumor ◽  
Optic Chiasm ◽  
Japanese Woman ◽  
Hbv Reactivation ◽  
Cushing Disease ◽  
Old Japanese ◽  
Threatening Condition ◽  
The Right ◽  
Subtotal Removal

AbstractReactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation.We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course.Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.

scholarly journals Giant Prolactinoma presenting with facial nerve palsy and hemiparesis

2021 ◽  
Author(s):  
Aleksandra Sliwinska ◽  
Fatima Jalil ◽  
Lori De La Portilla ◽  
Michael Baldwin ◽  
Joseph Lorenzo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Prolactin Level ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Sella Turcica ◽  
Neurological Deficits ◽  
Lower Extremity Weakness ◽  
Giant Prolactinoma ◽  
Giant Prolactinomas ◽  
The Brain

Abstract Background Giant prolactinomas are an exceedingly uncommon type of pituitary adenomas that usually occur in men, cause extremely high prolactin levels and mass related symptoms. Rarely, patients may experience neurological deficits resembling ischemic events. Methods We describe an unusual case of a young man who presented with stroke-like symptoms and was found to have a giant prolactinoma. Clinical Case 25-year-old man presented with the left facial droop and gradually progressing upper and lower extremity weakness for evaluation of stroke. He reported recent weight gain and erectile dysfunction. Physical exam revealed left homonymous hemianopsia, left VII nerve palsy, and left hemiparesis. MRI of the brain showed an enormous mass in the sella turcica, which invaded the sphenoid sinus and right side of the skull base. Prolactin level was elevated at 13580 ng/mL, and the testosterone level was low. The patient was started on cabergoline and had marked improvement in his symptoms in a few months. Fifteen months after starting treatment, he has had more than 90% reduction in tumor volume and a 93% reduction in prolactin level. Conclusion Giant prolactinomas are uncommon and present with compressive symptoms that can be mistaken for a stroke. Our case is a unique report of a facial nerve palsy and hemiparesis secondary to giant prolactinoma in the absence of stroke or pituitary apoplexy.

Contralateral Supracerebellar-Infratentorial Approach for Resection of Thalamic Cavernous Malformations

2018 ◽  
Vol 15 (4) ◽  
pp. 404-411 ◽  
Author(s):  
Justin Mascitelli ◽  
Jan-Karl Burkhardt ◽  
Sirin Gandhi ◽  
Michael T Lawton
Keyword(s):  
Intraoperative Complications ◽  
Occipital Lobe ◽  
Senior Author ◽  
Pineal Region ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Posterior Thalamus ◽  
Neurological Outcomes ◽  
The Right ◽  
Brain Retraction

Abstract BACKGROUND Surgical resection of cavernous malformations (CM) in the posterior thalamus, pineal region, and midbrain tectum is technically challenging owing to the presence of adjacent eloquent cortex and critical neurovascular structures. Various supracerebellar infratentorial (SCIT) approaches have been used in the surgical armamentarium targeting lesions in this region, including the median, paramedian, and extreme lateral variants. Surgical view of a posterior thalamic CM from the traditional ipsilateral vantage point may be obscured by occipital lobe and tentorium. OBJECTIVE To describe a novel surgical approach via a contralateral SCIT (cSCIT) trajectory for resecting posterior thalamic CMs. METHODS From 1997 to 2017, 75 patients underwent the SCIT approach for cerebrovascular/oncologic pathology by the senior author. Of these, 30 patients underwent the SCIT approach for CM resection, and 3 patients underwent the cSCIT approach. Historical patient data, radiographic features, surgical technique, and postoperative neurological outcomes were evaluated in each patient. RESULTS All 3 patients presented with symptomatic CMs within the right posterior thalamus with radiographic evidence of hemorrhage. All surgeries were performed in the sitting position. There were no intraoperative complications. Neuroimaging demonstrated complete CM resection in all cases. There were no new or worsening neurological deficits or evidence of rebleeding/recurrence noted postoperatively. CONCLUSION This study establishes the surgical feasibility of a contralateral SCIT approach in resection of symptomatic thalamic CMs It demonstrates the application for this procedure in extending the surgical trajectory superiorly and laterally and maximizing safe resectability of these deep CMs with gravity-assisted brain retraction.

Transsphenoidal Removal of Retroclival Chondroma with Pituitary Transposition Manifesting as Repeated Subarachnoid Hemorrhage: A Case Report

2019 ◽  
Vol 80 (03) ◽  
pp. 228-232
Author(s):  
Yoshikazu Ogawa ◽  
Kuniyasu Niizuma ◽  
Teiji Tominaga
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Residual Tumor ◽  
Good Prognosis ◽  
Growth Potential ◽  
Unknown Etiology ◽  
Large Tumor ◽  
Prepontine Cistern ◽  
Extended Transsphenoidal Approach ◽  
Short Period

Background Intracranial chondromas are extremely rare and represent only 0.2% of all intracranial primary neoplasms. The histologic appearance lacks nuclear atypism and mitoses, and it usually shows low growth potential, although these benign features do not necessarily imply a good prognosis. Case Description A 44-year-old man was referred to our institution with a subarachnoid hemorrhage (SAH). He had a history of SAH 5 years previously that was diagnosed as unknown etiology at another hospital. Head magnetic resonance imaging showed a large tumor located in the prepontine cistern and extending up to the interpeduncular cistern, and the tumor was irregularly enhanced with contrast medium. Retrospective analysis of the original computed tomography of 5 years earlier identified a small contrast enhancing defect behind the dorsum sellae. Tumor removal was planned to prevent repeated SAH and control the apparently growing tumor. An extended transsphenoidal approach was performed. The pituitary gland was dissected from the bottom of the sellar floor and transposed forward to the prechiasmatic cistern with preservation of the pituitary stalk and its blood supply, and subtotal removal of the tumor was achieved. Postoperative diabetes insipidus disappeared within a few days, and the patient was discharged without neurologic or endocrinologic deficits. Histologic examination established the diagnosis as chondroma without a sarcomatous component. Follow-up examination 3 months after surgery showed a re-enlargement of the residual tumor, and gamma knife surgery was performed. Conclusions Intracranial chondroma sometimes manifests as intracranial hemorrhage and grows comparatively rapidly in a short period despite the benign histologic features. A long and careful follow-up period is essential.

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