scholarly journals Complete endoscopic resection of a pituitary stalk epidermoid cyst using a combined infrasellar interpituitary and suprasellar endonasal approach: case report

2018 ◽  
Vol 128 (2) ◽  
pp. 437-443 ◽  
Author(s):  
Ana C. I. Nakassa ◽  
Joseph D. Chabot ◽  
Carl H. Snyderman ◽  
Eric W. Wang ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Epidermoid Cyst ◽  
Residual Tumor ◽  
Mass Effect ◽  
Visual Disturbance ◽  
Primary Hypothyroidism ◽  
Complete Resection ◽  
High Rate ◽  
Pituitary Stalk ◽  
Endoscopic Endonasal

Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.

scholarly journals A rare epidermoid cyst occurring in an young female: a case report and literature review

2020 ◽  
Author(s):  
Roxana Dumitriu ◽  
Roxana Dușceac ◽  
Anda Dumitrașcu ◽  
Cătălina Poiană
Keyword(s):  
Diabetes Insipidus ◽  
Epidermoid Cyst ◽  
Cushing Syndrome ◽  
Residual Tumor ◽  
Brain Structures ◽  
Pituitary Hormones ◽  
Young Female ◽  
High Rate ◽  
Epidermoid Cysts ◽  
Subarachnoid Spaces

Abstract Background Epidermoid cysts are very rare benign lesions of epithelial origin, slow growing extra-axial tumours and they accord for 1% of all intracranial tumours. They frequently occur at the cerebellopontine angle and parasellar regions insinuating brain structures. They are often associated with a high rate of residual tumor and recurrence. Clinical Case We present the case of a 18 year old patient who was admitted in the our clinic for secondary amenorrhea. The CT scan showed a large median mass with a mixed structure (calcareous and cystic) resembling a craniopharyngioma. Preoperatively the hormonal profile showed deficiency of all anterior pituitary hormones. Transsphenoidal surgery was performed and the histopathological exam established the diagnosis of sellar epidermoid cyst with parasellar extension. Postoperatively the patient developed iatrogenic Cushing syndrome (due to large amounts of dexamethasone given) and diabetes insipidus. Conclusion Epidermoid cysts are challenging tumours because of the extension along the subarachnoid spaces around delicate neurovascular structures therefore they are difficult to be completely resected. The particularity of this case stands in the rare occurrence of this types of tumours and the fact that although in these patients with hypopituitarism diabetes insipidus is present primarily our patient developed postoperatively.

scholarly journals SAT-LB312 Central Diabetes Insipidus as Presenting Manifestation of Suprasellar Epidermoid Cyst

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Samia Abdullah Bokhari
Keyword(s):  
Diabetes Insipidus ◽  
Epidermoid Cyst ◽  
Mass Effect ◽  
Cystic Mass ◽  
Central Diabetes Insipidus ◽  
Neural Tube Closure ◽  
Visual Field Defects ◽  
Sellar Region ◽  
Rare Presentation ◽  
Surrounding Areas

Abstract Back Ground: Epidermoid cysts (ECs) result from the inclusion of squamous epithelial elements during neural tube closure. ECs are tumors constituting 02-1.8% of all brain tumors. ECs are typically found in cerebellopontine angle, but occasionally develop in sellar region. ECs are usually clinically silent, but may produce signs of mass effect as headaches, visual field defects. ECs presenting with Central Diabetes insipidus is reported but rare. Only two cases were reported in literature (Ref: 1).Here we report a case of sellar Epidermoid cyst presenting with Diabetes insipidus. Case Description: 49-year male presented with one-month history of polyuria, polydipsia and weight loss. The initial work up identified normal blood glucose, serum calcium and renal function. The water deprivation test confirmed the diagnosis of central Diabetes insipidus. Further pituitary hormonal assessment revealed panhypopituitarism along with diabetes insipidus. The MRI of brain showed evidence of large sellar supracellar cystic mass with a differential diagnosis of craniopharyngioma, Rathkeys cyst. Surgery performed in order to remove the tumor. The pathological report confirmed the tumor as epidermoid cyst. He did well through hospital stay. DI and along with panhypopituitarism persisted post operatively and treated with hormonal replacement. Conclusion: ECs of sellar region vary in presentation depending upon their location, and extension into surrounding areas producing mass effects. Diabetes Insipidus is a rare presentation in these rare tumors. References: 1: CW huo, C Caputo,YY Wang: Supracellar keratinous cyst: A case report and review on its radiological features and treatment: Surgical Neurology International 2018,9;15

scholarly journals Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhengyuan Chen ◽  
Zengyi Ma ◽  
Wenqiang He ◽  
Xuefei Shou ◽  
Zhao Ye ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Tumor Recurrence ◽  
Progression Free Survival ◽  
Pituitary Stalk ◽  
Endoscopic Endonasal ◽  
Central Type ◽  
Kaplan Meier ◽  
Peripheral Type ◽  
The Impact ◽  
Surgically Induced

Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging.Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081–0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48–59) and 39 (95% CI 28–50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05).Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.

scholarly journals Cranial Nerve Preservation Following Surgical Treatment for Epidermoid Cysts of the Posterior and Middle Fossae

2018 ◽  
Vol 79 (05) ◽  
pp. 445-450 ◽  
Author(s):  
Kurt Grahnke ◽  
Daniel Burkett ◽  
Daphne Li ◽  
Caroline Szujewski ◽  
John Leonetti ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Residual Tumor ◽  
Mass Effect ◽  
Extent Of Resection ◽  
Brain Parenchyma ◽  
Complete Resection ◽  
Subtotal Resection ◽  
Nerve Preservation ◽  
Epidermoid Cysts ◽  
Presenting Symptoms

AbstractEpidermoid cysts are rare lesions, accounting for 0.2 to 1.8% of all intracranial tumors. They most commonly occur in the cerebellopontine angle where they may cause a breadth of neurologic complications due to mass effect on the nearby cranial nerves (CN), vascular structures, and the brain stem. Treatment of epidermoid cysts is surgical, with the goal of complete resection using microsurgical technique and even more importantly preservation of the involved CNs, vasculature, and brain parenchyma. Successful surgery can result in total resolution of symptoms, but, in certain situations, may not be advisable due to adherence, scarring, or inflammation making dissection of CN fascicles difficult and possibly hazardous. We conducted a retrospective review from 1998 to 2016 and compiled a series of 28 skull base epidermoid cysts operated on at our institution. Cases were evaluated for presenting symptoms, history of prior resection, and postoperative results including CN function, extent of resection, residual tumor, and need for reoperations. The average tumor size (largest diameter) was 3.9 cm with a range of 1 to 7cm. Eighteen of twenty-eight (64%) patients underwent a gross total resection and ten underwent subtotal resection. No patients, whether presenting with CN deficits or not, experienced permanent worsening of CN function following surgery. Complete resection of epidermoid cysts should remain a high priority of therapy, but, in our opinion, preservation of CN function should be a primary goal, determining the extent of resection to provide patients with the highest quality of life possible following surgery.

Endoscopic Endonasal Interdural Posterior Clinoidectomy: A Key Step to Achieve Complete Resection in Clival Chordomas

2019 ◽  
Author(s):  
Maria Vega ◽  
Vanessa Hernandez-Hernandez ◽  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
Eric Wang ◽  
...  
Keyword(s):  
Complete Resection ◽  
Endoscopic Endonasal

scholarly journals Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

2021 ◽  
Author(s):  
Gianluca Agresta ◽  
Alberto Campione ◽  
Fabio Pozzi ◽  
Pierlorenzo Veiceschi ◽  
Martina Venturini ◽  
...  
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Conformal Radiotherapy ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Tumor Location ◽  
Transsphenoidal Approach ◽  
Low Grade ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction

Abstract Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws.

scholarly journals Occult Langerhans Cell Histiocytosis Presenting with Papillary Thyroid Carcinoma, a Thickened Pituitary Stalk and Diabetes Insipidus

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Michael S. Gordon ◽  
Murray B. Gordon
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Diabetes Insipidus ◽  
Langerhans Cell Histiocytosis ◽  
Hypogonadotropic Hypogonadism ◽  
Langerhans Cell ◽  
Pituitary Stalk ◽  
Bright Spot ◽  
Molecular Testing ◽  
Papillary Thyroid

Etiologies of a thickened stalk include inflammatory, neoplastic, and idiopathic origins, and the underlying diagnosis may remain occult. We report a patient with a thickened pituitary stalk (TPS) and papillary thyroid carcinoma (PTC) whose diagnosis remained obscure until a skin lesion appeared. The patient presented with PTC, status postthyroidectomy, and I131therapy. PTC molecular testing revealed BRAF mutant (V600E, GTC>GAG). She had a 5-year history of polyuria/polydipsia. Overnight dehydration study confirmed diabetes insipidus (DI). MRI revealed TPS with loss of the posterior pituitary bright spot. Evaluation showed hypogonadotropic hypogonadism and low IGF-1. Chest X-ray and ACE levels were normal. Radiographs to evaluate for extrapituitary sites of Langerhans Cell Histiocytosis (LCH) were unremarkable. Germinoma studies were negative: normal serum and CSF beta-hCG, alpha-fetoprotein, and CEA. Three years later, the patient developed vulvar labial lesions followed by inguinal region skin lesions, biopsy of which revealed LCH. Reanalysis of thyroid pathology was consistent with concurrent LCH, PTC, and Hashimoto’s thyroiditis within the thyroid. This case illustrates that one must be vigilant for extrapituitary manifestations of systemic diseases to diagnose the etiology of TPS. An activating mutation of the protooncogene BRAF is a potential unifying etiology of both PTC and LCH.

What are the risk factors for residual tumor cells after endoscopic complete resection in gastric epithelial neoplasia?

2014 ◽  
Vol 29 (2) ◽  
pp. 487-492 ◽  
Author(s):  
Gak Won Yun ◽  
Jie-Hyun Kim ◽  
Yong Chan Lee ◽  
Sang Kil Lee ◽  
Sung Kwan Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tumor Cells ◽  
Residual Tumor ◽  
Complete Resection ◽  
Gastric Epithelial Neoplasia

Approach To The Pediatric Patient: Central Diabetes Insipidus

2022 ◽  
Author(s):  
Giuseppa Patti ◽  
Flavia Napoli ◽  
Daniela Fava ◽  
Emilio Casalini ◽  
Natascia Di Iorgi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Central Nervous System Damage ◽  
Gold Standard Method ◽  
Underlying Condition ◽  
Detailed Medical History ◽  
Over Time

Abstract Central diabetes insipidus (CDI) is a complex disorder in which large volumes of dilute urine are excreted due to arginine-vasopressin deficiency, and it is caused by a variety of disorders affecting the hypothalamic-posterior pituitary network. The differential diagnosis is challenging and requires a detailed medical history, physical examination, biochemical approach, imaging studies and, in some cases, histological confirmation. Magnetic resonance imaging is the gold standard method for evaluating congenital or acquired cerebral and pituitary stalk lesions. Pituitary stalk size at presentation could be normal, but it may change over time, depending on the underlying condition, while other brain areas or organs may become involved during follow up. Early diagnosis and treatment are crucial in order to avoid central nervous system damage, germ cell tumor dissemination, and to minimize complications of multiple pituitary hormone defects. We provide a practical update on the diagnosis and management of patients with CDI and highlight several pitfalls that may complicate the differential diagnosis of conditions presenting with polyuria and polydipsia. The need for a careful and close follow-up of patients with “apparently” idiopathic CDI is particularly emphasized, because the underlying condition may be recognized over time. The clinical scenario that we outline at the beginning of this article represents the basis for the discussion about how the etiological diagnosis of CDI can be overlooked, and demonstrates how a water intake and urine output improvement can be a sign of progressive damage of both hypothalamus and anterior pituitary gland with associated pituitary hormonal deficiencies.

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