Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm

1977 ◽  
Vol 46 (4) ◽  
pp. 527-529 ◽  
Author(s):  
Robert E. Decker ◽  
Robert Carras
Keyword(s):  
Visual Loss ◽  
Optic Chiasm ◽  
Content Type ◽  
Traction Injury ◽  
Diaphragma Sellae ◽  
Postoperative Improvement ◽  
Fine Print

✓ Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.

Surgical experiences with giant intracranial aneurysms

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Visual Loss ◽  
Considerable Improvement ◽  
Brain Circulation ◽  
Content Type ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.

Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome

1988 ◽  
Vol 69 (4) ◽  
pp. 523-528 ◽  
Author(s):  
Brian T. Andrews ◽  
Charles B. Wilson
Keyword(s):  
Visual Loss ◽  
Visual Outcome ◽  
Tumor Location ◽  
Postoperative Recovery ◽  
Optic Canal ◽  
Visual Disability ◽  
Content Type ◽  
Tuberculum Sellae ◽  
Diaphragma Sellae ◽  
Planum Sphenoidale

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.

Visual loss from optochiasmatic arachnoiditis after tuberculous meningitis

1977 ◽  
Vol 46 (4) ◽  
pp. 524-526 ◽  
Author(s):  
R. Michael Scott ◽  
Volker K. H. Sonntag ◽  
Lloyd M. Wilcox ◽  
Lester S. Adelman ◽  
Thomas H. Rockel
Keyword(s):  
Tuberculous Meningitis ◽  
Visual Loss ◽  
Visual Recovery ◽  
Optic Nerves ◽  
Content Type ◽  
Visual Deficit ◽  
Fine Print

✓ While recovering from tuberculous meningitis, a 5-year-old boy developed a profound visual deficit because of optochiasmatic arachnoiditis. Following micro-neurosurgical decompression of the optic nerves and chiasm, prompt visual recovery occurred.

The empty sella and some related syndromes

1972 ◽  
Vol 36 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Sixto Obrador
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Space ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Pituitary Glands ◽  
Diaphragma Sellae ◽  
Fine Print ◽  
Syndrome Association

✓ A case of empty sella syndrome due to a benign intrasellar cyst leads the author to a review of variations in this syndrome. Association with intrasellar diverticuli of the subarachnoid space, deficiencies of the diaphragma sellae, and small pituitary glands are identified. Its relationship with certain headaches in women and to unexplained nontraumatic cerebrospinal fluid rhinorrhea are discussed.

Retraction system for transsphenoidal surgery

1985 ◽  
Vol 62 (2) ◽  
pp. 307-309 ◽  
Author(s):  
Shigeaki Kobayashi ◽  
Kenichiro Sugita ◽  
Toshiki Takemae ◽  
Yoshio Tanizaki
Keyword(s):  
Transsphenoidal Surgery ◽  
The Self ◽  
Venous Sinus ◽  
Content Type ◽  
Tumor Bed ◽  
Tumor Tissues ◽  
Dural Venous Sinus ◽  
Diaphragma Sellae ◽  
Fine Print

✓ A retraction system has been developed for transsphenoidal surgery to use together with a conventional self-retaining speculum. The system comprises an attachment to the speculum, a self-retaining retractor, and a slim tapered brain spatula and pronged hook. The spatula or hook is secured with the self-retaining retractor and the attachment. The retractor can also be fixed to the Sugita multipurpose head frame. The system may be used to retract the bulging diaphragma sellae and tumor tissues, and to stop bleeding from the dural venous sinus or tumor bed, so the surgeon can continue the procedure with both hands.

Ectopic pinealoma in the region of the optic chiasm

1971 ◽  
Vol 35 (6) ◽  
pp. 755-759 ◽  
Author(s):  
Naoki Kageyama
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Clinical Characteristics ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Tumor Infiltration ◽  
Content Type ◽  
Visual Defects ◽  
Microscopic Studies ◽  
Fine Print

✓ Five cases of ectopic pinealoma in the chiasmal region are reported and the clinical characteristics emphasized. These include diabetes insipidus, hypopituitarism, visual defects, plus normal skull films and intracranial pressure. Microscopic studies of autopsy and surgical specimens show that visual disturbance is caused by destruction of the optic nerve or chiasm by tumor infiltration. Four patients received cobalt-60 radiotherapy and are healthy 6 to 10 years later.

Pituitary apoplexy in a child

1973 ◽  
Vol 39 (4) ◽  
pp. 519-522 ◽  
Author(s):  
Romas Sakalas ◽  
Ronald B. David ◽  
Frederick S. Vines ◽  
Donald P. Becker
Keyword(s):  
Operative Treatment ◽  
Visual Loss ◽  
Pituitary Apoplexy ◽  
Acute Hemorrhage ◽  
Content Type ◽  
Fine Print

✓ A rapidly growing 6-year-old boy with progressive visual loss suddenly became blind following an acute hemorrhage into an eosinophilic adenoma. The case is described and discussed, including the successful operative treatment.

Carotid-anterior cerebral artery anastomosis

1976 ◽  
Vol 44 (3) ◽  
pp. 378-382 ◽  
Author(s):  
Stephen Nutik ◽  
Domenico Dilenge
Keyword(s):  
Optic Nerve ◽  
Cerebral Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anatomical Features ◽  
Fine Print

✓ The angiographic and anatomical features of an anomalous communication between the intradural internal carotid artery and the anterior cerebral artery are described. Essential features of the anastomosis include an origin at, or close to, the origin of the ophthalmic artery, a course ventral to the ipsilateral optic nerve and anterior to the optic chiasm, and a termination near the anterior communicating artery. Although rare, the condition should be considered as an entity. The incidence of associated berry aneurysm and other congenital vascular anomalies is high.

Surgical management of suprasellar meningioma

1984 ◽  
Vol 61 (4) ◽  
pp. 642-648 ◽  
Author(s):  
Jacob Rosenstein ◽  
Lindsay Symon
Keyword(s):  
Tumor Size ◽  
Visual Loss ◽  
Visual Fields ◽  
Visual Outcome ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Before And After ◽  
Funduscopic Examination ◽  
Optic Discs ◽  
Fine Print

✓ Visual outcome in 101 consecutive cases of suprasellar meningioma treated over a 35-year period has been examined. Preoperative visual loss was evaluated using a scoring system that takes both visual acuity and visual fields into account. In this way a percentage visual loss was calculated for each patient before and after surgery. The effects on visual outcome of age, preoperative visual loss, duration of visual symptoms, tumor size, status of the optic disc, and binocular versus monocular involvement was examined. For the group as a whole, vision improved in 63 patients, was unchanged in 12 patients, and was worse in 24 patients. Prognosis was favorably affected by a mean duration of symptoms of less than 2 years, a tumor size of less than 3 cm, a preoperative visual loss of less than 50%, and the presence of normal optic discs on funduscopic examination. Age had some effect on prognosis, but the presence of binocular or monocular involvement had no effect.

Transsphenoidal microsurgery in the management of craniopharyngioma

1980 ◽  
Vol 52 (5) ◽  
pp. 661-666 ◽  
Author(s):  
Edward R. Laws
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Loss ◽  
Total Removal ◽  
Operative Death ◽  
Critical Feature ◽  
Content Type ◽  
Prior Therapy ◽  
Transsphenoidal Microsurgery ◽  
Cerebrospinal Fluid Leaks ◽  
Fine Print

✓ The rationale for the transsphenoidal approach in the surgical management of craniopharyngioma is presented, based on experience with 26 cases. In 14 patients without prior therapy, nine had “total” removal of the lesion, and only two had permanent postoperative diabetes insipidus. One operative death occurred in this group, and two patients had cerebrospinal fluid leaks. In 12 patients who had undergone prior craniotomy, successful palliation was accomplished, at least temporarily, in every case. Vision was improved postoperatively in 15 of the 16 patients who presented with visual loss. Enlargement of the sella by the tumor is the critical feature allowing for successful transsphenoidal management.

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