Preoperative imaging study in assessment of hazard to Internal Carotid Arteries injury during endoscopic endonasal transsphenoidal surgery

In endoscopic endonasal transsphenoidal procedures, ICA injury occurs up to 3.8%[8]. The highest hazard of injury is in case of contact between the ICA and pituitary gland, during opening of the dura. Preoperative imaging ie. CTA, MRA supports objectively intraoperative techniques of imaging. CTA as well as MRA are essential to access anatomic details in variability of cavernous segment of ICA (C4 ICA). The aim of the study was to measure the space between the pituitary gland and ICA on both sides. Anatomic relations between left and right ICAs were accessed on CTA ( coronal scans) at levels:A- the most concave point of the C4-C5 bend;B- at the most convex point of the C4 bend;C- at the C4 posterior ascending portion. Distances between pituitary gland and ICAs were measured on both sides on MRA (axial scans):A'- at the most concave point of C4-C5 bend;B'- the most convex point of the C4 bend.The Statistica 13 (StatSoft) software was used for the statistical analysis. The Mann Whitney U test was applied to determine differences between the quantitative variables, Spearman's rank correlation coefficients were calculated. The results were considered statistically significant at the level of p<0,05. Distance reduction was shown between pituitary glands and cavernous segment (C4) of ICAs on both sides, which is related to age. This has impact on surgical planning and highlights the risk of ICAs intraoperative injury.

Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus

Nonobstructive hydrocephalus in patients with craniopharyngiomas is uncommon. We describe our surgical series of 25 consecutive patients with craniopharyngioma who presented with hydrocephalus. Obstructive hydrocephalus was evident in most cases, and nonobstructive hydrocephalus was revealed in three cases. Even after improvement of cerebrospinal fluid (CSF) pathway obstruction by tumor removal, 10 patients (40%) required CSF diversion. Preoperative imaging study revealed thin intraventricular hemorrhage or superficial siderosis in five cases, and CSF examination revealed hemosiderin-laden phagocytes in one case. These findings indicate continuous bleeding into the CSF that might be associated with CSF malabsorption. We also describe a representative case of craniopharyngioma associated with nonobstructive hydrocephalus due to continuous minor bleeding from the tumor surface in a 62-year-old man with a complaint of disorientation and a decline in daily living activity.Our study demonstrated that minor bleeding into the CSF is a possible mechanism of the development of nonobstructive hydrocephalus in patients with craniopharyngiomas.