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William T Couldwell - One of the best experts on this subject based on the ideXlab platform.
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pituitary Macroadenomas with oculomotor cistern extension and tracking implications for surgical management
Journal of Neurosurgery, 2016Co-Authors: Nguyen Hoang, Ryan Herde, Diem Kieu Tran, Genevieve Couldwell, Anne G Osborn, William T CouldwellAbstract:OBJECT Oculomotor cistern extension of pituitary adenomas is an overlooked feature within the literature. In this study, 7 cases of pituitary Macroadenoma with oculomotor cistern extension and tracking are highlighted, and the implications of surgical and medical management are discussed. METHODS The records of patients diagnosed with pituitary Macroadenomas who underwent resection and in whom preoperative pituitary protocol MRI scans were available for review were retrospectively reviewed. The patient and tumor characteristics were reviewed along with the operative outcomes and complications. RESULTS Seven patients (4.1%) with oculomotor cistern extension and tracking were identified in a cohort of 170 patients with pituitary Macroadenoma. The most common presenting symptoms were visual deficit (6 patients; 86%), apoplexy (3 patients; 43%), and oculomotor nerve palsy (3 patients; 43%). Lone oculomotor nerve palsy was seen in 2 patients without apoplexy and 1 patient with an apoplectic event. Gross-total resection was achieved via a microscopic endonasal transsphenoidal approach with or without endoscopic aid to the sella in 14%, near-total resection in 29%, and subtotal resection in 57% of patients in the data set. CONCLUSIONS Pituitary adenoma extension along the oculomotor cistern is uncommon; however, preoperatively recognizing such extension should play an important role in the surgeon's operative considerations and postoperative clinical management because this extension can limit gross-total resection using the transsphenoidal approach alone.
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peritumoral cysts associated with pituitary Macroadenoma
Journal of Neurosurgery, 2015Co-Authors: Ryan Herde, Nguyen Hoang, Diem Kieu Tran, Genevieve Couldwell, William T Couldwell, Anne G OsbornAbstract:OBJECT Peritumoral cysts are benign nonneoplastic cysts that are found adjacent to extraaxial brain tumors such as meningiomas, schwannomas, craniopharyngiomas, and esthesioneuroblastomas. Peritumoral cysts associated with pituitary Macroadenomas have not been previously described in the literature. The authors report 6 cases of giant Macroadenoma-associated peritumoral cysts and delineate their imaging spectrum. METHODS The authors retrospectively reviewed the records of 179 patients diagnosed with pituitary Macroadenomas who underwent tumor resection at their institution and had preoperative MRI scans available for review. The patients were evaluated for the presence of associated peritumoral cysts. Clinical presentation, histopathology, follow-up time, tumor and peritumoral cyst dimensions were recorded. Signal intensity on T1-weighted, T2-weighted, diffusion-weighted, and FLAIR sequences, as well as pre- and postcontrast appearance, were determined. RESULTS Six patients (3.4%) with associated peritumo...
Masahiko Tosaka - One of the best experts on this subject based on the ideXlab platform.
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combined supra infrasellar approach to pituitary Macroadenoma with oculomotor cistern extension surgical strategy and experience
Acta Neurochirurgica, 2019Co-Authors: Masahiko Tosaka, Tatsuya Shimizu, Takaaki Miyagishima, Yukitaka Tanaka, Tadashi Osawa, Masanori Aihara, Rei Yamaguchi, Yuhei YoshimotoAbstract:Background Oculomotor cistern extension (OMCE) of pituitary adenoma through the oculomotor triangle may be one of the major characteristics of multi-lobulated adenoma. The OMCE may be hard to remove only through the endonasal approach. Method We applied the simultaneous combined supra-infrasellar approach to remove pituitary adenoma with relatively large OMCE. Four (7.3%) of 55 consecutive patients with initially operated pituitary Macroadenoma (> 10 mm) had OMCE. The combined supra-infrasellar approach was adopted in two cases with relatively large OMCE. Results The simultaneous combined supra-infrasellar approach was performed with the transcranial microscopic transsylvian anterior temporal approach and the nasal endoscopic approach. The medial main mass was removed through the nasal side. The lateral OMCE was also removed through the nasal side by pushing the tumor in the sellar direction from the transcranial side. The oculomotor nerve was confirmed with electrical nerve stimulation. The main medial mass and the OMCE were mostly removed in both cases. Remnant tumor in the cavernous sinus was treated by gamma knife radiosurgery. Endoscopic transsphenoidal removal was performed in the other two cases with relatively small OMCE. Conclusions Pituitary Macroadenomas with OMCE are a newly recognized form of progression with important implications for surgical strategy. The combined supra-infrasellar approach performed with the transcranial microscopic transsylvian anterior temporal approach using electrical nerve stimulation and the nasal endoscopic approach may be useful for this type of multi-lobulated pituitary adenoma.
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combined supra infrasellar approach to pituitary Macroadenoma with oculomotor cistern extension surgical strategy and experience
Acta Neurochirurgica, 2019Co-Authors: Masahiko Tosaka, Tatsuya Shimizu, Takaaki Miyagishima, Yukitaka Tanaka, Tadashi Osawa, Masanori Aihara, Rei Yamaguchi, Yuhei YoshimotoAbstract:Oculomotor cistern extension (OMCE) of pituitary adenoma through the oculomotor triangle may be one of the major characteristics of multi-lobulated adenoma. The OMCE may be hard to remove only through the endonasal approach. We applied the simultaneous combined supra-infrasellar approach to remove pituitary adenoma with relatively large OMCE. Four (7.3%) of 55 consecutive patients with initially operated pituitary Macroadenoma (> 10 mm) had OMCE. The combined supra-infrasellar approach was adopted in two cases with relatively large OMCE. The simultaneous combined supra-infrasellar approach was performed with the transcranial microscopic transsylvian anterior temporal approach and the nasal endoscopic approach. The medial main mass was removed through the nasal side. The lateral OMCE was also removed through the nasal side by pushing the tumor in the sellar direction from the transcranial side. The oculomotor nerve was confirmed with electrical nerve stimulation. The main medial mass and the OMCE were mostly removed in both cases. Remnant tumor in the cavernous sinus was treated by gamma knife radiosurgery. Endoscopic transsphenoidal removal was performed in the other two cases with relatively small OMCE. Pituitary Macroadenomas with OMCE are a newly recognized form of progression with important implications for surgical strategy. The combined supra-infrasellar approach performed with the transcranial microscopic transsylvian anterior temporal approach using electrical nerve stimulation and the nasal endoscopic approach may be useful for this type of multi-lobulated pituitary adenoma.
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assessment of hemorrhage in pituitary Macroadenoma by t2 weighted gradient echo mr imaging
American Journal of Neuroradiology, 2007Co-Authors: Masahiko Tosaka, Noriko Sato, Junko Hirato, H Fujimaki, R Yamaguchi, Hideaki Kohga, Koshi Hashimoto, M Yamada, M Mori, Nobuhito SaitoAbstract:BACKGROUND AND PURPOSE: Intratumoral hemorrhage occurs frequently in pituitary Macroadenoma and manifests as pituitary apoplexy and recent or old silent hemorrhage. T2*-weighted gradient-echo (GE) MR imaging is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. T2*-weighted GE MR imaging was used to investigate intratumoral hemorrhage in pituitary Macroadenomas. MATERIALS AND METHODS: Twenty-five consecutive patients who underwent total or subtotal resection of pituitary Macroadenoma with heights from 17 to 53 mm, including 1 patient with classic pituitary apoplexy, underwent MR imaging before surgery, including T2*-weighted GE MR imaging. For histologic assessment of the hemorrhage in whole surgical specimens, we used hematoxylin-eosin staining. RESULTS: T2*-weighted GE MR imaging detected various types of dark lesions, such as “rim,” “mass,” “spot,” and “diffuse” and combinations, indicating clinical and subclinical intratumoral hemorrhage in 12 of the 25 patients. The presence of intratumoral dark lesions on T2*-weighted GE MR imaging correlated significantly with the hemorrhagic findings on T1- and T2-weighted MR imaging (P CONCLUSION: T2*-weighted GE MR imaging could detect intratumoral hemorrhage in pituitary adenomas as various dark appearances. Therefore, this technique might be useful for the assessment of recent and old intratumoral hemorrhagic events in patients with pituitary Macroadenomas.
Christoph Ozdoba - One of the best experts on this subject based on the ideXlab platform.
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selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in cushing s syndrome
Neuroradiology, 2012Co-Authors: Lukas Andereggen, Gerhard Schroth, Jan Gralla, Rolf W. Seiler, Luigi Mariani, Jürgen Beck, H.r. Widmer, Robert H. Andres, Emanuel Christ, Christoph OzdobaAbstract:Introduction Conventional MRI may still be an inaccurate method for the non-invasive detection of a microadenoma in adrenocorticotropin (ACTH)-dependent Cushing’s syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) with ovine corticotropin-releasing hormone (oCRH) stimulation is an invasive, but accurate, intervention in the diagnostic armamentarium surrounding CS. Until now, there is a continuous controversial debate regarding lateralization data in detecting a microadenoma. Using BIPSS, we evaluated whether a highly selective placement of microcatheters without diversion of venous outflow might improve detection of pituitary microadenoma.
Marco J T Verstegen - One of the best experts on this subject based on the ideXlab platform.
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endoscopic vs microscopic transsphenoidal surgery for cushing s disease a systematic review and meta analysis
Pituitary, 2018Co-Authors: Leonie H A Broersen, Nienke R Biermasz, Wouter R Van Furth, Friso De Vries, Marco J T VerstegenAbstract:Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing’s disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing’s disease were eligible. Pooled proportions were reported including 95% confidence intervals. We included 97 articles with 6695 patients in total (5711 microscopically and 984 endoscopically operated). Overall, remission was achieved in 5177 patients (80%), with no clear difference between both techniques. Recurrence was around 10% and short term mortality < 0.5% for both techniques. Cerebrospinal fluid leak occurred more often in endoscopic surgery (12.9 vs. 4.0%), whereas transient diabetes insipidus occurred less often (11.3 vs. 21.7%). For microadenomas, results were comparable between both techniques. For Macroadenomas, the percentage of patients in remission was higher after endoscopic surgery (76.3 vs. 59.9%), and the percentage recurrence lower after endoscopic surgery (1.5 vs. 17.0%). Endoscopic surgery for patients with Cushing’s disease reaches comparable results for microadenomas, and probably better results for Macroadenomas than microscopic surgery. This is present despite the presumed learning curve of the newer endoscopic technique, although confounding cannot be excluded. Based on this study, endoscopic surgery may thus be considered the current standard of care. Microscopic surgery can be used based on neurosurgeon’s preference. Endocrinologists and neurosurgeons in pituitary centers performing the microscopic technique should at least consider referring Cushing’s disease patients with a Macroadenoma.
Nguyen Hoang - One of the best experts on this subject based on the ideXlab platform.
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pituitary Macroadenomas with oculomotor cistern extension and tracking implications for surgical management
Journal of Neurosurgery, 2016Co-Authors: Nguyen Hoang, Ryan Herde, Diem Kieu Tran, Genevieve Couldwell, Anne G Osborn, William T CouldwellAbstract:OBJECT Oculomotor cistern extension of pituitary adenomas is an overlooked feature within the literature. In this study, 7 cases of pituitary Macroadenoma with oculomotor cistern extension and tracking are highlighted, and the implications of surgical and medical management are discussed. METHODS The records of patients diagnosed with pituitary Macroadenomas who underwent resection and in whom preoperative pituitary protocol MRI scans were available for review were retrospectively reviewed. The patient and tumor characteristics were reviewed along with the operative outcomes and complications. RESULTS Seven patients (4.1%) with oculomotor cistern extension and tracking were identified in a cohort of 170 patients with pituitary Macroadenoma. The most common presenting symptoms were visual deficit (6 patients; 86%), apoplexy (3 patients; 43%), and oculomotor nerve palsy (3 patients; 43%). Lone oculomotor nerve palsy was seen in 2 patients without apoplexy and 1 patient with an apoplectic event. Gross-total resection was achieved via a microscopic endonasal transsphenoidal approach with or without endoscopic aid to the sella in 14%, near-total resection in 29%, and subtotal resection in 57% of patients in the data set. CONCLUSIONS Pituitary adenoma extension along the oculomotor cistern is uncommon; however, preoperatively recognizing such extension should play an important role in the surgeon's operative considerations and postoperative clinical management because this extension can limit gross-total resection using the transsphenoidal approach alone.
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peritumoral cysts associated with pituitary Macroadenoma
Journal of Neurosurgery, 2015Co-Authors: Ryan Herde, Nguyen Hoang, Diem Kieu Tran, Genevieve Couldwell, William T Couldwell, Anne G OsbornAbstract:OBJECT Peritumoral cysts are benign nonneoplastic cysts that are found adjacent to extraaxial brain tumors such as meningiomas, schwannomas, craniopharyngiomas, and esthesioneuroblastomas. Peritumoral cysts associated with pituitary Macroadenomas have not been previously described in the literature. The authors report 6 cases of giant Macroadenoma-associated peritumoral cysts and delineate their imaging spectrum. METHODS The authors retrospectively reviewed the records of 179 patients diagnosed with pituitary Macroadenomas who underwent tumor resection at their institution and had preoperative MRI scans available for review. The patients were evaluated for the presence of associated peritumoral cysts. Clinical presentation, histopathology, follow-up time, tumor and peritumoral cyst dimensions were recorded. Signal intensity on T1-weighted, T2-weighted, diffusion-weighted, and FLAIR sequences, as well as pre- and postcontrast appearance, were determined. RESULTS Six patients (3.4%) with associated peritumo...
