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de Rosa G, Serioli S, Musarra A, Brancaleone RM, Rigante M, di Domenico M, Gessi M, Mattogno PP, Lauretti L, Arena V, Olivi A, Doglietto F. Endoscopic Extended Transsphenoidal Surgery for Transbasal Tuberculum Sellae Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2025; 28:584-585. [PMID: 39132990 DOI: 10.1227/ons.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/16/2024] [Indexed: 08/13/2024] Open
Affiliation(s)
- Giorgia de Rosa
- Neurosurgery, Catholic University School of Medicine, Rome , Italy
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Simona Serioli
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia , Italy
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Alessandra Musarra
- Neurosurgery, Catholic University School of Medicine, Rome , Italy
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Riccardo Maria Brancaleone
- Neurosurgery, Catholic University School of Medicine, Rome , Italy
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Mario Rigante
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Otorhinolaryngology and Head-Neck Surgery Unit, "A. Gemelli" Hospital Foundation IRCCS, Catholic University of the Sacred Heart, Rome , Italy
| | - Michele di Domenico
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Marco Gessi
- Neuropathology Unit, Università Cattolica del Sacro Cuore, Rome , Italy
- Pathology Unit of Head and Neck, Lung and Endocrine Systems, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Pier Paolo Mattogno
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Liverana Lauretti
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Vincenzo Arena
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Alessandro Olivi
- Neurosurgery, Catholic University School of Medicine, Rome , Italy
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
| | - Francesco Doglietto
- Neurosurgery, Catholic University School of Medicine, Rome , Italy
- SURGEM, Surgical Research and Training Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome , Italy
- Current affiliation: Neurosurgery, Università Cattolica del Sacro Cuore, Rome , Italy
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2
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Shapiro M, Sharashidze V, Nossek E, Sen C, Rutledge C, Chung C, Khawaja A, Kvint S, Riina H, Nelson PK, Raz E. Superior hypophyseal arteries: angiographic re-discovery, comprehensive assessment, and embryologic implications. J Neurointerv Surg 2024; 17:e41-e46. [PMID: 37875341 DOI: 10.1136/jnis-2023-020922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
The superior hypophyseal arteries (SHAs) are well known in anatomical and surgical literature, with a well-established role in supply of the anterior hypophysis and superjacent optic apparatus. However, due to small size and overlap with other vessels, in vivo imaging by any modality has been essentially non-existent. Advances in high resolution cone beam CT angiography (CBCTA) now enables this deficiency to be addressed. This paper presents, to the best of our knowledge, the first comprehensive in vivo imaging evaluation of the SHAs. METHODS Twenty-five CBCTA studies of common or internal carotid arteries were obtained for a variety of clinical reasons. Dedicated secondary reconstructions of the siphon were performed, recording the presence, number, and supply territory of SHAs. A spectrum approach, emphasizing balance with adjacent territories (inferior hypophyseal, ophthalmic, posterior and communicating region arteries) was investigated. RESULTS The SHAs were present in all cases. Supply of the anterior pituitary was nearly universal (96%) and almost half (44%) originated from the 'cave' region, in excellent agreement with surgical literature. Optic apparatus supply was more difficult to adjudicate, but appeared present in most cases. The relationship with superior hypophyseal aneurysms was consistent. Patency following flow diverter placement was typical, despite a presumably rich collateral network. Embryologic implications with respect to the ophthalmic artery and infraoptic course of the anterior cerebral artery are intriguing. CONCLUSIONS SHAs are consistently seen with CBCTA, allowing for correlation with existing anatomical and surgical literature, laying the groundwork for future in vivo investigation.
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Affiliation(s)
- Maksim Shapiro
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Vera Sharashidze
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Erez Nossek
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
- Neurosurgery, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Chandra Sen
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Caleb Rutledge
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Neurosurgery, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Charlotte Chung
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Ayaz Khawaja
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Svetlana Kvint
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Howard Riina
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Peter Kim Nelson
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
| | - Eytan Raz
- Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Radiology, NYC Health Hospitals Bellevue, New York, NY, USA
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3
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Sakata K, Komaki S, Takeshige N, Negoto T, Kikuchi J, Kajiwara S, Orito K, Nakamura H, Hirohata M, Morioka M. Visual Outcomes and Surgical Approach Selection Focusing on Active Optic Canal Decompression and Maximum Safe Resection for Suprasellar Meningiomas. Neurol Med Chir (Tokyo) 2023; 63:381-392. [PMID: 37423756 PMCID: PMC10556211 DOI: 10.2176/jns-nmc.2021-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/17/2023] [Indexed: 07/11/2023] Open
Abstract
The goal of treating patients with suprasellar meningioma is improving or preserving visual function while achieving long-term tumor control. We retrospectively examined patient and tumor characteristics and surgical and visual outcomes in 30 patients with a suprasellar meningioma who underwent resection via an endoscopic endonasal (15 patients), sub-frontal (8 patients), or anterior interhemispheric (7 patients) approach. Approach selection was based on the presence of optic canal invasion, vascular encasement, and tumor extension. Optic canal decompression and exploration were performed as key surgical procedures. Simpson grade 1 to 3 resection was achieved in 80% of cases. Among the 26 patients with pre-existing visual dysfunction, vision at discharge improved in 18 patients (69.2%), remained unchanged in six (23.1%), and deteriorated in two (7.7%). Further gradual visual recovery and/or maintenance of useful vision were also observed during follow-up. We propose an algorithm for selecting the appropriate surgical approach to a suprasellar meningioma based on preoperative radiologic tumor characteristics. The algorithm focuses on effective optic canal decompression and maximum safe resection, possibly contributing to favorable visual outcomes.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine
| | - Satoru Komaki
- Department of Neurosurgery, Kurume University School of Medicine
| | | | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine
| | - Jin Kikuchi
- Department of Neurosurgery, Kurume University School of Medicine
| | - Sosho Kajiwara
- Department of Neurosurgery, Kurume University School of Medicine
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University School of Medicine
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University School of Medicine
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine
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4
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The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery. Acta Neurochir (Wien) 2023; 165:667-675. [PMID: 36355231 DOI: 10.1007/s00701-022-05415-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence. METHODS We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. RESULTS Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI. CONCLUSIONS Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.
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5
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Basma J, Dacus MR, Kumar R, Spencer D, Arnautović KI. Cisternal, Falciform, and Optic Canal Decompression Influencing Optic Nerve Biomechanics: A Microsurgical Anatomic Study. Oper Neurosurg (Hagerstown) 2023; 24:e75-e84. [PMID: 36637310 DOI: 10.1227/ons.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Questions remain regarding optic nerve (ON) physiology, mechanical compliance, and microvasculature, particularly surgical outcomes and atypical visual field defects associated with sellar/parasellar pathology (eg, tumors and aneurysms). OBJECTIVE To study the microsurgical/histological anatomy of each ON segment and corresponding microvasculature, calculate area of optic-carotid space at each decompression stage, and measure ON tension before/after compression. METHODS Five cadaveric heads (10 sides) underwent sequential dissection: (1) intradural (arachnoidal) ON dissection; (2) falciform ligament opening; (3) anterior clinoidectomy, optic canal decompression, and ON sheath release. At each step, we pulled the nerve superiorly/laterally with a force meter and measured maximal mobility/mechanical tension in each position. RESULTS Cisternal ON microvasculature was more superficial and less dense vs the orbital segment. ON tension was significantly lower with higher mobility when manipulated superiorly vs lateromedially. Optic-carotid space significantly increased in size at each decompression stage and with ON mobilization both superiorly and laterally, but the increase was statistically significant in favor of upward mobilization. At decompression step, upward pull provided more space with less tension vs side pull. For upward pull, each step of decompression provided added space as did side pull. CONCLUSION Opening the optic canal, falciform ligament, and arachnoid membrane decompresses the ON for safer manipulation and provided a wider optic-carotid surgical corridor to access sellar/parasellar pathology. When tailoring decompression, the ON should be manipulated superiorly rather than lateromedially, which may guide surgical technique, help prevent intraoperative visual deterioration, facilitate postoperative visual improvement, and help understand preoperative visual field deficits based on mechanical factors.
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Affiliation(s)
- Jaafar Basma
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.,Medical Education Research Institute, Memphis, Tennessee, USA
| | - Mallory R Dacus
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Rahul Kumar
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - David Spencer
- Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Kenan I Arnautović
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.,Semmes-Murphey Clinic, Memphis, Tennessee, USA
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6
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Neumaier F, Stoppe C, Stoykova A, Weiss M, Veldeman M, Höllig A, Hamou HA, Temel Y, Conzen C, Schmidt TP, Dogan R, Wiesmann M, Clusmann H, Schubert GA, Haeren RHL, Albanna W. Elevated concentrations of macrophage migration inhibitory factor in serum and cerebral microdialysate are associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Front Neurol 2023; 13:1066724. [PMID: 36712451 PMCID: PMC9880331 DOI: 10.3389/fneur.2022.1066724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Objective Inflammation is increasingly recognized to be involved in the pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) and may increase the susceptibility to delayed cerebral ischemia (DCI). Macrophage migration inhibitory factor (MIF) has been shown to be elevated in serum and cerebrospinal fluid (CSF) after aSAH. Here, we determined MIF levels in serum, CSF and cerebral microdialysate (MD) at different time-points after aSAH and evaluated their clinical implications. Methods MIF levels were measured in serum, CSF and MD obtained from 30 aSAH patients during early (EPd1-4), critical (CPd5-15) and late (LPd16-21) phase after hemorrhage. For subgroup analyses, patients were stratified based on demographic and clinical data. Results MIF levels in serum increased during CPd5-15 and decreased again during LPd16-21, while CSF levels showed little changes over time. MD levels peaked during EPd1-4, decreased during CPd5-15 and increased again during LPd16-21. Subgroup analyses revealed significantly higher serum levels in patients with aneurysms located in the anterior vs. posterior circulation during CPd5-15 (17.3 [15.1-21.1] vs. 10.0 [8.4-11.5] ng/ml, p = 0.009) and in patients with DCI vs. no DCI during CPd5-15 (17.9 [15.1-22.7] vs. 11.9 [8.9-15.9] ng/ml, p = 0.026) and LPd16-21 (17.4 [11.7-27.9] vs. 11.3 [9.2-12.2] ng/ml, p = 0.021). In addition, MIF levels in MD during CPd5-15 were significantly higher in patients with DCI vs. no DCI (3.6 [1.8-10.7] vs. 0.2 [0.1-0.7] ng/ml, p = 0.026), while CSF levels during the whole observation period were similar in all subgroups. Conclusion Our findings in a small cohort of aSAH patients provide preliminary data on systemic, global cerebral and local cerebral MIF levels after aSAH and their clinical implications. Clinical trial registration ClinicalTrials.gov, identifier: NCT02142166.
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Affiliation(s)
- Felix Neumaier
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany,Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Christian Stoppe
- Departments of Cardiac Anesthesiology and Intensive Care Medicine Charité, Berlin, Germany,Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany,Department of Anesthesiology and Intensive Care Medicine, Würzburg University, Würzburg, Germany
| | - Anzhela Stoykova
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Miriam Weiss
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany,Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Veldeman
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Anke Höllig
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Hussam Aldin Hamou
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Catharina Conzen
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Rabia Dogan
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Gerrit Alexander Schubert
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany,Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Walid Albanna
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany,*Correspondence: Walid Albanna ✉
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7
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Pailler JI, Villalonga JF, Ries-Centeno T, Saenz A, Baldoncini M, Pipolo DO, Cárdenas Ruiz-Valdepeñas E, Kaen A, Hirtler L, Roytowski D, Solari D, Cervio A, Campero A. Clinical Applicability of the Sellar Barrier Concept in Patients with Pituitary Apoplexy: Is It Possible? LIFE (BASEL, SWITZERLAND) 2023; 13:life13010158. [PMID: 36676107 PMCID: PMC9861876 DOI: 10.3390/life13010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.
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Affiliation(s)
- José Ignacio Pailler
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Juan Francisco Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
- Correspondence:
| | | | - Amparo Saenz
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Matías Baldoncini
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | - Derek Orlando Pipolo
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
| | | | - Ariel Kaen
- Hospital Virgen del Rocío, 41013 Sevilla, Spain
| | - Lena Hirtler
- Endoscopic Laboratory of Anatomy Center, Medical University of Vienna, 1090 Vienna, Austria
| | - David Roytowski
- Department of Neurosurgery, University of Cape Town, Cape Town 7701, South Africa
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita’ degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Andrés Cervio
- Departamento de Neurocirugía, FLENI, Buenos Aires 1625, Argentina
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán 4000, Argentina
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8
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Almeida JP, Kalyvas A, Mohan N, Oswari S, Takami H, Velasquez C, Asha M, Zadeh G, Gentili F. Current Results of Surgical Treatment of Craniopharyngiomas: The Impact of Endoscopic Endonasal Approaches. World Neurosurg 2021; 142:582-592. [PMID: 32987614 DOI: 10.1016/j.wneu.2020.05.174] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/05/2020] [Indexed: 10/23/2022]
Abstract
Surgery is the main treatment option for the management of craniopharyngiomas. Transcranial microsurgical approaches, such as pterional and subfrontal approaches, have constituted the classic operative strategy for resection of these tumors. However, the development of endoscopic endonasal approaches has revolutionized the treatment of craniopharyngiomas in the last 15 years, and endoscopic resection is favored for most craniopharyngiomas. In this article, we discuss our experience with the management of craniopharyngiomas and review the current results of the surgical treatment of those tumors, including discussion of goals of surgery, complications, recurrences, and the role of adjuvant treatment.
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Affiliation(s)
- Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aristotelis Kalyvas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nilesh Mohan
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Selfy Oswari
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hirokazu Takami
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Velasquez
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Asha
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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9
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Almeida JP, DE Andrade EJ, Vescan A, Zadeh G, Recinos PF, Kshettry VR, Gentili F. Surgical anatomy and technical nuances of the endoscopic endonasal approach to the anterior cranial fossa. J Neurosurg Sci 2020; 65:103-117. [PMID: 33245220 DOI: 10.23736/s0390-5616.20.05086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endoscopic endonasal approaches (EEA) to the skull base have significantly impacted the management of lesions located in the cranial base. Specifically, lesions arising from the anterior cranial fossa, such as pituitary macroadenomas, craniopharyngiomas meningiomas and craniofacial malignancies have benefited from the development of such approaches. Understanding of the anatomy of the anterior fossa is of utmost importance for the successful selection of the approach and application of surgical techniques in EEA. In the current manuscript, we review the most relevant points of surgical anatomy and nuances of the surgical technique of EEA to the anterior fossa. Anatomical landmarks for the transtuberculum transplanum and transcribriform approaches are discussed and a step-by-step description for those approaches is presented. We reinforce that safe and effective application of such techniques follow the same principles of other skull base surgery techniques: mastering of surgical anatomy, adequate case selection, correct instrumentation and surgical experience.
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Affiliation(s)
- Joao P Almeida
- Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.,Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Erion Jr DE Andrade
- Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan Vescan
- Department of Otolaryngology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Pablo F Recinos
- Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Varun R Kshettry
- Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada -
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Cironi KA, Decater T, Iwanaga J, Dumont AS, Tubbs RS. Arterial Supply to the Pituitary Gland: A Comprehensive Review. World Neurosurg 2020; 142:206-211. [PMID: 32634634 DOI: 10.1016/j.wneu.2020.06.221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
Knowledge of the blood supply to the pituitary gland is important for clinicians and surgeons. Therefore, a good working knowledge of this anatomy is important. The goal of this article was to review current anatomic knowledge of the blood supply to the pituitary gland and its clinical relevance.
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Affiliation(s)
- Katherine A Cironi
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies
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Kalyvas A, Almeida JP, Mohan N, O'Halloran PJ, Vescan A, Gentili F. Expanded Endoscopic Endonasal Approach for Removal of a Tuberculum Sella Meningioma. World Neurosurg 2020; 142:62. [PMID: 32561487 DOI: 10.1016/j.wneu.2020.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022]
Abstract
This 46-year-old female patient presented after a 6-month progressive right-sided visual loss, with a visual acuity of 20/60, a temporo/infranasal visual field deficit, and optic atrophy. The magnetic resonance imaging disclosed a tuberculum sella meningioma with minimal right medial canal invasion, however, no encasement of carotid arteries. Tuberculum sella meningiomas represent 5%-10% of intracranial meningiomas and are surgically challenging tumors that can severely hinder vision. The endoscopic approach allows for early coagulation of the tumor meningeal supply, and importantly, facilitates gross total removal without any manipulation of the optic nerve while preserving the superior hypophyseal arteries.1-9.
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Affiliation(s)
- Aristotelis Kalyvas
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada.
| | - João Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nilesh Mohan
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada
| | - Philip J O'Halloran
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada
| | - Allan Vescan
- Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, Canada
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Villalonga JF, Fuchssteiner C, Solari D, Campero A, Cavallo LM, Cappabianca P, Hirtler L. Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room. Clin Anat 2020; 33:468-474. [PMID: 31943393 DOI: 10.1002/ca.23566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/18/2019] [Accepted: 01/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. METHODS We provided anatomical models in six fresh-frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. RESULTS We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. CONCLUSION We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.
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Affiliation(s)
- Juan F Villalonga
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina.,Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.,Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Christoph Fuchssteiner
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Domenico Solari
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Alvaro Campero
- LINT, Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Luigi M Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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