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Wang Z, Zhu J, Yao Y, Zhu H, Deng K, Lu L, Zhang Y, Duan L, Wang L, Yang H, Xiao Y, Zhao D, You H, Feng F, Ma J, Wang X, Pan H. Clinical and pathological features of 124 patients with indistinguishable sellar lesions and central diabetes insipidus. J Clin Neurosci 2020; 80:215-222. [PMID: 33099348 DOI: 10.1016/j.jocn.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sellar lesions with central diabetes insipidus have a wide range of causes, and diagnosis is relatively difficult. The indication and clinical value of biopsy are still controversial. OBJECTIVE To describe the etiology, demographic characteristics, manifestations, laboratory tests and imaging findings of this disease and to explore the clinical value and safety of endoscopic transsphenoidal biopsy. METHODS Retrospective analysis of 124 patients with sellar lesions and central diabetes insipidus who underwent endoscopic transsphenoidal biopsy at the Neurosurgery Department, Peking Union Medical College Hospital, from 2011 to 2019. RESULTS The main etiology includes congenital diseases, inflammatory/infectious diseases and tumor diseases. The most common diseases were germ cell tumors, Langerhans cell histiocytosis, lymphocytic hypophysitis, and Rathke's cleft cysts. Except for the age at the time of biopsy of patients with tumor diseases, which was significantly lower than that of the other two, the other clinical manifestations of the three types of diseases were not significantly different. Among the 124 patients, biopsy was performed via an endoscopic transsphenoidal approach for 101 with intrasellarly available lesions or via an endoscopic extended transsphenoidal approach for 23 with intrasellarly unavailable lesions. 6 patients had central nervous system infections after surgery, and 3 had cerebrospinal fluid rhinorrhea, of which 2 were surgically repaired. These incidences were basically the same as those of classic surgery. 2 patients had worse visual acuity, 2 had worse visual field, and 2 had worse eye movement. Excepting one patient, all of whom have recovered after treatment. CONCLUSIONS Noninvasive examination is difficult for identifying the common causes of this type of disease. Endoscopic transsphenoidal biopsy is relatively safe and effective, helps doctors to select the best treatment for patients, and is worth promoting.
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Affiliation(s)
- Zhicheng Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Jianyu Zhu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yi Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xuqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K. Traumatic Nonmissile Penetrating Transnasal Anterior Skull Base Fracture and Brain Injury with Cerebrospinal Fluid Leak: Intraoperative Leak Detection and an Effective Reconstruction Procedure for a Localized Skull Base Defect Especially After Coronavirus Disease 2019 Outbreak. World Neurosurg 2020; 140:166-172. [PMID: 32497852 PMCID: PMC7263210 DOI: 10.1016/j.wneu.2020.05.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
Background Cerebrospinal fluid (CSF) leakage after penetrating skull base injury is relatively rare compared with close head injuries involving skull base fractures. Case Description We report the case of a 65-year-old man who had presented with epistaxis and serous rhinorrhea. When he had fallen to the ground near his bee boxes, a garden pole had poked into his right nostril. He had instantly removed the pole from his nostril himself. However, immediately after removal of the pole, he had developed nasal bleeding and serous rhinorrhea. He then drove to our emergency room. Computed tomography showed pneumocephalus with a minor cerebral contusion in the left frontal lobe and a penetrating injury in the left anterior skull base. His CSF leakage had not resolve spontaneously within 1 week after the injury with strict bed rest. We repaired the CSF leakage using a fat (adipose tissue)-on-fascia autograft plug and caulked the defect in the anterior skull base with the fat-on-fascia graft (FFG) plug through the left nostril with endoscopic guidance. The CSF rhinorrhea was successfully controlled. Intranasal local application of fluorescein aided in the detection of the direction of flow of the CSF leakage. Conclusions Endonasal endoscopic caulking of a skull base defect using an FFG plug can be useful to treat CSF leakage due to the localized skull base defect, especially in the coronavirus disease 2019 pandemic. It is simple, inexpensive, and timesaving. It requires no special skills nor sophisticated instruments that can cause aerosolization, reducing the risk of infection during the surgery.
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Affiliation(s)
- Yuichiro Yoneoka
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Naotaka Aizawa
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yoriko Nonomura
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Manabu Ogi
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Wang F, Zhang J, Wang P, Zhou T, Meng X, Jiang J. Prediction of pituitary stalk position in pituitary adenomas by visualization of the hypothalamo-hypophyseal tract using diffusion tensor imaging tractography. Medicine (Baltimore) 2018; 97:e0052. [PMID: 29517662 PMCID: PMC5882425 DOI: 10.1097/md.0000000000010052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The preservation of pituitary stalk during surgery is very important for neurosurgeons. Sometimes, it is hard to identify the pituitary stalk in the operation. The hypothalamo-hypophyseal tract (HHT) projects through the pituitary stalk to the posterior pituitary gland. If the HHT can be identified, the position of pituitary stalk will be visualized. The diffusion tensor imaging (DTI) fiber tracking technique has been widely used for the quantitative assessment of the white matter integrity and thus may be suitable for the evaluation of the HHT.DTI was used to track the HHT in 11 patients with pituitary adenoma, and the location of the tract was compared with the pituitary stalk of postoperative image in those patients.The fiber tracking and 3D visualization of the HHT were successfully carried out in all 11 patients. Comparison between the tract and pituitary stalk of postoperative magnetic resonance imaging (MRI) was carried out in 9 patients. The results revealed that the position of tract was consistent with the pituitary stalk of postoperative MRI image in 8 patients (88.9%). The properties of tract showed that the median number of tract was 5.18 ± 7.00, the median fractional anisotropy (FA) was 0.14 ± 0.04, and the median length was 28.81 ± 7.94 mm.HHT can be tracked and visualized with the DTI-FT technique. It will be helpful to identify the location of pituitary stalk preoperatively.
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Serial Re-Expansion of Pituitary Gland Is Associated with Endocrinologic Recovery. World Neurosurg 2016; 90:496-503. [PMID: 27020971 DOI: 10.1016/j.wneu.2016.03.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimizing pituitary dysfunction by preservation of the normal pituitary gland has a significant clinical impact on patient outcome after pituitary surgery. This study aimed to determine whether re-expansion of the healthy gland after surgery was related to endocrinologic outcome. METHODS From January 2012 to July 2014, 112 patients were eligible for this retrospective study. Magnetic resonance imaging with dynamic contrast enhancement done2 days and 3 months before and after surgery was evaluated to assess the tumor and normal pituitary gland. We assessed the size of the pituitary gland and evaluated the relationship with endocrinologic outcome. RESULTS The mean preoperative size of the gland was 3.86 mm, within 2 days after surgery it was 5.50 mm and 3 months after surgery it was 7.17 mm. Preoperatively patients were grouped based on their requirement of hormone replacement. Patients who required hormone replacement therapy before surgery and did not recover from hormonal insufficiency were classified as group 1 (26 patients), those who recovered from preoperative hormonal insufficiency and discontinued hormone replacement after surgery were classified as group 2 (17 patients), and those who showed hormonally normal status and did not need hormone replacement before and after surgery were in group 3 (68 patients). In group 1, the size of the gland expanded 1.24 times within postoperative 2 days but had no increase after 3 months (1.25 mm) (P = 0.716). Group 2 showed a 1.30 times larger gland within postoperative 2 days and 2.37 times at 3 months follow-up (P = 0.001). Group 3 showed 1.62 times larger gland at postoperative day 2 and 2.1 times larger at the 3-month follow-up. CONCLUSIONS Serial re-expansion of the healthy pituitary gland at the 3-month follow-up magnetic resonance imaging can predict the endocrinologic recovery.
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