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Gulati R, Pal HK, V Krishnan N. Management Strategy of a Grade-3 Cerebrospinal Fluid Leak Repair Following Endoscopic Endonasal Transsphenoidal Excision of Pituitary Macroadenoma. Indian J Otolaryngol Head Neck Surg 2024; 76:2844-2846. [PMID: 38883493 PMCID: PMC11169123 DOI: 10.1007/s12070-024-04529-7] [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: 11/05/2023] [Accepted: 01/18/2024] [Indexed: 06/18/2024] Open
Abstract
A skull- base defect with grade-3 cerebrospinal fluid (CSF) leak following a pituitary macroadenoma removal is rare and challenging. We provide a simple sample model of multilayer closure with naturally available hard and soft tissue components. Tamponade was provided to the reconstructed site with a simple inflated Foley's catheter bulb. There was no repair failure and cavities were well mucosalised on follow-up. Mucosal and turbinate preservation was fully achieved in this method as no turbinate flaps were raised or large raw surface exposure was there.
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Affiliation(s)
- Rohit Gulati
- Department of ENT-Head & Neck Surgery, Saudi German Hospital, Dubai, United Arab Emirates
| | - Hillol Kanti Pal
- Department of Neurosurgery, Al Zahra Hospital, Dubai, United Arab Emirates
| | - Neethu V Krishnan
- Department of ENT-Head & Neck Surgery, Saudi German Hospital, Dubai, United Arab Emirates
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Harel E, Cossu G, Daniel RT, Messerer M. Relationship with the diaphragm to predict the surgical outcome in large and giant pituitary adenomas. Front Surg 2022; 9:962709. [PMID: 36211275 PMCID: PMC9534030 DOI: 10.3389/fsurg.2022.962709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Large and giant pituitary adenomas (L- and G-PAs) continue to remain a surgical challenge. The diaphragm may have a role in determining the shape of the tumor and therefore influencing the extent of resection. Our study aims to analyze our surgical series of L- and G-PAs according to their relationship with the diaphragm and invasion of cavernous sinus (CS). Material and methods We performed a retrospective analysis of our surgical series of patients operated for L- and G-PAs. We categorized the tumors into four grades according to their relationship with the diaphragm: grade 1 (supradiaphragmatic component with a wide incompetent diaphragm), grade 2 (purely infra-diaphragmatic tumor with a competent diaphragm), grade 3 (dumbbell-shape tumors), and grade 4 (multilobulated tumor with invasion of the subarachnoid space). Results A total of 37 patients were included in our analysis. According to our classification, 43.3% of patients had grade 1 tumors, 27% had grade 2, 5.4% had grade 3, and 24.3% had grade 4 tumors. CS invasion was confirmed intraoperatively in 17 out of 37 patients (46%). The gross total resection (GTR) was obtained in 19% of the cases, near-total resection in 46%, and subtotal resection in 35%. All the patients who achieved GTR had grade 1 tumors and the lowest rate of CS invasion (p < 0.01). Conclusion Radiological evaluation of the tumor relationship with the diaphragm, invasion of CS, and invasion of the subarachnoid space are crucial to plan the surgical strategy and maximize the possibilities of achieving GTR in L- and G-PAs.
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Shu X, Zhou Y, Li F, Zhou T, Meng X, Wang F, Zhang Z, Pu J, Xu B. Three-Dimensional Semantic Segmentation of Pituitary Adenomas Based on the Deep Learning Framework-nnU-Net: A Clinical Perspective. MICROMACHINES 2021; 12:1473. [PMID: 34945322 PMCID: PMC8703586 DOI: 10.3390/mi12121473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
This study developed and evaluated nnU-Net models for three-dimensional semantic segmentation of pituitary adenomas (PAs) from contrast-enhanced T1 (T1ce) images, with aims to train a deep learning-based model cost-effectively and apply it to clinical practice. METHODS This study was conducted in two phases. In phase one, two models were trained with nnUNet using distinct PA datasets. Model 1 was trained with 208 PAs in total, and model 2 was trained with 109 primary nonfunctional pituitary adenomas (NFPA). In phase two, the performances of the two models were investigated according to the Dice similarity coefficient (DSC) in the leave-out test dataset. RESULTS Both models performed well (DSC > 0.8) for PAs with volumes > 1000 mm3, but unsatisfactorily (DSC < 0.5) for PAs < 1000 mm3. CONCLUSIONS Both nnU-Net models showed good segmentation performance for PAs > 1000 mm3 (75% of the dataset) and limited performance for PAs < 1000 mm3 (25% of the dataset). Model 2 trained with fewer samples was more cost-effective. We propose to combine the use of model-based segmentation for PA > 1000 mm3 and manual segmentation for PA < 1000 mm3 in clinical practice at the current stage.
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Affiliation(s)
- Xujun Shu
- Medical School of Chinese PLA, Beijing 100853, China;
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Yijie Zhou
- School of Computer Science, Fudan University, Shanghai 200433, China;
| | - Fangye Li
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Tao Zhou
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Xianghui Meng
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Fuyu Wang
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Zhizhong Zhang
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
| | - Jian Pu
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Bainan Xu
- Department of Neurosurgery, The First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; (F.L.); (T.Z.); (X.M.); (F.W.); (Z.Z.)
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Zhang P, Zhang L, Zhao R. Application of MRI images based on Spatial Fuzzy Clustering Algorithm guided by Neuroendoscopy in the treatment of Tumors in the Saddle Region. Pak J Med Sci 2021; 37:1600-1604. [PMID: 34712290 PMCID: PMC8520360 DOI: 10.12669/pjms.37.6-wit.4850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/12/2021] [Accepted: 07/18/2021] [Indexed: 01/02/2023] Open
Abstract
Objective: The paper applies spatial fuzzy clustering algorithm to explore the role and value of neuroendoscopic assisted technology in the operation of tumors in the saddle region, and analyze the MRI image characteristics of tumors in the saddle region. Methods: The clinical data of 63 patients from our hospital who underwent neuroendoscopic assisted microscopy to remove tumors in the saddle area from 2017 to 2019 (neuroendoscopy-assisted group) were collected. Seventy six patients who occupied the saddle area by microscopic resection only in the same period (Simple microscope group) clinical data. By comparing the patient’s tumor resection rate, postoperative complication rate and postoperative recurrence rate, the surgical effect was evaluated. Results: The total resection rates of the tumors in the neuroendoscopy-assisted group and the microscope-only group were 95.24% (60/63) and 80.26% (61/76). The incidence of postoperative vasospasm was 3.17% (2/63) and 13.16% (10/76), the incidence of nerve injury was 0 (0/63) and 6.58% (5/76), the difference was statistically significant (P <0.05). There was no significant difference in the incidence of postoperative infection, cerebrospinal fluid leakage and postoperative recurrence rate between the two groups (P> 0.05). Conclusion: Neuroendoscopy-assisted microscopy-based removal of the saddle area occupying space based on spatial fuzzy clustering algorithm can increase the total tumor resection rate and reduce the incidence of complications.
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Affiliation(s)
- Peng Zhang
- Peng Zhang, Attending Physician. Department of Neurosurgery, Chongqing Three Gorges Central Hospital, 165 Xincheng Road, Wanzhou District, Chongqing, 404100, China
| | - Lingdang Zhang
- Lingdang Zhang, Attending Physician. Department of Neurosurgery, Chongqing Three Gorges Central Hospital, 165 Xincheng Road, Wanzhou District, Chongqing, 404100, China
| | - Rui Zhao
- Rui Zhao, Associate Chief Physician. Department of Neurosurgery, Chongqing Three Gorges Central Hospital, 165 Xincheng Road, Wanzhou District, Chongqing, 404100, China
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Evaluation of the Gross Total Resection Rate of Suprasellar Pituitary Macroadenomas with and without the Removal of the Tuberculum Sellae Bone. World Neurosurg 2021; 156:e291-e299. [PMID: 34547527 DOI: 10.1016/j.wneu.2021.09.049] [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: 07/13/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Improving the gross total resection (GTR) rate of suprasellar pituitary macroadenomas (SPMAs) using the pure endoscopic endonasal transsphenoidal approach (EETA) has been a long-standing focus of neurosurgeons. This study was aimed at evaluating the influences of the removal of the tuberculum sellae bone (TSB) without opening the dura of the tuberculum sellae on the GTR rate of SPMAs via the EETA. METHODS We retrospectively analyzed medical reports of patients with SPMAs who underwent EETA between February 2015 and November 2020. Data on clinical manifestations, endocrinologic types, imaging features (Hardy classification, morphology, and texture), clinical outcomes, and TSB removal status were collected. All patients were followed up for 6 months postoperatively. RESULTS Seventy-eight patients were enrolled in our study. The GTR rates of the TSB removal group (45/78, 57.7%) and nonremoval group (33/78, 42.3%) were 80.0% (36/45) and 57.6% (19/33), respectively. Univariate logistic regression analysis found that the removal of TSB, rounded morphology, and low Hardy classification were correlated with higher GTR rates. Multiple logistic regression analysis indicated that even after adjusting for tumor types and imaging features, the removal of TSB had an independent effect on the GTR rate (odds ratio, 7.6; 95% confidence interval, 1.8-31.6; P = 0.005). The incidence rates of postoperative cerebrospinal fluid leakage and diabetes insipidus were not significantly different between the TSB removal group and TSB nonremoval group. CONCLUSIONS TSB removal using EETA without opening the tuberculum sellae dura improves the GTR rate of SPMAs without increasing the incidence of postoperative complications.
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Zhao P, Cheng J, Li B, Nie D, Wang H, Li C, Gui S, Zhang Y. LncRNA PCAT6 regulates the progression of pituitary adenomas by regulating the miR-139-3p/BRD4 axis. Cancer Cell Int 2021; 21:14. [PMID: 33407504 PMCID: PMC7789787 DOI: 10.1186/s12935-020-01698-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dysregulated lncRNA PCAT6 was discovered in many cancers excluding pituitary adenomas (PA). Therefore, we explored the role of PCAT6 in PA in this research. METHODS Abnormally expressed miRNAs were analyzed by bioinformatics and RT-qPCR. The target and regulator of miR-139-3p were determined by bioinformatics, dual-luciferase reporter assay, or RIP. The correlation among PCAT6, miR-139-3p, and BRD4 was further analyzed. The viability, apoptosis, cell cycle distribution of PA cells, as well as their ability to invade, migrate, and proliferate, were tested after transfection through CCK-8, flow cytometry, transwell, wound healing, and colony formation assays. After construction of transplanted-tumor model in nude mice, cell apoptosis in the tumor was detected by TUNEL. The expressions of PCAT6, BRD4, miR-139-3p, and apoptosis-related factors in PA tissues, cells, or tumor tissues were detected by RT-qPCR, Western blot, or IHC. RESULTS PCAT6 and BRD4 were high-expressed but miR-139-3p was low-expressed in PA. Both the 3'-untranslated regions of PCAT6 and BRD4 mRNAs were demonstrated to contain a potential binding site for miR-139-3p. PCAT6 was positively correlated to BRD4, and miR-139-3p was negatively correlated to PCAT6 and BRD4. MiR-139-3p mimic, shPCAT6 and siBRD4 inhibited the viability, migration, invasion, and proliferation of PA cells while inducing apoptosis. MiR-139-3p mimic and shPCAT6 inhibited the cell cycle progression of PA cells, decreased the weight and volume of the xenotransplanted tumor, and reduced the levels of Bcl-2 and BRD4 while enhancing the levels of Bax, miR-139-3p, and Cleaved caspase-3. MiR-139-3p inhibitor caused the opposite effect of miR-139-3p mimic and further reversed the effect of shPCAT6 on on PA cells. CONCLUSION PCAT6 regulated the progression of PA via modulating the miR-139-3p/BRD4 axis, which might provide a novel biomarker for the prevention, diagnosis, and treatment of PA.
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Affiliation(s)
- Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China.
| | - Jianhua Cheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Bin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Ding Nie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Hongyun Wang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
| | - Yazhuo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People's Republic of China
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