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Firouzabadi FD, Soldatelli MD, Rameh V, Heidary G, Vargas SO, Gonzalez E, Rispoli J, Rahbar R, Robson CD. Morning Glory Disc Anomaly: Expanding the MR Phenotype. AJNR Am J Neuroradiol 2024; 45:1070-1075. [PMID: 38991766 PMCID: PMC11383415 DOI: 10.3174/ajnr.a8296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE Morning glory disc anomaly (MGDA) is a congenital malformation characterized by a funnel-shaped optic disc excavation with radiating vessels and a central glial tuft. Imaging is essential to evaluate associated cephalocele and steno-occlusive vasculopathy. The goal of this study was to assess optic nerve, chiasmatic, and sphenoid bone morphology in MGDA. MATERIALS AND METHODS This retrospective study examined all subjects with funduscopically confirmed MGDA diagnosed and imaged with brain MR imaging between 2008 and 2023. RESULTS Thirty-two children met inclusion criteria. Ocular involvement was unilateral in 29 subjects and bilateral in 3. Segmental optic nerve enlargement ipsilateral to the MGDA was seen in 21 subjects, with 3 also demonstrating a segmental reduction in the size of the ipsilateral optic nerve. Segmental reduction in the size of the ipsilateral optic nerve was present in 3 additional subjects, one with bilateral MGDA. The optic chiasm appeared asymmetrically thickened in 21 subjects, often with deformity. The optic nerves appeared normal in signal intensity in all subjects, with faint peripheral chiasmatic enhancement in 4 of 20 patients who received contrast. Optic nerve findings were stable in 15 subjects with multiple examinations. A persistent craniopharyngeal canal was identified in 17 subjects with sphenoid cephalocele in 1 and mild inferior pituitary gland displacement in 4. Tubular or nodular nasopharyngeal lesions were seen in 10 subjects. One subject had an off-midline sphenoid bone cleft, midbrain deformity, and abnormal thickening of and enhancement around the left oculomotor nerve; the oculomotor nerve finding was present in 1 additional patient. CONCLUSIONS MGDA often manifests with ipsilateral optic nerve thickening, leading to a potential misdiagnosis as optic glioma. MGDA is also commonly associated with a persistent craniopharyngeal canal with variable pituitary gland and infundibular deformity, cephalocele, and tubular or nodular nasopharyngeal lesions.
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Affiliation(s)
- F D Firouzabadi
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Radiology and Biomedical Engineering (F.D.F.), University of San Francisco School of Medicine, San Francisco, California
| | - M D Soldatelli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - V Rameh
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - G Heidary
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - S O Vargas
- Department of Pathology (S.O.V.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Gonzalez
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Rispoli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - R Rahbar
- Department of Otolaryngology (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Communication Enhancement, (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - C D Robson
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Colliander R, Sharma S, Shlobin NA, Fernandez LG, LoPresti MA, Lam S, DeCuypere M. Visual outcomes after treatment of craniopharyngioma in children: A systematic review. Childs Nerv Syst 2024; 40:1641-1659. [PMID: 38416204 DOI: 10.1007/s00381-024-06328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Craniopharyngiomas (CP) are rare brain tumors that often result in visual impairment due to their proximity to the optic pathway. The optimal management approach to preserve visual function in these patients remains controversial. We sought to investigate visual outcomes of children with craniopharyngiomas based on treatment modality. METHODS A systematic review was performed according to PRISMA guidelines. PubMed, Embase, and Scopus databases were searched in December 2022 for relevant articles. Articles were screened by title/abstract for relevance, then by full-text. Relevant demographic, intervention, and outcome data were extracted from included studies. RESULTS A total of 59 studies were included, representing 2655 patients. The overall visual status (OVS) of patients receiving surgery alone was improved in 27.6% of reported outcomes, unchanged in 50.3%, and deteriorated in 22.1%. The OVS for patients receiving radiation alone was improved in 21.1%, unchanged in 42.1%, and deteriorated in 36.8%. Patients receiving surgery plus adjuvant radiotherapy had OVS improvement in 27.4%, unchanged in 63.2%, and deteriorated in 9.4%. Of those receiving intracystic bleomycin, 23.1% had improvement in OVS, 46.2% remained unchanged, and 30.8% deteriorated. Of patients receiving interferon-α, 34.8% improved, 54.5% remained unchanged, and 10.6% deteriorated. CONCLUSION OVS most frequently remained unchanged regardless of intervention. The greatest improvement in OVS was seen in those receiving interferon-α or surgery alone. The greatest OVS deterioration was noted with radiation alone. Future standardized, randomized, large-scale studies with focused assessment of ophthalmologic findings are key to further understanding the impact different interventions have on visual outcomes in these children.
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Affiliation(s)
- Reid Colliander
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Shelly Sharma
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Luis G Fernandez
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Melissa A LoPresti
- Division of Pediatric Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
- Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Michael DeCuypere
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
- Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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3
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Wang W, Patel J. Imaging of congenital anomalies and defects of the skull base and calvarium. Br J Radiol 2024; 97:902-912. [PMID: 38478401 PMCID: PMC11075995 DOI: 10.1093/bjr/tqae042] [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: 10/17/2023] [Revised: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 05/09/2024] Open
Abstract
Congenital anomalies and defects of the skull base and calvarium encompass a broad and complex spectrum of pathologies. The clinical presentation is highly variable, and these anomalies may be discovered incidentally in asymptomatic individuals. Radiological assessment plays a pivotal role in precisely characterizing these abnormalities, facilitating the diagnostic process, and assisting in any preoperative preparation.
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Affiliation(s)
- Wen Wang
- Radiology Department, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, United States
| | - Jeet Patel
- Radiology Department, University of Florida College of Medicine—Jacksonville, Jacksonville, FL 32209, United States
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Suthar PP, Nagarajan M, Bhabad S. Case 325: Persistent Craniopharyngeal Canal. Radiology 2024; 311:e223335. [PMID: 38805728 DOI: 10.1148/radiol.223335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
HISTORY A 76-year-old female patient with a history of rheumatoid arthritis, Sjögren syndrome, and hypertension presented with headache, fever, and dysphagia. The patient was taking prednisone and leflunomide to treat rheumatoid arthritis. The headache was primarily left sided and occasionally radiated to the occipital region. The patient had a high-grade fever spike, with a temperature of 104 °F (40 °C). Results of a prior lumbar puncture and temporal artery biopsy from an outside hospital were negative. Findings of a neurologic examination were unremarkable. Oropharyngeal examination for dysphagia revealed minimal pharyngeal motility, with pooling of food in the pharynx, which was thought to be due to cranial nerve dysfunction. Laboratory analysis revealed that, except for anemia, complete blood count parameters were within normal limits. C-reactive protein level (49.7 mg/L; reference range, 0.0-8.0 mg/L), erythrocyte sedimentation rate (>140 mm/h with Westergren method; reference range, 0-27 mm/h), and brain-type natriuretic peptide level (145 pg/mL; reference range, 0-100 pg/mL) were elevated. Blood and urine cultures were negative. A lumbar puncture was performed, which revealed cloudy cerebrospinal fluid (CSF), with an elevated CSF protein level (78 mg/dL; reference range, 7.0-35.0 mg/dL) and a low CSF glucose level (37 mg/dL [2.05 mmol/L]; reference range, 45-70 mg/dL [2.50-3.89 mmol/L]); otherwise, CSF encephalopathy, an autoimmune panel, and cultures were negative. CT and MRI of the brain with paranasal sinus were performed. Nasal endoscopy-guided drainage of the preclival fluid collection was performed, and biopsy of nasopharyngeal tissue was performed. Fluid culture revealed the growth of Candida albicans, as well as Pseudomonas and Enterobacter aerogenes. The patient received fluconazole, ceftriaxone, vancomycin, and metronidazole. Follow-up MRI was performed after 2 weeks.
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Affiliation(s)
- Pokhraj Prakashchandra Suthar
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)
| | - Murali Nagarajan
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)
| | - Sudeep Bhabad
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612 (P.P.S., S.B.); and College of Medicine, University of Oklahoma, Oklahoma City, Okla (M.N.)
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Guyodo H, Rizzo A, Diab F, Noury F, Mironov S, de Tayrac M, David V, Odent S, Dubourg C, Dupé V. Impact of Sonic Hedgehog-dependent sphenoid bone defect on craniofacial growth. Clin Exp Dent Res 2024; 10:e861. [PMID: 38558491 PMCID: PMC10982674 DOI: 10.1002/cre2.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES The main objective of this study was to evaluate how an apparently minor anomaly of the sphenoid bone, observed in a haploinsufficient mouse model for Sonic Hedgehog (Shh), affects the growth of the adult craniofacial region. This study aims to provide valuable information to orthodontists when making decisions regarding individuals carrying SHH mutation. MATERIALS AND METHODS The skulls of embryonic, juvenile and adult mice of two genotypes (Shh heterozygous and wild type) were examined and measured using landmark-based linear dimensions. Additionally, we analysed the clinical characteristics of a group of patients and their relatives with SHH gene mutations. RESULTS In the viable Shh+/ - mouse model, bred on a C57BL/6J background, we noted the presence of a persistent foramen at the midline of the basisphenoid bone. This particular anomaly was attributed to the existence of an ectopic pituitary gland. We discovered that this anomaly led to premature closure of the intrasphenoidal synchondrosis and contributed to craniofacial deformities in adult mice, including a longitudinally shortened skull base. This developmental anomaly is reminiscent of that commonly observed in human holoprosencephaly, a disorder resulting from a deficiency in SHH activity. However, sphenoid morphogenesis is not currently monitored in individuals carrying SHH mutations. CONCLUSION Haploinsufficiency of Shh leads to isolated craniofacial skeletal hypoplasia in adult mouse. This finding highlights the importance of radiographic monitoring of the skull base in all individuals with SHH gene mutations.
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Affiliation(s)
- Hélène Guyodo
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Aurélie Rizzo
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Farah Diab
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), “Maladies génétiques d'expression pédiatrique”ParisFrance
| | - Fanny Noury
- Faculté des Sciences Pharmaceutiques et BiologiquesUniv Rennes, INSERM, LTSI ‐ UMR 1099RennesFrance
| | - Svetlana Mironov
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Marie de Tayrac
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Moléculaire et Génomique, CHURennesFrance
| | - Véronique David
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
| | - Sylvie Odent
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Clinique, CHURennesFrance
| | - Christèle Dubourg
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
- Service de Génétique Moléculaire et Génomique, CHURennesFrance
| | - Valérie Dupé
- Univ Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes)‐UMR6290RennesFrance
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Dougherty CC, Branstetter BF. Persistent craniopharyngeal canal with an associated sphenoid sinus fistula. J Radiol Case Rep 2023; 17:14-20. [PMID: 38343882 PMCID: PMC10852052 DOI: 10.3941/jrcr.v17i8.4707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Persistent craniopharyngeal canal (PCC) is a rare congenital anomaly that appears as a linear well-corticated canal running from the sella through the clivus and into the nasopharynx. Case reports of this anomaly have shown it is associated with a range of craniofacial defects, pituitary abnormalities, and meningoencephaloceles. It predisposes patients to bacterial meningitis. In this case a 46-year-old gentleman presenting for preoperative planning for surgical drainage of Potts Puffy tumor was found to have a PCC on CT and MRI. Imaging also demonstrated the presence of chronic inflammation and a fistula extending from the tract into the sphenoid sinus. This unusual presentation of a PCC with a sphenoid sinus fistula broadens the potential clinical presentations of PCC and further emphasizes the ability of this anomaly to serve as a conduit for CNS infection.
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Affiliation(s)
- Chase C Dougherty
- Department of Family Medicine University of Pittsburgh School of Medicine, Altoona, USA
- Department of Radiology Penn State Hershey Medical Center, Hershey, USA
| | - Barton F Branstetter
- Department of Radiology University of Pittsburgh School of Medicine, Pittsburgh, USA
- Department of Otolaryngology University of Pittsburgh School of Medicine, Pittsburgh, USA
- Department of Biomedical Informatics University of Pittsburgh School of Medicine, Pittsburgh, USA
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7
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Perogiannaki A, Chandra J, Buchanan C, Arya VB, Thomas NW, Zebian B, Kapoor RR. Nasopharyngeal glial heterotopia, ectopic pituitary and craniopharyngeal canal. Arch Dis Child 2023; 108:348-349. [PMID: 36863847 DOI: 10.1136/archdischild-2022-325086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/04/2023]
Affiliation(s)
| | - Julie Chandra
- Department of Neuroradiology, King's College Hospital, London, London, UK
| | - Charles Buchanan
- Department of Paediatric Endocrinology, King's College Hospital, London, UK
| | - Ved Bhushan Arya
- Department of Paediatric Endocrinology, King's College Hospital, London, UK
- Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Nicholas Wm Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ritika R Kapoor
- Department of Paediatric Endocrinology, King's College Hospital, London, UK
- Faculty of Medicine and Life Sciences, King's College London, London, UK
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8
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Raman EV, Emmanuel R, Acharya UV, Venkatesh HA, Rajeev A. Endoscopic Repair of Nasopharyngeal Glial Heterotopia in a Neonate with Persistent Craniopharyngeal Canal: A Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:711-714. [PMID: 37206719 PMCID: PMC10188676 DOI: 10.1007/s12070-022-03251-6] [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: 01/14/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
A case of nasopharyngeal glial heterotopia with persistent craniopharyngeal canal is being reported. These lesions though rare should be considered in the differential diagnosis of neonates who present with nasal obstruction. Careful radiological evaluation for a persistent craniopharyngeal canal and differentiating the nasopharyngeal mass from brain tissue is of paramount importance.
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Affiliation(s)
- E. V. Raman
- Children’s Airway and Swallowing Centre, Manipal Hospital, Old airport road, Bangalore, India
| | - Ria Emmanuel
- Department of ENT, Manipal Hospital, Old airport road, Bangalore, 560017 India
| | - Ullas V. Acharya
- Department of Radiodiagnosis, Manipal Hospital, Old airport road, Bangalore, India
| | - H. A. Venkatesh
- Department of Neonatology, Manipal Hospital, Old airport road, Bangalore, India
| | - Anjali Rajeev
- Department of ENT, Manipal Hospital, Old airport road, Bangalore, 560017 India
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9
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Virupakshaiah A, Teixeira SR, Sotardi S, Liu G, Agarwal S. Frontonasal Dysplasia: A Diagnostic Challenge with Fetal MRI in Twin Pregnancy. Child Neurol Open 2023; 10:2329048X231157147. [PMID: 36910596 PMCID: PMC9996711 DOI: 10.1177/2329048x231157147] [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: 08/01/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
Callosal agenesis is a complex condition with disruption in the steps such as cellular proliferation, migration, axonal growth, guidance, or glial patterning at the midline. Agenesis of the corpus callosum (AgCC) is associated with diverse midline craniofacial malformations affecting the frontal-cranial and midface skeleton. Diagnosing midline abnormalities prenatally can be challenging, especially in twin pregnancies, due to poor resolution of skull base structures on fetal MRI, basal cephalocele could be mistaken for fluid in the nasopharynx, motion limitation, and fetal positioning. Our case highlights the importance of evaluation for other associated midline anomalies when there is callosal agenesis.
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Affiliation(s)
- Akash Virupakshaiah
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
| | - Sara Reis Teixeira
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Susan Sotardi
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Grant Liu
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
| | - Sonika Agarwal
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia Division of Neurology, Philadelphia, USA
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10
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Das L, Dutta P. Approach to a case with an unusual cause of hypopituitarism. J Clin Endocrinol Metab 2022; 108:1488-1504. [PMID: 36573291 DOI: 10.1210/clinem/dgac747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 12/29/2022]
Abstract
Hypopituitarism refers to insufficiency of one or more hormones of the pituitary and can be due to myriad causes. The clinical and radiological spectrum of the condition is heterogeneous, based on the age, gender, clinical setting and/or other past medical history. Hypopituitarism includes central hypocortisolism, hypothyroidism, hypogonadism and growth hormone deficiency. Both hypo- and hyperprolactinemia can be associated with hypopituitarism, with low prolactin signifying more extensive pituitary damage. Posterior pituitary insufficiency (arginine vasopressin deficiency), occurs either in isolation or with anterior pituitary hormone deficiency. Clinical symptomatology of hypopituitarism is usually non-specific and insidious in onset and progression. Overall, the most common cause of hypopituitarism is a pituitary adenoma and/or its management (surgery, radiotherapy, pharmacotherapy or a combination of these). However, it is this subset of patients which is more likely to be identified and managed timely, possibly alleviating the premature mortality associated with hypopituitarism. What is more challenging is the recognition of hypopituitarism in less common settings, which may be either due to direct involvement of the pituitary (infection, traumatic brain injury, or infiltrative causes) or indirectly as a consequence of the primary process (thalassemia, vasculotoxic snakebite, subarachnoid hemorrhage). These entities are often under-recognised, and increased awareness can help in greater recognition of the problem burden. Further, pituitary insufficiency in most of these settings is dynamic, which may progress, or rarely, show recovery of function. This renders complexity to the problem, but makes it even more imperative to suspect, screen and appropriately manage patients with less common causes of hypopituitarism.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
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11
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Pascual JM, Prieto R, Carrasco R, Barrios L. Duct-like diverticulum at the base of third ventricle tumors: a morphological signature diagnostic of papillary craniopharyngioma. Neurosurg Rev 2022; 45:3361-3379. [PMID: 35982344 DOI: 10.1007/s10143-022-01848-7] [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: 05/05/2022] [Revised: 07/02/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
This study describes and characterizes a narrow, hollow tubular structure, termed as duct-like diverticulum (DV), found specifically at the basal midline of papillary craniopharyngiomas (PCPs) located within the third ventricle (3V). The presence of this structure was systematically investigated on autopsy studies and magnetic resonance imaging (MRI) scans of 3536 craniopharyngioma (CP) cases published in the medical literature from 1911 to 2021, as well as in other twelve 3V tumor categories (n = 1470 cases). A basal DV was observed in a total of 50 PCPs, including two of our own cases. This DV corresponds to a tubular-shaped recess invaginated at the midline bottom of the tumor, following the same angled trajectory as the pituitary stalk. It can be easily seen as a hypointense linear structure on T1- and T2-weighted MRI scans, with two main length types: long DVs (74%), which reach the tumor center, and short DVs (26%), which penetrate the tumor only a few millimeters. The DV sign identifies the papillary CP type with a specificity of 100% and a sensitivity of 33% in the overall CP population. This finding also serves to establish the strictly intra-3V location of the lesion with a 95% specificity and 42% sensitivity among papillary CPs. No similar basal DV was found in adamantinomatous CPs nor among other categories of strictly 3V tumors. Consequently, the presence of a diverticulum in a 3V tumor represents a morphological signature pathognomonic of the papillary type and a valuable sign to reliably define the strictly 3V topography.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, C/ Diego de León 62, 28006, Madrid, Spain.
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C., Madrid, Spain
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12
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Extracranial Craniopharyngioma Confined to the Sphenoid Sinus. J Craniofac Surg 2022; 33:e537-e538. [PMID: 35762626 DOI: 10.1097/scs.0000000000008660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Craniopharyngioma is rare epithelial tumor that develops along the craniopharyngeal duct, and most of these tumors occur in the sellar and suprasellar regions. Although it rarely occurs in the extracranial region, sphenoid solitary lesions were not reported in previous literature. In this study, we report a case of infrasellar craniopharyngioma within the sphenoid sinus without intracranial lesion. A patient with intermittent headache visited a private clinic and presented with sphenoid lesions based on the Magnetic resonance imaging scan results. The mass was completely removed using endoscopic endonasal transsphenoidal approach without any complications and showed characteristic pathologic findings, which lead to the diagnosis of craniopharyngioma.
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13
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Serindere G, Gunduz K, Avsever H. Morphological Measurement and Anatomical Variations of the Clivus Using Computed Tomography. Skull Base Surg 2022; 83:e75-e82. [DOI: 10.1055/s-0040-1722712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objectives The aim of this study was to evaluate the clivus morphology, including fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CC), on computed tomography (CT) images.
Design This is a retrospective study.
Setting Faculty of Dentistry, Department of Dentomaxillofacial Radiology.
Participants The CT images of 500 patients (253 males; 247 females) were evaluated.
Main Outcome Measures The prevalence of FNM, CBM, and CPC; the length, width, and depth of FNM; and CBM types were recorded. Also, a morphological analysis of the clivus (length of the clivus, angle between the clivus and the posterior margin of the foramen magnum, angle between the clivus and the dens axis, and anteroposterior diameter of the foramen magnum) was performed.
Results FNM was identified in 5.4%, CBM in 4%, and CC in 0.8% of the study group. Type 5 CBM was not found. Type 6 was the most common CBM type. There was no significant correlation between the age and gender of patients with FNM. There were significant differences between the clivus length, the angle between the clivus and the dens axis, the anteroposterior diameter of the foramen magnum, and gender. Also, there was a significant difference between the angle between the clivus and the foramen magnum and age.
Conclusions The anatomical variations of the clivus are rare and important for the oral and maxillofacial radiologist to make the differential diagnosis. These anatomical variations should not be confused with pathologic formations. The morphological measurements and anatomical variations of the clivus can be evaluated in detail on CT images.
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Affiliation(s)
- Gozde Serindere
- Department of Dentomaxillofacial Radiology, Hatay Mustafa Kemal University, Faculty of Dentistry, Hatay, Turkey
| | - Kaan Gunduz
- Department of Dentomaxillofacial Radiology, Ondokuz Mayıs University, Faculty of Dentistry, Samsun, Turkey
| | - Hakan Avsever
- Department of Dentomaxillofacial Radiology, Health Sciences University, Gulhane Faculty of Dentistry, Ankara, Turkey
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14
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Persisting embryonal infundibular recess (PEIR) and transsphenoidal-transsellar encephaloceles: distinct entities or constituents of one continuum? Childs Nerv Syst 2022; 38:1059-1067. [PMID: 35192025 DOI: 10.1007/s00381-022-05467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
Persisting embryonal infundibular recess (PEIR) is a very rare anomaly of the floor of the third ventricle in which the embryonic morphology of the infundibular recess (IR) persists. The exact underlying mechanism of development of PEIR is unknown, and the anomaly has been reported as an isolated finding or in association with other conditions. On the other hand, trans-sphenoidal encephaloceles are the rarest form of basal encephaloceles. The trans-sphenoidal trans-sellar encephalocele (TSE) is the least common variant in which the pituitary gland, pituitary stalk, optic pathways, parts of the third ventricle and IR may be present within the encephalocele. We recently treated one patient with TSE. Based on the observed morphological similarity of the IR in our patient and in the published cases of PEIR, we reviewed the literature in order to validate the hypothesis that PEIR and TSE may possibly belong to one spectrum of malformations. Across the published reports, the morphology of the IR in TSE is very closely similar to PEIR. Moreover, radiological, patho-anatomical, and embryological evidence is in support to our hypothesis that PEIR and TSE are most likely the two extremes of the same continuum of malformations.
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15
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Huang JH, Hagiwara M. Skull Base Tumor Mimics. Neuroimaging Clin N Am 2022; 32:327-344. [DOI: 10.1016/j.nic.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Pascual JM, Prieto R, Carrasco R, Barrios L. Basal Recess in Third Ventricle Tumors: A Pathological Feature Defining a Clinical-Topographical Subpopulation of Papillary Craniopharyngiomas. J Neuropathol Exp Neurol 2022; 81:330-343. [PMID: 35472085 DOI: 10.1093/jnen/nlac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates the presence of a hollow recess at the midline undersurface of tumors primarily localized within the third ventricle (3V). This structure was originally identified by magnetic resonance imaging (MRI) of 6 3V craniopharyngiomas (CPs) from our series and was then methodically scrutinized in autopsy studies (n = 1091) and MRI scans (n = 5558) of CPs and in 1251 3V tumors reported in the medical literature from 1839 to 2021. A recess at the tumor base was identified in 110 CPs, 95 with a verified papillary histology (papillary craniopharyngioma [PCP]) and 15 with typical gross appearance of PCP. Topographically, 90 tumors were strictly within the 3V (82%); 20 developed at the infundibulo-tuberal region of the 3V floor (18%). Morphologically, 2 main types of recess were identified: (i) a long, narrow recess with either a duct-like or a tubular shape that reached the central region of the CP (n = 47, 42.5%); and (ii) a short recess extending only a few millimeters into the lesion, either with a duct-like or a shallow cleft-like morphology (n = 63, 57.5%). Thus, the presence of a basal recess represents a pathological hallmark of a subpopulation of 3V PCPs. The presumed nature and diagnostic significance of this novel finding is comprehensively addressed.
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Affiliation(s)
- José María Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
| | - Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rodrigo Carrasco
- Department of Neurosurgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C. Madrid, Spain
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17
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Imaging of Developmental Skull Base Abnormalities. Neuroimaging Clin N Am 2021; 31:621-647. [PMID: 34689936 DOI: 10.1016/j.nic.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The skull base is a critical structure in the craniofacial region, supporting the brain and vital facial structures in addition to serving as a passageway for important structures entering and exiting the cranial cavity. This paper will review and highlight some of the embryology, developmental anatomy, including ossification, and related abnormalities of the anterior, central and posterior skull base using illustrative cases and tables. Pathologies such as dermoids/epidermoids, cephaloceles, nasal gliomas, glioneuronal heterotopias, various notochordal remnants, persistent craniopharyngeal canal, teratomas, platybasia, basilar invagination, clival anomalies and Chiari malformations will be discussed. Developmental pearls and pitfalls will also be highlighted.
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18
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Castle-Kirszbaum M, Uren B, Goldschlager T. Anatomic Variation for the Endoscopic Endonasal Transsphenoidal Approach. World Neurosurg 2021; 156:111-119. [PMID: 34610448 DOI: 10.1016/j.wneu.2021.09.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Knowledge of anatomy and its variations is the key to safe and efficient surgery. The endoscopic endonasal route to the sella has evolved to become the preferred route to access a wide variety of diseases. We describe the skeletal, vascular, and neural anatomic variations that could be encountered from the nasal phase, through the sphenoid phase, to the sellar phase of the operative exposure. A preoperative checklist is also provided.
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Affiliation(s)
| | - Brent Uren
- Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
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19
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A rare triad of morning glory disc anomaly, moyamoya vasculopathy, and transsphenoidal cephalocele: pathophysiological considerations and surgical management. Neurol Sci 2021; 42:5433-5439. [PMID: 33825116 PMCID: PMC8642253 DOI: 10.1007/s10072-021-05221-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
Morning glory disc anomaly is a congenital abnormality of the optic disc and peripapillary retina reported as an isolated condition or associated with various anomalies, including basal encephaloceles and moyamoya vasculopathy. However, the co-occurrence of these three entities is extremely rare and the pathogenesis is still poorly understood. Moreover, data on the surgical management and long-term follow-up of the intracranial anomalies are scarce. Here, we describe the case of a 11-year-old boy with morning glory disc anomaly, transsphenoidal cephalocele, and moyamoya vasculopathy, who underwent bilateral indirect revascularization with encephalo-duro-myo-arterio-pericranio-synangiosis at the age of 2 years, and endoscopic repair of the transsphenoidal cephalocele at the age of 6 years. A rare missense variant (c.1081T>C,p.Tyr361His) was found in OFD1, a gene responsible for a X-linked ciliopathy, the oral-facial-digital syndrome type 1 (OFD1; OMIM 311200). This case expands the complex phenotype of OFD1 syndrome and suggests a possible involvement of OFD1 gene and Shh pathway in the pathogenesis of these anomalies.
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20
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Clival prolactinoma masquerading as a chordoma: a case report. Radiol Case Rep 2021; 16:1320-1324. [PMID: 33897924 PMCID: PMC8053778 DOI: 10.1016/j.radcr.2021.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
Ectopic pituitary adenomas are a rare clinical entity and are frequently mistaken for other base of skull lesions on imaging. We report the clinical presentation and management of a woman presenting with an ectopic prolactinoma located in the clivus. A 66-year-old female presented with a 6-month history of headaches and light-headedness. Anatomical imaging demonstrated a clival lesion most suspicious for chordoma. Endocrinological assessment revealed modestly increased prolactin level with lower-than-expected gonadotrophins levels for her age. Surgical resection confirmed an ectopic prolactinoma. A skull base lesion in a patient with hormonal derangement should lend to a high clinical suspicion of an EPA as they may be treated with medications before surgery. Guidelines could assist clinicians investigating skull-based lesions to identify the rare, but important diagnosis of ectopic pituitary adenomas.
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21
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Habermann S, Silva AHD, Aquilina K, Hewitt R. A persistent craniopharyngeal canal with recurrent bacterial meningitis: case report and literature review. Childs Nerv Syst 2021; 37:699-702. [PMID: 32705329 DOI: 10.1007/s00381-020-04798-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A persistent craniopharyngeal canal (PCC) is a rare but treatable anatomical abnormality that causes recurrent meningitis and should be considered as a differential diagnosis. CASE REPORT We report a case of an 8-year-old boy who presented with recurrent meningitis associated to his PCC. Surgical repair was performed, and no further episodes occurred.
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Affiliation(s)
- Stephanie Habermann
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Adikarige Haritha Dulanka Silva
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Kristian Aquilina
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard Hewitt
- Department of Paediatric Otorhinolaryngology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
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22
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Anatomical variations of clivus: a descriptive anatomical study. Surg Radiol Anat 2021; 43:945-951. [PMID: 33483831 DOI: 10.1007/s00276-021-02686-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The clivus is a part of the sphenoid bone. It may show some anatomical variations such as fossa navicularis magna (FNM), canalis basilaris medianus (CBM) and craniopharyngeal canal (CPC). These variations have been associated with conditions like meningitis and tumors of skull base. Inadequate information about these structures may pose a risk of inaccurate diagnosis resulting in unwarranted interventional procedures. Hence, the knowledge about the prevalence of these variations is important. Thus, the objective of this study was to determine the prevalence of fossa navicularis magna, craniopharyngeal canal and canalis basilaris medianus and its types utilizing cone-beam computed tomography (CBCT) images. METHODS Retrospectively, a total of 350 CBCT scans were evaluated for the presence of FNM, CBM, its types and CPC. The analysis was done by two observers independently. Cohen's kappa statistics was used to determine the interobserver agreement. RESULTS FNM was noted in 19.4% cases, CBM in 9.7% cases, whereas CPC was not identified in any case. Type 5 was the most common type of CBM. There was no significant difference (p > 0.05) between genders and age groups for the prevalence and a highly significant (p < 0.01) substantial agreement between observers for the prevalence of FNM and highly significant (p < 0.01) moderate agreement for the prevalence of CBM and its types was obtained. CONCLUSION FNM, CBM, CPC, albeit rare anatomical variations of clivus, knowledge of these structures is important for radiologists, anatomists and surgeons to avoid misdiagnosis and provide awareness to the individual of a higher possibility of meningitis or tumors of the skull base.
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23
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Lingappa L, Konanki R, Varma R, Shah N, Raju S, Sura S, Reddy L, Rani S. Persistent Craniopharyngeal Canal: A Rare Cause for Recurrent Meningitis in Pediatric Population. Ann Indian Acad Neurol 2020; 23:545-548. [PMID: 33223676 PMCID: PMC7657271 DOI: 10.4103/aian.aian_411_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022] Open
Abstract
We present the case of a 5-year-old girl who had six episodes of meningitis. She also had panhypopituitarism and was found to have a persistent craniopharyngeal canal (CPC) as the cause of her recurrent meningitis. Role of neuroradiology and a high index of suspicion by the clinical team are highlighted here. Persistent CPC is a rare cause of recurrent meningitis. We discuss the approach to the child with recurrent meningitis.
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Affiliation(s)
- Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Ramesh Konanki
- Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Ravi Varma
- Department of Neuroradiology, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Nikit Shah
- Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Subodh Raju
- Department of Neurosurgery, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Sukumar Sura
- Department of Neurosurgery, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Leenatha Reddy
- Department of Endocrinology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Sirisha Rani
- Department of Pediatric Hemato-Oncology, Rainbow Children's Hospital, Hyderabad, Telangana, India
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24
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Başak H, Kahiloğulları G, Güler TM, Sayacı EY, Etuş V, Meço C. Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant. Childs Nerv Syst 2020; 36:2883-2886. [PMID: 32270272 DOI: 10.1007/s00381-020-04602-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
Abstract
Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).
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Affiliation(s)
- Hazan Başak
- Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey
| | | | | | - Emre Yağız Sayacı
- Department of Neurosurgery, Ankara University, Sihhiye, 06100, Ankara, Turkey
| | - Volkan Etuş
- Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey
| | - Cem Meço
- Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey.,Department of Otolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
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25
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Kumar S, Pujari VS, Munshi M, Hastak MS. Neonatal respiratory distress produced by a nasopharyngeal glioma with a persistent craniopharyngeal canal. J Med Imaging Radiat Oncol 2020; 64:824-826. [PMID: 32945599 DOI: 10.1111/1754-9485.13101] [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: 07/03/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
Nasopharyngeal gliomas are congenital masses of heterotopic glial tissue. Our case report describes an infant with respiratory distress produced by a nasopharyngeal glioma with a persistent craniopharyngeal canal (CPC). The identification of CPC is important for medical and surgical management of possible pituitary dysfunction and preventing operative and post-operative complications.
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Affiliation(s)
- Sachin Kumar
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Vishnu S Pujari
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mihir Munshi
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Meenal S Hastak
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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26
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Zou YF, Meng LB, Wang QQ, He ZK, Hu CH, Shan MJ, Wang DY, Yu X. Identification and Functional Enrichment Analysis of Potential Diagnostic and Therapeutic Targets in Adamantinomatous Craniopharyngioma. J Comput Biol 2020; 27:55-68. [PMID: 31424286 DOI: 10.1089/cmb.2019.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yang-fan Zou
- Department of Neurosurgery, Affiliated Navy Clinical College of Anhui Medical University, Beijing, P.R. China
- Department of Neurosurgery, Chinese PLA General Hospital—Sixth Medical Center, Beijing, P.R. China
| | - Ling-bing Meng
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Qing-qing Wang
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, P.R. China
| | - Zhao-kai He
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Chen-hao Hu
- Department of Neurosurgery, Chinese PLA General Hospital—Sixth Medical Center, Beijing, P.R. China
| | - Meng-jie Shan
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Deng-yuan Wang
- Department of Neurosurgery, Chinese PLA General Hospital—Sixth Medical Center, Beijing, P.R. China
| | - Xin Yu
- Department of Neurosurgery, Affiliated Navy Clinical College of Anhui Medical University, Beijing, P.R. China
- Department of Neurosurgery, Chinese PLA General Hospital—Sixth Medical Center, Beijing, P.R. China
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27
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Magat G. Evaluation of morphometric features of fossa navicularis using cone-beam computed tomography in a Turkish subpopulation. Imaging Sci Dent 2019; 49:209-212. [PMID: 31583203 PMCID: PMC6761062 DOI: 10.5624/isd.2019.49.3.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Fossa navicularis is a bone defect in the clivus. Familiarity with this anatomical variant is important because it is close to vital anatomical structures in the base of the skull. The aim of this study was to determine the prevalence and morphometric properties of fossa navicularis within the clivus in a Turkish subpopulation using cone-beam computed tomography (CBCT). Materials and Methods A total of 168 CBCT scans (female: 96, male: 71) were evaluated. High-quality CBCT images of patients without a syndromic condition or a history of neurological disease or surgery were included in the study. The prevalence, depth, length, and width of the fossa navicularis were performed. Results The prevalence of fossa navicularis was 27.5% (n=46 patients). Sex was not associated with the depth, length, or width of the fossa navicularis (P>0.05). A significant positive correlation was found between age and length of the fossa navicularis (P>0.05). Conclusion Fossa navicularis was found to be rare (27.5%). Anatomical variants of the skull base can also be clearly identified on CBCT images. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.
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Affiliation(s)
- Guldane Magat
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
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28
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[Rathke cysts, craniopharyngioma, and colloid cysts : What are the differences between these pathologies?]. Radiologe 2019; 58:646-652. [PMID: 29777270 DOI: 10.1007/s00117-018-0398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CLINICAL ISSUE Headache is the most common symptom of colloid cysts, Rathke cysts, and craniopharyngioma due to their location in the midline, being extra-axial and typically presenting in the parasellar region. THERAPEUTIC PROBLEMS Although these tumors are generally considered benign, each has its typical characteristics defined by its location and histology. These individual characteristics define whether surgery is necessary at all and if so, the preferred surgical approach and resection's totality. The histopathological findings primarily indicate that embryonic malformations-at the first glance, ectodermal in nature-cause these tumors. ACHIEVEMENT Due to the fact that these disturbances occur at the boundary between ectodermal stomodeum and endodermal cephalogaster, however, does leave some doubts.
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29
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Poonia SK, Cazzador D, Kaufman AC, Kohanski MA, Kuan EC, Tong CCL, Carlson RD, Borsetto D, Emanuelli E, Palmer JN, Adappa ND. Disorders Involving a Persistent Craniopharyngeal Canal: A Case Series. J Neurol Surg B Skull Base 2019; 81:562-566. [PMID: 33134023 DOI: 10.1055/s-0039-1692638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives A persistent craniopharyngeal canal (CPC) is a rare embryologic remnant that presents as a well-corticated defect of the midline sphenoid body extending from the sellar floor to the nasopharynx. Our case series aims to describe three unique presentations of this congenital anomaly and their subsequent management. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent endoscopic transnasal surgical repair of a CPC lesion. Main Outcome Measures Resolution of symptoms and surgical outcomes. Results A total of three patients were identified. The clinical presentation varied, however, all cases prompted further imaging which demonstrated a persistent CPC and associated pathologic lesion. The presentation of a persistent CPC with nasal obstruction and subsequent iatrogenic cerebrospinal fluid leak as in Case 1 demonstrates the importance of imaging in this work-up. Cases 2 and 3 in the series were representative of the larger subset of patients in the literature who present with the defect incidentally but still warrant surgical management. Nonetheless, a standard approach to diagnosis with preoperative imaging and subsequent transnasal endoscopic repair of the skull base defect was undertaken. Conclusion The persistent CPC is a rare congenital anomaly associated with diverse pathology and careful review of preoperative radiology is critical to the management. When warranted, subsequent surgical repair and reconstruction is associated with excellent postoperative outcomes.
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Affiliation(s)
- Seerat K Poonia
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Padua, Italy
| | - Adam C Kaufman
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michael A Kohanski
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Edward C Kuan
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, United States
| | - Charles C L Tong
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Roy D Carlson
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Daniele Borsetto
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Padua, Italy
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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30
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Jain N, Singh L, Roy S. Nasopharyngeal pituitary in newborn: A diagnostic dilemma. OTOLARYNGOLOGY CASE REPORTS 2019. [DOI: 10.1016/j.xocr.2019.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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D'Amico A, Ugga L, Cuocolo R, Cirillo M, Grandone A, Conforti R. Persisting Embryonal Infundibular Recess in Morning Glory Syndrome: Clinical Report of a Novel Association. AJNR Am J Neuroradiol 2019; 40:899-902. [PMID: 30846438 DOI: 10.3174/ajnr.a6005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/14/2019] [Indexed: 11/07/2022]
Abstract
Morning glory syndrome is characterized by a congenital optic disc defect that resembles the eponymous flower. We present the MR imaging findings of 2 pediatric patients with morning glory disc anomaly and persisting embryonal infundibular recess, another rare malformative finding, a previously unreported association. Neuroradiologists should be aware of the possible presence of a persisting embryonal infundibular recess in patients with morning glory syndrome, to aid in the differential diagnosis including other pituitary malformations such as pituitary stalk duplication.
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Affiliation(s)
- A D'Amico
- From the Department of Advanced Biomedical Sciences (A.D., L.U., R. Cuocolo), University of Naples "Federico II," Naples, Italy
| | - L Ugga
- From the Department of Advanced Biomedical Sciences (A.D., L.U., R. Cuocolo), University of Naples "Federico II," Naples, Italy
| | - R Cuocolo
- From the Department of Advanced Biomedical Sciences (A.D., L.U., R. Cuocolo), University of Naples "Federico II," Naples, Italy
| | - M Cirillo
- Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche (M.C.)
| | - A Grandone
- Metaboliche e dell'Invecchiamento, Dipartimento della Donna (A.G.), del Bambino e di Chirurgia Generale e Specialistica
| | - R Conforti
- Dipartimento di Medicina di Precisione (R. Conforti), University of Campania "Luigi Vanvitelli," Naples, Italy
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Bayrak S, Göller Bulut D, Orhan K. Prevalence of anatomical variants in the clivus: fossa navicularis magna, canalis basilaris medianus, and craniopharyngeal canal. Surg Radiol Anat 2019; 41:477-483. [PMID: 30725217 DOI: 10.1007/s00276-019-02200-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/31/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE This study determined the prevalence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC), the size of FNMs, and types of CBM using 3D computed tomography (CT) images. METHODS A total of 1059 3D images [649 cone beam computed tomography (CBCT) and 410 CT] were evaluated in this study. The prevalence of FNM, CBM, and CPC, length, width, and depth of FNM, and type of CBM were assessed. RESULTS Overall, FNM was identified in 7.6%, CPC in 0.3%, and CBM in 2.5% of the study group. Type 2 (0.1%) and Type 6 (0.1%) are the least common CBM types. There was no significant difference between genders for depth and width measurements (p > 0.05), however, the length of FNM was significantly higher in males than females in CBCT images (p = 0.02). CONCLUSION FNM, CBM, and CPC are rare anatomical variants of clivus. However, they can facilitate spread of infection to the skull base or vice-versa. These types of anatomical variations should be known by radiologists to avoid unnecessary diagnosis and treatment procedures and to distinguish anatomic variations from pathological conditions.
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Affiliation(s)
- Seval Bayrak
- Department of Dentomaxillofacial Radiology, Dentistry Faculty, Bolu Abant İzzet Baysal University, Gölköy, 14000, Bolu, Turkey.
| | - Duygu Göller Bulut
- Department of Dentomaxillofacial Radiology, Dentistry Faculty, Bolu Abant İzzet Baysal University, Gölköy, 14000, Bolu, Turkey
| | - Kaan Orhan
- Dentomaxillofacial Radiology Department, Dentistry Faculty, Ankara University, Ankara, Turkey.,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral &Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Vinayagamani S, Thomas B, Gohil J, Sekar S, Nair P, Kesavadas C. Bipartite craniopharyngeal canal with a lipoma and cephalocele: a previously unreported entity. Acta Neurochir (Wien) 2019; 161:355-359. [PMID: 30637485 DOI: 10.1007/s00701-018-03795-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
A 13-year-old male child was evaluated for headache and visual deterioration; he underwent routine MRI imaging which revealed a large craniopharyngeal canal, divided by an abnormal bony septum giving a bipartite appearance of the canal, with a lipoma and cephalocele on either side of the septum. The child had undergone a previous surgery for cleft palate repair at the age of 7. The child had normal pituitary function inspite of nonvisualization of pituitary gland in MRI. To best our knowledge, this is the first case with such a variation. We have also discussed the possible embryological hypothesis for this previously unreported entity. Knowledge about this rare variant might have surgical relevance in selected cases.
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Affiliation(s)
- S Vinayagamani
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India.
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
| | - Jaypalsinh Gohil
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sabarish Sekar
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Room no 318, Srishty building, SCTIMST Staff Quarters, Poondi Road, Kumarapuram Junction, Medical college (P.O), Trivandrum, Kerala, 695011, India
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Rajasekar G, Nair P, Abraham M, Jaiswal P. Endoscopic Endonasal Repair of a Persistent Craniopharyngeal Canal and Sphenoid Meningoencephalocele: Case Report and Review of Literature. World Neurosurg 2018; 122:196-202. [PMID: 30391602 DOI: 10.1016/j.wneu.2018.10.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND A persistent craniopharyngeal canal (PCC) is a rare cause of cerebrospinal fluid rhinorrhea in children. The condition often coexists with other midline facial defects, such as cleft palate. Children with PCC may also have pituitary dysfunction or neoplasms, such as craniopharyngiomas within the canal. CASE DESCRIPTION A 5-year-old girl presented with bacterial meningitis and active cerebrospinal fluid rhinorrhea from her left nostril. Imaging showed a large nasopharyngeal meningoencephalocele, communicating with the subarachnoid space through a persistent craniopharyngeal canal. An endonasal approach was chosen to excise the PCC and meningoencephalocele and to repair the resulting skull base defect. CONCLUSIONS The extended endonasal approach can be used to treat PCC with nasopharyngeal encephaloceles in young children. The approach is suitable to address both conditions at the same time. The extended endonasal approach avoids potentially morbid transfacial approaches and can help in earlier recovery after surgery.
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Affiliation(s)
- Gopikrishnan Rajasekar
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Prakash Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Palak Jaiswal
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Kasim N, Choudhri A, Alemzadeh R. Craniopharyngeal canal, morning glory disc anomaly and hypopituitarism: what do they have in common? Oxf Med Case Reports 2018; 2018:omy018. [PMID: 29977576 PMCID: PMC6007484 DOI: 10.1093/omcr/omy018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/23/2018] [Accepted: 04/10/2018] [Indexed: 12/02/2022] Open
Abstract
A 14-year-old girl with a history of mid-line defects, basal encephalocele and morning glory disc anomaly presented with untreated growth hormone deficiency, pubertal delay and hypothyroidism. She was found to have a large craniopharyngeal canal based on MRI scan. Craniopharyngeal canal is an uncommon condition that has not been well described in the pediatric population. Consideration of craniopharyngeal canal in the differential diagnosis for basal encephaloceles and understanding its presentation can impact medical decision making and follow-up for patients.
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Affiliation(s)
- Nader Kasim
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Asim Choudhri
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ramin Alemzadeh
- Le Bonheur Children's Hospital, Memphis, TN, USA.,Department of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, USA
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Persistent craniopharyngeal canal, bilateral microphthalmia with colobomatous cysts, ectopic adenohypophysis with Rathke cleft cyst, and ectopic neurohypophysis: case report and review of the literature. Childs Nerv Syst 2018; 34:1407-1410. [PMID: 29445918 DOI: 10.1007/s00381-018-3747-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Persistent craniopharyngeal canal (PCC) is a rare anomaly of the base of the skull. PCC is defined as a well-corticated osseous canal, extending from the roof of the nasopharynx to the base of the sella over the course of the sphenoid corpus. We reported a PCC case with unique associations. The magnetic resonance imaging findings are discussed. CASE PRESENTATION We report a case of a 2-year-old boy with persistent craniopharyngeal canal, bilateral microphtalmia with large colobomatous cyst, and ectopic adenohypophysis with Rathke cleft cyst. He also has ectopic neurohypophysis and optic atrophy. CONCLUSION The presence of orbital and optic tract malformations, craniofacial and intracranial anomalies, and tumors can accompany craniopharyngeal canals (CCs). MRI is helpful in the evaluation of PCC and associated anomalies in these patients.
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Choudhri AF, Cohen HL, Siddiqui A, Pande V, Blitz AM. Twenty-Five Diagnoses on Midline Images of the Brain: From Fetus to Child to Adult. Radiographics 2018; 38:218-235. [PMID: 29320328 DOI: 10.1148/rg.2018170019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Midsagittal images of the brain provide a wealth of anatomic information and may show abnormalities that are pathognomonic for particular diagnoses. Using an anatomy-based approach, the authors identify pertinent anatomic structures to serve as a checklist when evaluating these structures. Subregions evaluated include the corpus callosum, pituitary gland and sellar region, pineal gland and pineal region, brainstem, and cerebellum. The authors present 25 conditions with characteristic identifiable abnormalities at midsagittal imaging. Midsagittal views from multiple imaging modalities are shown, including computed tomography, ultrasonography, and magnetic resonance (MR) imaging. Standard MR imaging sequences are shown, as well as fetal MR and sagittal diffusion-weighted images. To demonstrate these conditions, fetal, neonatal, childhood, adolescent, and young adulthood images are reviewed. The differentiation of normal variants is guided by the understanding of anatomy and pathology. When a specific diagnosis is not possible, the authors present information to evaluate differential considerations and discuss when follow-up imaging may be indicated. The authors hope each case will clarify a pertinent differential diagnosis, appropriately guide patient management, and improve understanding of normal anatomy and identification of pathologic entities. It is in these hopes that the authors have presented a checklist of pertinent anatomy and pathologic entities that can build on existing search patterns. Improved confidence and accuracy in the evaluation of midsagittal images will benefit physicians and patients. ©RSNA, 2018.
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Affiliation(s)
- Asim F Choudhri
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Harris L Cohen
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Adeel Siddiqui
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Vijay Pande
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
| | - Ari M Blitz
- From the Department of Radiology, Le Bonheur Children's Hospital, 848 Adams Ave, G216, Memphis, TN 38103 (A.F.C., H.L.C., A.S., V.P.); Departments of Radiology (A.F.C., H.L.C., A.S., V.P.), Neurosurgery (A.F.C.), Ophthalmology (A.F.C.), Pediatrics (H.L.C.), and Obstetrics (H.L.C.), University of Tennessee Health Science Center, Memphis, Tenn; and Department of Radiology, Johns Hopkins University, Baltimore, Md (A.M.B.)
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38
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Normal neuroanatomical variants that may be misinterpreted as disease entities. Clin Radiol 2017; 72:810-825. [PMID: 28747250 DOI: 10.1016/j.crad.2017.06.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/12/2017] [Accepted: 06/19/2017] [Indexed: 12/23/2022]
Abstract
Variations of normal development and benign incidental anomalies are frequently observed on diagnostic neuroimaging. It is important these are recognised for what they are, as misinterpretation may result in unnecessary further investigation, follow-up imaging and anxiety. In this article, we review benign intracranial anomalies commonly referred to our unit for specialist neuroradiology advice or multidisciplinary discussion, concerning cysts of the pineal gland and pituitary fossa, vascular anomalies, and perivascular spaces. This article outlines the embryology and development, the various imaging features as well as the clinical relevance and differential diagnoses of each normal neuroanatomical variant.
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Analysis and Long-Term Follow-Up of the Surgical Treatment of Children With Craniopharyngioma. J Craniofac Surg 2017; 27:e763-e766. [PMID: 28005815 DOI: 10.1097/scs.0000000000003176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the relationship between the operative approach, clinical pathological factors, and curative effect of the surgical treatment in the patients with craniopharyngioma; to provide a theoretical basis for determining the prognosis and reducing the recurrence rate during the long-term postoperative follow-up in children. METHODS This was a retrospective analysis of the clinical data of 92 children who underwent surgical treatment in our department from May 2011 to January 2005. Long-term follow-up was performed from 12 months to 8 years. The pterional approach was used in 49 patients, the interhemispheric approach in 20 patients, the corpus callosum approach in 16 patients, and the butterfly approach in 7 patients. Pathological classification was performed by hematoxylin and eosin stain staining of the pathological tissues and evaluated according to the different surgical approaches, MRI calcification status, calcification type, pathological type, whether radiotherapy was performed, postoperative recurrence, and death. RESULTS For the pterion approach resection, there was near total resection in 46 patients (93.9%) with the lowest recurrence rate. The operative approach and postoperative recurrence rates were compared; the difference was statistically significant (P <0.05). For comparison of the operative approach and postoperative mortality, the difference was not statistically significant (P >0.05). There was not a significant difference between the MRI classification and postoperative recurrence rate (P >0.05). Comparing the degree of tumor calcification with the recurrence rate after operation and the mortality rate, the difference was statistically significant (P <0.05). The recurrence rate and mortality rate of adamantimous craniopharyngioma and squamous papillary craniopharyngioma in 2 groups following operation were compared, and the differences were statistically significant (P <0.05). Postoperative adjuvant radiotherapy was compared with the postoperative recurrence rate and mortality; the differences were statistically significant (P <0.05). CONCLUSION The main effects on tumor recurrence include the choice of surgical approach and degree of calcification. The adamantimous craniopharyngioma relapse rate is higher, which could be because invasion of craniopharyngioma only occurs with adamantimous craniopharyngioma. Postoperative radiotherapy can significantly prolong the recurrence time and reduce the mortality rate of patients with craniopharyngioma.
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Abstract
As the obesity epidemic grows in the United States, rhinorrhea and otorrhea from spontaneous cerebrospinal fluid (CSF) leaks secondary to untreated idiopathic intracranial hypertension are increasing in prevalence. CSF rhinorrhea and otorrhea should also be carefully evaluated in posttraumatic and postsurgical settings, because untreated CSF leaks often have serious consequences. The work-up, diagnosis, and characterization of a CSF leak can be complex, often requiring a multimodality approach to optimize surgical planning. This article reviews the causes of CSF leaks, describes the methodology used to work up a suspected leak, and discusses the challenges of making an accurate diagnosis.
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Affiliation(s)
- Mahati Reddy
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Kristen Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
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41
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Abstract
The skull base is a complex bony and soft tissue interface that is divided anatomically into compartments. This article will focus specifically on the central skull base, which has a complex embryologic development and anatomy. Multiple entities from notochord remnants, neoplasm, infection, and other abnormalities may occur, and imaging is critical for depicting skull base pathology.
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Chiloiro S, Giampietro A, Bianchi A, De Marinis L. Clinical management of teratoma, a rare hypothalamic-pituitary neoplasia. Endocrine 2016; 53:636-42. [PMID: 26701679 DOI: 10.1007/s12020-015-0814-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
Intracranial teratomas are rare and comprise about 0.5 % of all intracranial tumours. Actually, a total of 15 cases of sellar-suprasellar teratoma have been described in the last 24 years. Although rare, hypothalamic-pituitary teratomas should be taken into account in the differential diagnosis of hypothalamic-pituitary region tumours. The current review focuses on the clinical and therapeutic management of pituitary region teratomas. Teratomas occur more frequently in children and young adults than in the older population and in males as compared to females. Symptoms at diagnosis are usually neurological defects, diabetes insipidus and hypopituitarism. Teratoma diagnosis can be suggested though neuroimaging findings. Magnetic resonance imaging remains the preferred modality for assessment of teratoma. Neuro-radiological findings of mixed-density mass, usually with mixed cystic and solid components or inclusions of teeth, fat and calcification can be suggestive. Tumour markers as beta-HCG and alpha-FP can be useful at teratoma diagnosis for distinguishing immature teratomas, mixed GCTs and mature teratomas with immature or malignant components. Optimal treatment for mature teratoma is neurosurgical excision. Radical excision is advocated as recurrence rate for a mature teratoma is extremely low in cases of complete resection and long-term outcome is excellent. During post-treatment follow-up, in cases of healing, according to tumour marker evaluation and contrasted MRI findings, hormone replacement therapy should be considered, also for secondary hypogonadism and GH deficit, with a more intense follow-up. However, as actually few evidence are available, safety data have to be confirmed also trough a surveillance study.
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Affiliation(s)
- S Chiloiro
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - A Giampietro
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A Bianchi
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - L De Marinis
- Pituitary Unit, Depertment of Endocrinology, School of Medicine, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy
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Abou-Al-Shaar H, Blitz AM, Rodriguez FJ, Ishii M, Gallia GL. Expanded Endonasal Endoscopic Approach for Resection of an Infrasellar Craniopharyngioma. World Neurosurg 2016; 95:618.e7-618.e12. [PMID: 27554305 DOI: 10.1016/j.wneu.2016.08.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Craniopharyngiomas are uncommon benign locally aggressive epithelial tumors mostly located in the sellar and suprasellar regions. An infrasellar origin of these tumors is rare. CASE DESCRIPTION The authors report a 22-year-old male patient with a purely infrasellar adamantinomatous craniopharyngioma centered in the nasopharynx with extension into the posterior nasal septum, sphenoid sinus, and clivus. Gross total resection was achieved using an expanded endonasal endoscopic transethmoidal, transsphenoidal, transpterygoid, and transclival approach. Follow-up at one year demonstrated no evidence of disease recurrence. CONCLUSIONS Infrasellar craniopharyngioma should be included in the differential diagnosis of sinonasal masses even in the absence of sellar extension. Expanded endonasal endoscopic approaches provide excellent access to and visualization of such lesions and may obviate the need for postoperative radiotherapy when gross total resection is achieved.
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Affiliation(s)
| | - Ari M Blitz
- Division of Neuroradiology, Department of Radiology and Radiologic Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Fausto J Rodriguez
- Division of Neuropathology, Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Masaru Ishii
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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44
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Tijssen MP, Poretti A, Huisman TA. Chiari type 1 malformation, corpus callosum agenesis and patent craniopharyngeal canal in an 11-year-old boy. Neuroradiol J 2016; 29:307-9. [PMID: 27329972 DOI: 10.1177/1971400916656487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the neuroimaging findings of an 11-year-old boy who presented with mild occipital headache and precocious puberty. This child was found to have a combination of various midline anomalies including a Chiari type 1 malformation, corpus callosum agenesis and patent craniopharyngeal canal with adjacent intracranial dermoid cyst.
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Affiliation(s)
- Maud Pm Tijssen
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
| | - Thierry Agm Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, USA
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45
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Mehemed TM, Fushimi Y, Okada T, Kanagaki M, Yamamoto A, Okada T, Takakuwa T, Yamada S, Togashi K. MR Imaging of the Pituitary Gland and Postsphenoid Ossification in Fetal Specimens. AJNR Am J Neuroradiol 2016; 37:1523-7. [PMID: 27127005 DOI: 10.3174/ajnr.a4808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A thorough knowledge of fetal growth and development is key to understanding both the normal and abnormal fetal MR imaging findings. We investigated the size and signal intensity of the normal pituitary gland and the intrasphenoidal ossification around the Rathke pouch in formalin-fixed fetuses on MR imaging. MATERIALS AND METHODS Thirty-two fetuses with undamaged brains were included in this study (mean age, 19.93 weeks; age range, 12-31 weeks). Visual inspection of the pituitary and ossification around the Rathke pouch in the sphenoid bone or the postsphenoid ossification was conducted. The extent of pituitary and postsphenoid ossification, pituitary/pons signal ratio, and postsphenoidal ossification/sphenoid bone signal ratio was compared according to gestational age. RESULTS The pituitary gland was identified as a hyperintense intrasellar structure in all cases, and postsphenoid ossification was identified as an intrasphenoidal hyperintense area in 27 of the 32 cases (84%). The mean pituitary/pons signal ratio was 1.13 ± 0.18 and correlated weakly with gestational age (R(2) = 0.243), while the mean postsphenoid ossification/sphenoid bone signal ratio was 2.14 ± 0.56 and did not show any increase with gestational age (R(2) = 0.05). No apparent change in the size of pituitary hyperintensity was seen with gestational age (R(2) = 0.001). Postsphenoid ossification showed an increase in size with gestational age (R(2) = 0.307). CONCLUSIONS The fetal pituitary gland was hyperintense on T1-weighted images and the pituitary/pons ratio and extent of postsphenoid ossification correlated weakly with gestational age.
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Affiliation(s)
- T M Mehemed
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | - Y Fushimi
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | - T Okada
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | - M Kanagaki
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | - A Yamamoto
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | - T Okada
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
| | | | - S Yamada
- Human Health Science (T.T., S.Y.) Congenital Anomaly Research Center (S.Y.), Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Togashi
- From the Department of Diagnostic Imaging and Nuclear Medicine (T.M.M., Y.F., Tomohisa Okada, M.K., A.Y., Tsutomu Okada, K.T.)
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Halayem S, Hamza M, Maazoul F, Ben Turkia H, Touati M, Tebib N, Mrad R, Bouden A. Distinctive findings in a boy with Simpson-Golabi-Behmel syndrome. Am J Med Genet A 2015; 170A:1035-9. [DOI: 10.1002/ajmg.a.37518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 12/06/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Soumeyya Halayem
- Department of Child Psychiatry; Razi Hospital; Manouba Tunisia
- Faculty of Medicine of Tunis; Tunis Tunisia
| | - Mariem Hamza
- Faculty of Medicine of Tunis; Tunis Tunisia
- Department of Child Psychiatry; Mongi Slim Hospital; La Marsa Tunisia
| | - Faouzi Maazoul
- Department of Human Genetics; Charles Nicolle Hospital; Tunis Tunisia
| | - Hadhemi Ben Turkia
- Faculty of Medicine of Tunis; Tunis Tunisia
- Department of Pediatrics; La Rabta Hospital; Tunis Tunisia
| | - Maissa Touati
- Department of Child Psychiatry; Razi Hospital; Manouba Tunisia
| | - Neji Tebib
- Faculty of Medicine of Tunis; Tunis Tunisia
- Department of Pediatrics; La Rabta Hospital; Tunis Tunisia
| | - Ridha Mrad
- Faculty of Medicine of Tunis; Tunis Tunisia
- Department of Human Genetics; Charles Nicolle Hospital; Tunis Tunisia
| | - Asma Bouden
- Department of Child Psychiatry; Razi Hospital; Manouba Tunisia
- Faculty of Medicine of Tunis; Tunis Tunisia
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48
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Biswas S, Millward CP, Riordan A, Sinha A, Avula S. Craniopharyngeal duct: a cause of recurrent meningitis. BJR Case Rep 2015; 1:20150022. [PMID: 30363566 PMCID: PMC6180822 DOI: 10.1259/bjrcr.20150022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/05/2022] Open
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Ginat DT, Robson CD. CT and MRI of congenital nasal lesions in syndromic conditions. Pediatr Radiol 2015; 45:1056-65. [PMID: 25573243 DOI: 10.1007/s00247-014-3239-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 10/01/2014] [Accepted: 11/12/2014] [Indexed: 11/25/2022]
Abstract
Congenital malformations of the nose can be associated with a variety of syndromes, including solitary median maxillary central incisor syndrome, CHARGE syndrome, Bosma syndrome, median cleft face syndrome, PHACES association, Bartsocas-Papas syndrome, Binder syndrome, duplication of the pituitary gland-plus syndrome and syndromic craniosynsotosis (e.g., Apert and Crouzon syndromes) among other craniofacial syndromes. Imaging with CT and MRI plays an important role in characterizing the nasal anomalies as well as the associated brain and cerebrovascular lesions, which can be explained by the intimate developmental relationship between the face and intracranial structures, as well as certain gene mutations. These conditions have characteristic imaging findings, which are reviewed in this article.
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Affiliation(s)
- Daniel T Ginat
- Department of Radiology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA,
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Abstract
In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries.
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Affiliation(s)
- Bernadette L Koch
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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