1/31. Traumatic aneurysm and carotid-cavernous fistula following transsphenoidal approach to a pituitary adenoma: treatment by transcranial operation.A 39-year old woman presented with galactorrhoea. magnetic resonance imaging revealed an intrasellar tumour. During transsphenoidal surgery to remove the tumour, arterial bleeding occurred from the right internal carotid artery (ICA). The bleeding was stopped by packing with Surgicel. The operation was discontinued at this point and the intrasellar tumour was not removed. Four-vessel angiography was performed on the third day after the operation, revealing a traumatic (false) ICA aneurysm and a low-flow carotid-cavernous fistula (CCF) on the right side. The patient did not have any neurological deficit, and was re-operated on transcranially. Both the traumatic ICA aneurysm and the CCF were excluded from the circulation by a Sundt-Kees cuff clip. The patency of the ICA was preserved.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/31. radiation-induced cerebrovasculopathy of the distal middle cerebral artery and distal posterior cerebral artery--case report.A 15-year-old girl underwent partial removal of a pituitary adenoma followed by local irradiation of the brain with a total of 70 Gy through two lateral opposing ports. Twenty years later, she experienced frequent transient ischemic attacks with left sensory disturbance. cerebral angiography revealed stenoses of the right distal middle cerebral artery (MCA) and the right distal posterior cerebral artery without net-like vessels. There was a severe decrease of vasoreactivity in the right hemisphere. Right superficial temporal artery (STA)-MCA anastomosis was performed. Her neurological deficits were resolved and perfusion reserve capacity had markedly improved 6 months later. We recommend STA-MCA anastomosis in such cases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/31. Endovascular access to the meningohypophyseal trunk.SUMMARY: We describe a novel technique to selectively catheterize the meningohypophyseal trunk (MHT) and its branches. We emphasize the difficulty in accessing the MHT via an ipsilateral approach because of the geometric orientation of this vessel to the parent internal carotid artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/31. Suprasellar monomorphous pilomyxoid neoplasm: an ultastructural analysis.The authors report 3 patients, 2 children and 1 adult, each of whom presented with an unusual myxoid lesion reminiscent of pilocytic astrocytoma but with other features of myxopapillary ependymoma. The magnetic resonance imaging findings in all cases showed a diffusely contrast-enhancing suprasellar mass focally extending into the third ventricle. Involvement of adjacent structures was more extensive in both infants. By light microscopy, all were composed of a monotonous population of cells with delicate piloid-like processes, loosely arranged within a prominent myxoid background. Focally, the neoplastic cells converged upon small blood vessels in pseudorosette-like formations. These histomorphologic features are identical to those of the recently described astrocytoma with monomorphous pilomyxoid features. In addition, the individual tumor cells showed strong cytoplasmic immunoreactivity with antibodies to glial fibrillary acidic protein (GFAP) and vimentin, as well as nuclear and cytoplasmic staining with S-100. All stained positive for synaptophysin and negative for chromogranin. By electron microscopy, the tumor cells were bipolar with elongated processes and apical surfaces displaying microvilli, cytoplasmic blebs and rare cilia. Vesicles and coated pits were seen, as were occasional synaptoid complexes. The current study serves to expand our clincopathologic experience with this rare and enigmatic lesion, with particular attention given to the ultrastructural characteristics.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/31. Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern: an evaluation of the frontobasal interhemispheric approach.OBJECT: Craniopharyngiomas frequently grow from remnants of the Rathke pouch, which is located on the cisternal surface of the hypothalamic region. These lesions can also extend elsewhere in the infundibulohypophyseal axis. The aim of this study was to establish the usefulness of the frontobasal approach made through a relatively small craniotomy window for the removal of tumors protruding from the sellar-suprasellar region into the third and basal cistern. methods: Thirty-one patients who were surgically treated for craniopharyngiomas extending outside the sellar-suprasellar region were evaluated. The diagnoses were established in all cases by using magnetic resonance and computerized tomography imaging. The initial symptoms and signs were increased intracranial pressure in eight, vision impairment or visual field defect in 16, hypopituitarism in 17, and psychological disturbances in three cases. All patients underwent surgery via the frontobasal interhemispheric approach, and the average follow-up period was 30 months. Total removal of the lesion was achieved in 22 cases, six patients underwent subtotal resection, and three underwent partial removal due to tumor recurrence after previous surgeries performed with or without adjunctive radiotherapy. Major complications, including impairment of the cranial nerves, were not observed in the immediate postoperative period. One patient exhibited transient memory disturbance due to infarction of the perforating vessels; after 3 months this symptom was ameliorated. None of the patients died during long-term follow up; however, four of the 22 who underwent total removal and six of the nine patients who underwent subtotal or partial removal suffered recurrence. Of the 10 patients with recurrence, six experienced a small recurrence of the lesion (average 3 months postsurgery); after gamma knife surgery (GKS), the size of two of the lesions was unchanged and in four reoperation was performed due to tumor enlargement during the follow-up period. Ultimately, a total of eight patients (four with recurrence and four who had been treated with GKS) underwent reoperation, with gross-total removal via the same approach or combined with the orbitozygomatic approach in patients with very short optic nerves. In no patient was deterioration of visual acuity and visual field observed after surgery. Although all patients except four children and one adult were receiving some form of hormone replacement therapy, their endocrine status was stably controllable. CONCLUSIONS: In the authors' experience, the frontobasal interhemispheric approach, even made through a small craniotomy window, is a valid choice for the removal of craniopharyngiomas extending outside the sellar-suprasellar region. Via this approach, tumors can be removed without significant sequelae related to the surgical method, due to ease of preservation of the pituitary stalk, hypothalamic structures, and perforating vessels. This approach offers a safe and minimally invasive means of treating craniopharyngiomas.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/31. Prolactin-producing pituitary adenoma associated with prolactin cell hyperplasia.A 24-yr-old woman with amenorrhea, galactorrhea, hyperprolactinemia, and sellar mass underwent transsphenoidal surgery. Histologic, immunohistochemical, and electron microscopic investigation revealed a well-differentiated, sparsely granulated prolactin (PRL) cell adenoma of the pituitary showing conclusive PRL immunoreactivity. In the nontumorous adenohypophysis PRL cell hyperplasia was noted. Marked differences were evident between the neoplastic and hyperplastic areas. The tumor consisted of sparsely granulated PRL cells immunoreactive only for PRL. As demonstrated by immunoelectron microscopy, the hyperplastic area comprised monohormonal sparsely granulated PRL cells as well as bihormonal mammosomatotrophs immunoreactive for both PRL and growth hormone. The MIB-1 index was higher whereas microvessel density was lower in the adenoma as compared with the hyperplastic area. In addition, the nontumorous area showed lymphocytic infiltration whereas inflammatory reaction was not seen in the adenoma. This case represents a rare association of a PRL cell adenoma and PRL cell hyperplasia. The fact that these two lesions were contiguous in the surgically removed material raises the possibility that hyperplasia can precede and transform into adenoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/31. Pituicytomas, a mis-diagnosed benign tumor of the neurohypophysis: report of three cases.Pituicytoma is a rare benign primary tumor of the neurohypophysis, occurring in the sellar and suprasellar spaces. We report here three new cases with immunohistochemical and electron microscopic study. Particular attention was paid to the expression of some cell adhesion molecules. These tumors were characterized by bundles of elongated cells strongly immunoreactive to anti-vimentin, S-100 protein, neural cell adhesion molecule and neuron-specific enolase antibodies. glial fibrillary acidic protein (GFAP) was not recorded. It expressed the very late antigen alpha2 (VLAalpha2), but not VLAalpha5, and lacked epithelial markers expression (epithelial membrane antigen, E-cadherin), and specific neuronal markers (synaptophysin, chromogranin, neurofilament). Staining for pituitary hormones was negative. At the ultrastructural level, tumor/blood vessel basal lamina and cytoplasmic intermediate filaments were observed but desmosome or pericellular basal lamina were lacking. In one case few secretory granules were recorded. Differential diagnoses include granular cell tumors, pilocytic astrocytomas and spindle cell tumors such as solitary fibrous tumors, fibroblastic meningiomas and schwannomas. However, the unique pattern of antigenic expression and ultrastructural features of pituicytomas distinguish this rare tumor. As a subpopulation of pituicytes (which are distinctive glial cells of the neurophypophysis), some pituicytomas do not expressed GFAP. This suggests that pituicytomas presumably arise from pituicytes at various stages of their differentiation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/31. moyamoya disease associated with pituitary adenoma--report of two cases.moyamoya disease associated with prolactin (PRL)-producing pituitary adenomas occurred in two females with elevated blood PRL levels (285 and 120 ng/ml). Computed tomography revealed cystic tumors extending from the sella turcica to the suprasellar cistern. Carotid angiography demonstrated stenoses or obstructions of the bilateral internal carotid arteries at their end point and development of bilateral basal moyamoya vessels. Histological diagnosis in one case was PRL-producing chromophobe adenoma. No stigmata of neurofibromatosis or any history of irradiation was found. Compression of carotid arteries by the tumor was unlikely. These cases should therefore be classified as moyamoya disease accompanied by brain tumor, a very rare occurrence. The hypothalamic disturbance caused by moyamoya disease may have induced the hyperprolactinemia, resulting in secondary prolactinoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/31. growth hormone-secreting pituitary adenoma associated with primary moyamoya disease--case report.A 40-year-old female presented with growth hormone (GH)-secreting pituitary adenoma associated with primary moyamoya disease manifesting as amenorrhea, acromegaly, and transient ischemic attack. Magnetic resonance (MR) imaging revealed a tumor mass extending from the sella turcica to the suprasellar cistern, and MR angiography demonstrated stenoses in the bilateral internal carotid arteries with basal moyamoya vessels. Her blood GH and insulin-like growth factor (IGF-1) levels were elevated to 78.94 and 923.0 ng/ml, respectively. The patient underwent removal of the pituitary adenoma because her ischemic symptoms disappeared after oral aspirin medication. Subtotal resection resulted in persistence of the high blood GH and IGF-1 levels. Postoperative MR angiography showed progression of the stenoses in the bilateral internal carotid arteries. Excess systemic GH and IGF-1 may participate in the progression of vascular disease and so could have caused the deterioration of the moyamoya disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/31. Effect of gamma knife radiosurgery on a pituitary gonadotroph adenoma: a histologic, immunohistochemical and electron microscopic study.The morphologic findings in a pituitary macroadenoma removed from a 65-year old man by the transsphenoidal approach 9 months after gamma knife surgery are reported. The tumor was immunoreactive for FSH beta and showed ultrastractural features consistent with an oncocytic gonadotroph adenoma. Accumulation of connective tissue separating small groups of adenoma cells was evident. Several dilated vessels and numerous vascular endothelial growth factor immunopositive adenoma cell were noted. By electron microscopy the endothelial linings frequently showed discontinuities with platelet accumulation attached to the gaps. Several vessels were severely injured showing necrosis of endothelial cells. It can be concluded that gamma knife surgery caused severe alterations in pituitary adenoma microcirculation indicating that vascular injury plays a crucial role in tumor shrinkage.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
| | Next -> |