Top PDF CT of the Sella Turcica after Transsphenoidal Resection of Pituitary Adenomas

CT of the Sella Turcica after Transsphenoidal Resection of Pituitary Adenomas

CT of the Sella Turcica after Transsphenoidal Resection of Pituitary Adenomas

A retrospective review of 120 patients undergoing transsphenoidal surgery for pituitary adenomas revealed that computed tomography CT was less sensitive and less specific than hormonal m[r]

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Pituitary Adenomas: Early Postoperative MR Imaging After Transsphenoidal Resection

Pituitary Adenomas: Early Postoperative MR Imaging After Transsphenoidal Resection

periphery of the gelatin foam implant demonstrated a circular rim of contrast enhancement, which was seen in all cases except one. This patient underwent postoperative MR imaging 5 days after surgery. Steiner suggested this peripheral enhancement was very likely caused by granulation tissue, which was seen several months after surgery. Peripheral en- hancement in our study focused on early postop- erative findings. A thin enhancing rim, as seen on CT, has been referred to as a persistent tumor cap- sule (9, 12, 13). Dina et al (2) also reported this peripheral enhancing rim in three of 10 patients in the early postoperative period, and it could not be determined on a single imaging study whether this tissue represented a residual tumor, tumor capsule, or pituitary gland. Dina et al (2) suggested that on follow-up studies, this tissue assumed a more nor- mal pituitary size and shape within the confines of the sella 4 to 9 months later. In our patients with peripheral rim enhancement, there was no case that showed increased size on follow-up MR images or elevation of hormone level on follow-up laboratory studies. In addition, on follow-up MR images, pe- ripheral rim enhancement disappeared and normal gland reexpanded in the pituitary fossa. Therefore, we regarded this peripheral rim enhancement as
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The accuracy of CT and MR evaluation of the sella turcica for detection of adrenocorticotropic hormone secreting adenomas in Cushing disease

The accuracy of CT and MR evaluation of the sella turcica for detection of adrenocorticotropic hormone secreting adenomas in Cushing disease

ation of the sella turcica in this rare kind of pituitary hypersecretion syndrome are mainly attributable to the small size of these lesions and the fact that they frequently escape dire[r]

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One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

One-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas—a technical report

Results: The gross total resection rate was 79%. The gross complete resection rate of Knosp grade 3 tumors were 63.6, and 27.3% in grade 4 tumors. Postoperative hormone remission was achieved in 14 out of 18 (77.8%) patients with secreting adenomas. Postoperative abnormal visual function improvement was achieved in 23 out of 32 patients (73%) with preoperative visual dysfunction. The overall intra-operative CSF leak was 17.5%, with the postoperative CSF leak decreased to 3.5% after the sellar reconstruction with the unilateral “ rescue ” nasoseptal flap procedure. The main sinonasal complaints 2 weeks after surgery were: loss of sense of smell (28%), decrease in sense of taste (4%), trouble breathing during the day (18%), thick nasal discharge (36%), post nasal discharge (8%), dried nasal material (6%), and headache (6%). Three months after surgery, there were no reports of decrease of taste, post nasal discharge, or dried nasal material. Other complaints were decreased significantly. Six months after surgery, the main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery to preoperative status.
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Endoscopic Endonasal Transsphenoidal Approach for Pituitary Adenomas: a Prospective Review of Our Early Experience

Endoscopic Endonasal Transsphenoidal Approach for Pituitary Adenomas: a Prospective Review of Our Early Experience

curve and the development of surgical techniques, thus, the writing with regard to pituitary surgery has changed significantly (14-16). Santos et al. described a retrospective analysis of 30 patients with pituitary adenomas, submitted to endoscopic endonasal removal with a subsequent follow up from 3 to 36 months, from January 2005 to September 2008. They reported that 100% (7) of patients with microadenoma and 43% (13) of patients with macroadenoma had a total resection of tumors (17). Gomez-Amador, in a large series of 167 patients with non-functional adenoma that had undergone endoscopic surgery reported that 60.20% (59) of patients received up to a 90% tumor resection (18). Our results were a sign of our learning process and the fact that many of the patients were in an advanced state with regard to the disease. 25% (7) of the patients with microadenoma were totally resected. In our series, macroadenomas with sellar/supraselar and cavernous sinus extensions were common 75% (21) cases and gross macroscopical resection was done on 76% (16) of patients. On the other hand, the endocrinological outcomes for micro adenomas patients were better because it was possible to completely remove all of the tumors (100%). There was a characteristic improvement in visual symptoms, with the greatest degree of improvement occurring within the first few months. MRI and perimetry played an important part in the post-treatment monitoring of patients. Based on visual field perimetry, our rate of visual improvement after surgery (78.5%) was similar to that reported by other studies (16,17,19).
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Management of Pituitary Adenomas: Mononostril  Endoscopic Transsphenoidal Surgery

Management of Pituitary Adenomas: Mononostril Endoscopic Transsphenoidal Surgery

The use of 30 degrees and 45 degrees scopes also allows the surgeon to look inside the sella and more importantly allows access to hidden tumor in the lat- eral aspects of the sella, thus attaining a safer and more complete resection of tumor under direct vision (Cap- pabianca, Cavallo, & de Divitiis, 2004). This has been demonstrated in our series in the high rate of gross total resection achieved in the non-invasive macroadenoma group, where the endoscope allows further inspection of the hidden corners and the suprasellar region. Fur- thermore, less invasive endoscopic approach has the po- tential to shorten operation time, obviates the need for nasal packing, and shortens hospital stay (Koren, Hadar, Rappaport, & Yaniv 1999). In a comprehensive meta- analysis in 2006, Tabaee et al. demonstrated both safety and efficacy of the endoscopic approach with high rates of gross total removal, normalization of endocrine func- tion, and improved vision (Tabaee et al., 2009).
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Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection

Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection

Mattozo et al. [9] and Alahmadi et al. [10] ever reported that sellar floor opening insufficiency is the major cause of residual tumor after the previous surgery. Nevertheless, the possibility of enlargement and migration of the re- sidual tumors also may significantly increase due to rela- tively long interval between the consective two surgeries. Thus, the conclusion that sellar floor opening is associated with residual tumor, still remain untenable due to lack of solid evidence. Even early signs of errhysis, cataclysm and artificial materials for sellar reconstruction after surgery tend to affect the evaluation accuracy of residual tumors, several research groups [21, 22] insisted no statistical sig- nificance noted in terms of the detection rate of residual tumors for patients undergoing MRI between early and late stages. Consequently, postoperative early CT and MRI images were properly fused by two independent experienced physicians, which significantly improved Table 2 Postoperative complication of 51 patients undergoing
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Visual Disorders Outcome after Endoscopic Endonasal Trans Sphenoidal Surgery of Pituitary Macroadenomas

Visual Disorders Outcome after Endoscopic Endonasal Trans Sphenoidal Surgery of Pituitary Macroadenomas

Pituitary adenomas accounts for about 10% of intracranial tumors among which 14% to 28% are non-function- ing adenomas [1]-[3]. Such cases spontaneously grow up yielding to typical visual disorders related to optic chiasmal compression. Nowadays, the incidence of optic chiasmal compression is observed with MRI in 9% of the pituitary macroadenomas [4]. More rarely, involvement of the cavernous sinus leads to oculomotor symp- toms. Such complications justify surgery to avoid visual degradation and to stop tumor growth progression. En- doscopic endonasal transsphenoidal (EET) surgery proved to be an effective procedure for such cases [2] [5] [6]. The aim of this retrospective study was to analyze visual outcome after EET surgery for pituitary macroade- nomas.
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Micro-computed tomography study of the abnormal osseous extensions of sella turcica

Micro-computed tomography study of the abnormal osseous extensions of sella turcica

dorsum sellae showed alteration of the osseous composition. In these osseous components the spongy bone disappeared, and the compact bone, which was well mineralised, dominated. However, the compact substance was not homogenous in the whole area of the heterotopic ossification. Texture analysis of the micro-CT scans revealed the presence of numerous brighter circular spots, which were aggregated mostly along the peripheral layer of the ossified dura mater. In the transverse section it resembles tiny granulations that adhere to each other, forming a dense osseous cortex. In fact, these are bony trabeculas, which lay down in the matrix of the dura mater during its heterotopic ossification. The trabeculas were arranged in longitudinal man- ner, from the top of the posterior clinoid process they spread mainly posteriorly, probably along the bundles of the collagen fibers, which gradually cal- cified. Coronal CT scans demonstrated spots of bony tissue condensation within abnormal extensions of the sellar region. In fact, these spots are transverse sections through the aggregates of the osseous trabeculas, which laid down in the dura mater and caused its ossification. Longitudinal arrangement of the bony trabeculas can be perceived on the inferior aspect of the specimen and is also visible as darker spots in the transverse section (Fig. 4).
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Original Article Transverse compensation of first molars in different sagittal and vertical classifications: a retrospective study using cone-beam computed tomography

Original Article Transverse compensation of first molars in different sagittal and vertical classifications: a retrospective study using cone-beam computed tomography

As one of the criteria, buccolingual inclination is of fundamental importance in orthodontic treatment. In the 1970s, Andrews brought up the six keys after researching 120 Caucasian dental casts with ideal occlusion, laying the foundation for the preadjusted appliance [1]. However, even experienced orthodontists found it difficult to achieve all the keys without selecting suitable molar torque in certain cases. The American Board of Orthodontics (ABO) Objective Grading System also assessed the buccolingual inclination as a part of its final phase III clinical examination [2]. A list of clini- cal problems could occur without the concern of transverse discrepancies, such as relapse,
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Comparative analysis of size of sella turcica with different skeletal patterns

Comparative analysis of size of sella turcica with different skeletal patterns

: A total of 60 pretreatment digital lateral cephalograms were selected ups, group 1: Class I (n=20), group 2: Class II (n=20) and group 3: Class III (n=20). Lateral cephalograms were traced and analyzed on basis of sella turcica i.e. the following linear measurements were recorded: length, depth and diameter of the sella and the The linear measurements of length and diameter showed statistically significant differences value=0.0 and 0.02 respectively). However, the depth showed no The importance of the sella turcica is established and the normalcy is set by statistical analysis and the standard values are given for the dimensions of the sella turcica. This can be used for erence standards for the Indian population. The length and diameter of the sella were statistically significant with the different groups. Largest values were given in Class III. Length of the mandible and the length of the sella in each group can be correlated.
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Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications

Transsphenoidal canal (large craniopharyngeal canal) and its pathologic implications

There is little documentation in patients with a transsphenoidal canal without a nasopharyngeal mass regarding the status of the dura in the floor of the sella, the status of the diaphra[r]

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Volumetric and three-dimensional examination of sella turcica by cone-beam computed tomography: reference data for guidance to pathologic pituitary morphology

Volumetric and three-dimensional examination of sella turcica by cone-beam computed tomography: reference data for guidance to pathologic pituitary morphology

the area under examination and establishing normal standards to distinguish abnormal morphology. CBCT images of healthy adults were used for this purpose which had been collected previously for several reasons (for orthodontic treatment, prior to planning of im- plant angulations and/or occlusal plane constructions, evaluation of stabilisation occlusal splint or periodontal problems, etc.). The patients having cleft lip and pal- ate, impacted canines, dental transposition, and dental anomalies were excluded as authors mentioned associ- ation between these features and sellar dimensions or bridging [13, 21, 24, 27]. Also, patients with previous history of orthognatic treatment were excluded given that abnormal sella dimensions and bridging were re- ported in those patients [14]. As there is an increase in di- mensions of sella turcica until skeletal maturation [1, 2], only adult patients were included in present study. Table 1. Dimensions and volume of the sella turcica according to gender and statistical comparisons
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Hemorrhage Within Pituitary Adenomas: How Often Associated with Pituitary Apoplexy Syndrome?

Hemorrhage Within Pituitary Adenomas: How Often Associated with Pituitary Apoplexy Syndrome?

To determine the clinical significance and specificity of suspected intratumoral hemorrhage in pituitary adenomas, we reviewed the clinical presentations, CT results , and findings at su[r]

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Mandibular prognathism caused by acromegaly – a surgical orthodontic case

Mandibular prognathism caused by acromegaly – a surgical orthodontic case

Histological examination showed a highly vascularised pituitary adenoma with a diffuse (solid) growth pattern. Higher magnification showed uniform cells with broad eosinophilic cytoplasm and round to oval nuclei (fig. 6a). The proliferation index was very low with approximately 3% of cells showing immunoreactivity against MiB-1 (fig. 6b). Parts of the tumour cells showed immunopositivity for prolactin in peripheral parts of cytoplasm (fig. 6c). However, no immunoreactivity was present that provided an antibody against the human growth hormone (fig. 6d). Reestablishment of endocrine balance would be followed by mandibular osteotomies to reestablish facial harmony and Angle class I occlusion.
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CDK5 and Its Activator P35 in Normal Pituitary and in Pituitary Adenomas: Relationship to VEGF Expression

CDK5 and Its Activator P35 in Normal Pituitary and in Pituitary Adenomas: Relationship to VEGF Expression

Pituitary tumors are monoclonal adenomas that account for about 10–15% of intracranial tumors. Cyclin-dependent kinase 5 (CDK5) regulates the activities of various proteins and cellular pro- cesses in the nervous system, but its potential roles in pituitary adenomas are poorly understood. The kinase activity of CDK5 requires association with an activating protein, p35 (also known as CDK5 activator 1, p35). Here, we show that functional CDK5, associated with p35, is present in normal human pituitary and in pituitary tumors. Furthermore, p35 mRNA and protein levels were higher in pituitary adenomas than in the normal glands, suggesting that CDK5 activity might be upregulated in pituitary tumors. Inhibition of CDK5 activity in rat pituitary cells, reduced the expression of vascular endothelial growth factor (VEGF), a protein that regulates vasculogenesis and angiogenesis. Our results suggest that increased CDK5-mediated VEGF expression might play a crucial role in the development of pituitary adenomas, and that roscovitine and other CDK5 inhibitors could be useful as anticancer agents.
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Hemorrhagic pituitary adenomas of adolescence

Hemorrhagic pituitary adenomas of adolescence

Hemorrhage within pituitary adenomas has been previously described in the absence of pituitary apoplexy (10 –14). The association of bromocriptine with intratumoral hemorrhage in pituitary adenomas has also been reported (14). The frequency of hemorrhage in our 17 untreated patients was 47% as compared with a frequency of 7% to 8% in the literature (13–15). A later study by Yousem et al (16), however, showed a prevalence of subacute intratumoral hemorrhage in 43% of nonsurgically treated pi- tuitary adenomas, but it is not clear whether these patients received bromocriptine. The fre- quency of hemorrhage in our series of untreated macroadenomas (75%) exceeds that reported for adults (14.5%) (13, 14). As in our series, most of the previously reported hemorrhagic adenomas were prolactinomas (13, 14). Imag- ing findings in our study concur with other pub- lished studies in which mixed density has been noted on CT scans and high intensity noted on T1- and T2-weighted MR images, reflecting subacute hemorrhage (11–14, 16 –18) (Figs 1–3).
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A new morphometric method for the sella turcica and the hypophyseal fossa and its clinical relevance

A new morphometric method for the sella turcica and the hypophyseal fossa and its clinical relevance

Studies currently being performed have con- cerned the entire sella turcica. In our study, special regard was paid to the morphology of the hypophy- seal fossa itself. An original method is presented, by which the geometrical features of the fossa were obtained and its deepest point was accurately de- termined. A comparison is made with previous find- ings concerning its dimensions and volume. The most frequent or clinically important abnormalities in the shape and volume of the pituitary gland and their eventual correlation with the morphology of the sella turcica are reviewed. A possible correlation of our method with MRI techniques is finally discussed.
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Morphometric analysis of the sella turcica in Turkish individuals with different dentofacial skeletal patterns

Morphometric analysis of the sella turcica in Turkish individuals with different dentofacial skeletal patterns

According to our results, the anatomical varia- tions of the sella turcica in this study were normal morphology at 39.0% with the other morphological variations at 61%. The pyramidal shape was 15.5%, double contour floor was 14.6%, and oblique anterior wall was 14.4%. The irregular dorsum sella and sella turcica bridge were observed in 8.6% and 8.0%, re- spectively. The least-seen sella turcica shape was the sella bridge (8.0%), and the most common type was the normal shape (39.0%). Class III patients had more irregularity of the dorsum sella types than the others and fewer oblique anterior wall types than the oth- ers. However, reported normal morphology of sella turcica in patients with different dentofacial skeletal types was 67%. The remaining 33% of the cases had variations of sella turcica morphologies [4]. Shah et al. [35] found that the normal morphology was also seen in approximately 66% of the subjects. Our results are lower than the results of previous studies, which may be due to sample size, ethnicity, and the use of different methodologies.
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CT surgical correlation in pituitary adenomas: evaluation in 113 patients

CT surgical correlation in pituitary adenomas: evaluation in 113 patients

The location of the normal pituitary gland could not be determined by attenuation characteristics ; only in the presence of infundibulum displacement contralateral to an adenoma or a dis[r]

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