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Objective:To investigate the method and effect of microneurosurgery in the treatment of recurrent craniopharyngioma.Methods:The clinical data of 41 recurrent craniopharyngioma patients treated by microneurosurgery in Capital Medical University Sanbo Brain Hospitalfrom January 2018 to January 2022 were retrospectively analyzed.Results:Among the 41 patients, 38 cases were treated with the frontal basal interhemispheric approach and 3 cases with the translongitudinal fissure combined with the transSylvian fissure approach. Gross total resection was performed in 34 cases (82.9%) and subtotal resection in 7 cases (17.1%). One patient (2.4%) died of pulmonary embolism during perioperative period. All patients had transient electrolyte disorder after operation, and recovered within 3 months after treatment. All patients had endocrine dysfunction. After 3 months of hormone replacement therapy, 11 patients were cured. Visual acuity decreased in 3 cases after operation, and 2 cases improved after treatment.Conclusions:Surgical treatment of recurrent craniopharyngioma is very difficult, which is a great challenge for doctors and patients. However, through the individualized evaluation of the patients and the meticulous technique of the doctors during the operation, a satisfactory effect can be achieved post the operation of recurrent craniopharyngioma.
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Objective:To compare the image quality of turbo gradient and spin echo-BLADE diffusion weighted imaging (TGSE-BLADE-DWI) with that of readout segmentation of long variable echo-trains (RESOLVE) at the sellar region.Methods:From September 15 th, 2019 to February 15 th, 2020, 38 patients with suspected sellar abnormalities were enrolled prospectively to perform RESOLVE and TGSE-BLADE-DWI at a 3.0 T MR scanner in Department of Radiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Totally, 32 patients were identified with sellar lesions. The DWI images were evaluated subjectively and objectively. Two experienced radiologists scored images of the two DWI methods for anatomical structures (including the internal carotid arteries, optic chiasm, pituitary stalk and pituitary gland), lesion conspicuity, susceptibility artifacts, geometric distortions and overall image quality using a five-point scale respectively. Objective parameters on the images of the two DWI methods were analyzed, including lesion size, signal to noise ratio (SNR) and apparent diffusion coefficient (ADC). The consistency of subjective scores of two radiologists was tested by Kappa test. Paired t-test, Wilcoxon signed rank test, Kappa statistics were used for statistical evaluation. Results:TGSE-BLADE-DWI performed significantly better than RESOLVE in depicting the sellar anatomical structures, lesion conspicuity, geometric distortion and overall image quality (all P<0.05). There were no significant differences in SNR, maximum longitudinal diameter of lesions and ADC of lesions between the two DWI methods(all P>0.05). The maximum transverse diameter measured by TGSE-BLADE-DWI was significantly smaller than that of RESOLVE ( Z=3.31, P=0.001). Conclusions:Compared with RESOLVE, TGSE-BLADE-DWI is superior in depicting the anatomical structures, decreasing susceptibility artifacts and geometric distortions at the sellar region and effectively improves the image quality of DWI, which has great value in clinical applications.
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Background: Sellar and parasellar/ juxtasellar regions are complex areas of the brain, hold delicate neurovascular structures. A number of diseases that affect the pituitary-hypothalamic axis can have profound clinical, endocrinological as well as neurological consequences. Aim of this retrospective study was to identify the MR imaging characteristics and epidemiology of sellar and suprasellar lesions, to correlate the MRI findings with histopathological findings and to highlight the diagnostic superiority of MR imaging.Methods: Author studied the records of 65 patients with sellar and suprasellar lesions for which preoperative MR imaging films or reports were available. Radiological appearances were correlated with intraoperative findings and post-operative histopathology.Results: Majority of patients in this study belonged to the age group 21-40 years. Most common mass lesion found was pituitary macroadenoma comprising 58% of the total cases. The accuracy of MRI in diagnosing macroadenomas are 96.80%. MR was 87.50%accurate, in diagnosing craniopharyngioma. MR was 100% in diagnosing meningioma in our study.Conclusions: MRI is the modality for characterizing sellar and suprasellar lesions, morphology of lesions, nature of contrast material enhancement and extent of lesions. Hence MRI is the modality of choice for diagnosing sellar and suprasellar masses with high accuracy
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Epidermoid cysts (ECs) of the central nervous system (CNS) constitute benign circumscribed lesions that aremore common in lateral than in midline sites. Epidermoid cysts of the CNS arise more frequently in the cerebellopontine angle, around the pons, near the sella, within the temporal lobe, in the diploe, and in the spinal canal. Most common tumoral lesion of sellar region is pituitary adenoma, and sellar cystic epithelial masses may be difficult to differentiate based only on clinical and imaging findings. Epidermoid cysts are covered by keratinized squamous epithelium and are usually filled with keratin lamellae. The process is, for the most part, maldevelopmental in origin, presumably arising from trapped surface ectodermal elements in association with the developing CNS during the closure of the neural groove or formation of the secondary cerebral vesicles. In the present study, the authors describe a case of sellar epidermoid cyst producing endocrine alterations and visual disturbance in a 35 years woman, and review the physiopathological and diagnostic criteria of this lesion.
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Humans , Female , Adult , Sella Turcica/abnormalities , Epidermal Cyst/surgery , Epidermal Cyst/physiopathology , Epidermal Cyst/diagnostic imaging , Central Nervous System CystsABSTRACT
Objective To compare lateral orbital keyhole approach(LOK) with conventional keyhole approach including supraorbital keyhole approach (SOK) and pterional approach(PTK) for exposuring the sellar region and oper-ation ability, to provide theoretical and practical basis for the clinic. Methods From January, 2017 to Feburary, 2018, 15 cadaver head specimens of Chinese (30 sides) fixed by formalin were randomly divided into 3 groups, simu-lating SOK, LOK and PTK, application of frameless neuronavigation system, intersection of the posterior margin of the optic chiasma and the lamina terminalis served as the base point. Six different reference points were selected to radi-ate into the parasellar region of the skull base. The direction of the 2 adjacent reference points were connected to the base point to form a triangle. Six triangles constituted the sellar region to represent the total area. The supratentorial area, ipsilateral area, inferior area and contralateral area were calculated by stacking triangle. The comparison was made between groups. The Salma operation exposure scale was used to simulate the aneurysms of the common parts in the brain and the quantitative scores were performed. Results The total parasellar regions by SOK, LOK and PTK respectively were:(1641.6±295.6)mm2, (1782.3±294.6)mm2 and (1552.5±307.4)mm2. There was no statistical differ-ence(P>0.05); To compare the supratentorial region, SOK and LOK were both bigger than PTK ( P<0.05); To compare the ipsilateral and infratentorial area, LOK and PTK were both bigger than SOK respectively ( P<0.05);To compare the contralateral area, SOK, LOK and PTK were increased in turn (P<0.05). Salma operation exposure scale was used to get the scores:the score of SOK was 29.7 (39.08％), LOK was 37.0 (48.68％), and PTK was 36.1 (47.50％). Conclusion Anatomical analysis displayed that the 3 keyhole approaches showed different exposure of each part the parasellar re-gions, the LOK had a good exposure to the parasellar region and so as the higher maneuverability. But the clinical appli-cation should be comprehensive analysis, pay attention to specific lesions and make an appropriate choice. It has impor-tant clinical significance to improve the prognosis of patients.
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Objective To analyze CT and MRI characteristics of sellar cystic lesions.Methods Clinical and imaging data of 83 sellar cystic lesions were retrospectively analyzed.The location,size,number of the sac,thickness of the wall and some special signs,such as mural nodules,cavernous sinus invasion were observed.Results Totally 83 patients with sellar cystic lesions including cystic pituitary adenoma (n=33),craniopharyngioma (n=28),rathke cleft cyst (n-15),dermoid cyst (n =2),epidermoid cyst (n =2),arachnoid cyst (n =2) and pituitary abscess (n =1) were enrolled.The cystic pituitary adenoma and arachnoid cyst showed low signal on T1WI and high signal on T2WI.The signal of Rathke cleft cyst and craniopharyngioma displayed complex.Dermoid cysts,epidermoid cyst and pituitary abscess exhibited high signal on DWI.There were significant statistic differences of the size,number of the sac and the wall thickness among cystic pituitary adenomas,craniopharyngiomas and Rathke cleft cysts (all P＜0.05).Conclusion Observation of imaging features,including location,shape,signal intensity,characteristics of the capsule and some special signs can improve differential diagnosis of cystic lesion of sellar region.
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Objective To evaluate the clinical and imaging features of the sellar region lesions in children.Methods The clinical and imaging features of 112 cases with sellar region lesions were analyzed retrospectively,which were confirmed by pathology.Results 37 cases were craniopharyngiomas, which had two main symptoms of intracranial hypertension(57%)and diabetes insipidus(11%).On imaging it demonstrated as a calcified cystic tumor(81%).18 cases were gliomas, the main clinical feature of which was decreased visual acuity,13 of them were pilocytic astrocytoma, which manifested as a solid tumor with significantly enhancement(94%).16 cases were germ cell tumors,the main complaint was diabetes insipidus (75%),13 of them were germinoma, which showed iso-high density on CT and moderate enhancement after administration of contrast.And it showed high signal intensity on DWI.7 cases were hamartoma,86% patients of which showed gelasmus epilepsy,the imaging showed iso-signal masses with no enhacement in the hypothalamic papillary region.5 cases were LCH,80% of which had the complaint of diabetes insipidus,imaging findings manifested as thinkened pituitary stalk and loss of hyperintensity of posterior pituitary on T1WI.3 cases were pituitary tumors.23 cases were Rathke's cleft cysts,3 cases were arachnoid cyst.Most of the patients presented with headache.Conclusion The clinical and imaging features shows some specific features, which is helpful to improve the correct rate of diagnosis and provide the basis for further treatment.
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Objective To investigate the therapeutic effect and safety of microneurosurgery associated with Gamma Knife radiosurgery on the large meningiomas in sellar region, and to clarify its clinical curative effect. Methods The clinical data of 34 patients with large meningiomas in sellar region underwent microsurgery were retrospectively analyzed.All of them underwent microsurgery,and then treated with Gamma Knife radiosurgery in one month after operation if there were residual tumors.The tumor removal of situation,complication,rate of symptom remission,and recurrence rate were analyzed.Results Among the 34 patients,total resection (7 cases of Simpson grade Ⅰ and 12 cases of Simpson grade Ⅱ)was achieved in 19 cases (55.9%),subtotal resection (Simpson grade Ⅲ )in 14 cases (41.2%), and partial resection (Simpson grade Ⅳ )was achieved in 1 case (2.9%).The major complications were cranial nerve injuries (such as oculomotor nerve, trochlear nerve and abducens nerve,n=6),the contralateral limb paresis (n = 2),postoperative bleeding (n = 1),CSF leak with infection (n=3),and secondary epilepsy (n = 3 ); no death occurred postoperatively. All these patients were followed up for about 3 to 48 months.Postoperative headache disappeared in 24 cases (80%),and 6 cases were alleviated (20%);postoperative vision improved in 12 cases (80%),remained unchanged in 2 cases (13.3%)and deteriorated in 1 case (6.7%); postoperative olfactory function improved in 5 cases (62.5%) and 3 cases unchanged (37.5%); 5 cases recoverd from the ocular motility disorder (71.4%), and 2 cases unchanged (28.6%);7 cases recoverd from thehemiplegia (100%).One of the total resection cases (5.2%)and two of the non-total resection (13.3%)suffered from tumor recurrence.All of the non-total resection cases were treated with Gamma Knife radiosurgery.Conclusion The clinical effect of microneurosurgery associated with Gamma Knife radiosurgery in treatment of large meningiomas in sellar region is satisfactory.
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La evolución de las técnicas microquirúrgicas ha permitido que los accesos transcraneales sean cada vez de menor tamaño con lo cual el tiempo quirúrgico, de estancia hospitalaria y de costos sean menores, así mismo la satisfacción estética de los pacientes es mayor por lo cual la accesibilidad de los mismos a aceptar conductas quirúrgicas es mayor. El presente estudio muestra nuestra experiencia inicial realizando la Craneotomía Mini-Supraorbitaria para acceder a lesiones de la región selar. Hemos incluido 12 pacientes que corresponde al 20% de los pacientes operados de Lesiones en la región selar en los últimos 2 años, en los cuales el seguimiento ha sido francamente favorable obteniéndose un G.O.S alto (5) en el 92% de los casos así como no haber presentado complicaciones relacionadas con el acto quirúrgico en el 92% de los casos. Los reportes en la literatura y los resultados obtenidos por nuestro equipo, demuestran que la craneotomía Mini-Supraorbitaria es un acceso que debe tenerse en mente al momento del planeamiento quirúrgico en las patologías de la región selar.
The evolution of microsurgical techniques has allowed access transcranial become increasingly smaller so that the operative time, hospital stay and costs are lower, also the aesthetic satisfaction of patients is thus greater accessibility to accept the same surgical behavior is increased. The present study shows ourinitial experience performing Mini-supraorbital craniotomy to access lesions of the sellar region. We included 12 patients corresponding to 20% of patients operated on for lesions in the sellar region in the last two years, in which the monitoring was frankly favorable GOS yield a high (5) in 92% of cases and failure to submit related complications during surgery in 92% of cases. Reports in the literature and the results obtained by our team, show that the Mini-supraorbital craniotomy access is to be borne in mind when planning surgical pathologies of the sellar region.
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Humans , Craniotomy , Anterior Cerebral Artery , NeurosurgeryABSTRACT
Introducción: La región selar es considerada por algunos autores como el tercer sitio en orden de aparición de lesiones tumorales en la cavidad craneal. Método: Se realizó un estudio descriptivo de 15 pacientes que fueron intervenidos quirúrgicamente en el Hospital Roberto Rodríguez, de la ciudad de Morón, provincia de Ciego de Ávila, Cuba, en el período comprendido entre enero de 1996 y diciembre del 2008, con el diagnóstico de tumor selar, con crecimiento supraselar dependiente o no de la silla turca, el diagnóstico fue obtenido con la tomografía axial computarizada (TAC) simple y contrastada de cráneo y silla turca, así como por imágenes de resonancia magnética nuclear (RMN). Resultados: Las principales manifestaciones clínicas al momento de la cirugía fueron la cefalea, presente en todos los casos y los trastornos visuales en 10 (66,67 por ciento), en todos se pudo demostrar crecimiento supraselar excéntrico. En seis pacientes (40 por ciento), se realizaron abordajes combinados, transcraneal-transesfenoidal o viceversa, en tiempos quirúrgicos diferentes, en otros seis (40 por ciento) solo transesfenoidal y en tres (20 por ciento) solo transcraneal. Las complicaciones fueron tres casos (20 por ciento) con anosmia, luego de un corredor bifrontal, una crisis convulsiva tónicoclónica generalizada en el post operatorio inmediato (6,67 por ciento), un sangrado transoperatorio con infarto cerebral secundario a vasospasmo cerebral (6,67 por ciento). Los resultados fueron excelentes en 10 (66,66 por ciento), en tres casos (20 por ciento) buenos, en uno (6,67 por ciento), regular y una paciente falleció (6,67 por ciento).
Introduction: The sellar region is considered the third site of brain tumors. Methods: A retrospective descriptive study was carried out in 15 patients operated on of sellar region tumor by transeptal transsphenoidal microsurgery and transcranialapproaches. Results: 10 giants pituitary adenoma by transesphenoidal or transcranial approaches, 2 craneopharyngiomas by transsphenoidal approach, 2 meningiomas and 1 dermoid tumor by transcranial approach. Complete resection was obtained in 73,33% of cases. The most frecuent complication was anosmia related with transcranial approaches. Results were excellent in 10 patients and with a mortality of 6,67%.
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Humans , Male , Female , Middle Aged , Diagnostic Imaging , Microsurgery , Pituitary Neoplasms/surgery , Pituitary Neoplasms/complications , Pituitary Neoplasms/diagnosis , Sphenoid Sinus , CubaABSTRACT
Objective To compraison the of exposure in the endonasal transsphenoidal approach to the sellar between microscope and endoscope. Methods Ten formalin-fixed, silicone-injected adult cadveric heads were studied. A direct endonasal transsphenoidal approach was performed via the right nostril, pushing aside the nasal septum, then reach the sphenoidal sinus. The approach was performed with the operating microscope first, then with the endoscope. For each step (sellar, suprasellar, parasellar and clival), the operative region afforded by direct microscopic view was measured and then compared with that obtained by using the edndoscope. Results It was found that the endoscope provided greater view than microscope in this approach. Although the microscope provides an adequate view of the midline structures and part of the contralateral parasellar areas; under direct endoscopic vision, the lateral extension could be widened by an additional 6.5 mm on the ipsilateral and 4 mm on the contralateral side. At suprasellar region, the microscope provides could expose the posterior part of, optic nerve and optic chiasma; but could not expose the areas anterior and superior the interspace superior the optic chiasma. Compare with the microscope, the endoscope allowed extension of bone removal and dual opening for an additional 4 mm anteriorly at the sagittal axis and an additional 3.5 mm on the ipsilateral and 4 mm on the contralateral side. At the clivus region, the medial surface of the vertical segment of the ICA and the basilar artery could be partially 7 exposed by the microscope. By the endoscope, it could gain an additional 4 mm on the ipsilateral side and 2.5 mm on the contralateral side in width. Because of the anatomical boundaries of the sphenoid sinus, the anatomincal exposure by the microscope same as the endocope at the sagittal axis. Conclusion The endoscope allows for a panoramic view and permits widening of the operative exposure in all directions. The endoscope is more suitable in the the minimal and expanded endonasal transsphenoial approach.
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La alta prevalencia de los macroadenomas hipofisarios en el mundo motivó la realización de esta investigación, cuyo objetivo fundamental fue demostrar el valor de la tomografía computadorizada en el diagnóstico presuntivo de la variedad histológica de los macroadenomas hipofisarios así como de otros tumores menos frecuentes de la región selar, teniendo en cuenta el cuadro clínico. Para ello se estudiaron 124 pacientes operados con el diagnóstico clínico y tomográfico de macroadenomas hipofisarios y otros tumores de la región selar. Se registró la edad, sexo, clínica, signos tomográficos, resultados anatomopatológicos posquirúrgicos. Se observó mayor incidencia de los adenomas hipofisarios (110), con predominio de los no secretores (41,1 %). El grueso de los pacientes se ubicó en las edades entre 30 y 50 años. El sexo femenino prevaleció en los adenomas adrenocorticotrópicos y los meningiomas, y el masculino en los productores de gonadotropina y prolactina. Dentro de los signos tomográficos, la erosión de las clinoides y el dorso selar, así como la hidrocefalia predominaron en los adenomas no secretores y los tumores no adenohipofisarios. Los adenomas productores de gonadotropina se destacaron en la erosión del piso y en el balonamiento selar al igual que los adrenocorticotrópicos. Las calcificaciones fueron frecuentes en los teratomas y craneofaringiomas, al igual que la captación no homogénea del contraste, la cual fue característica en estos casos como en los quistes de la bolsa de Rathke. La TC demostró ser de gran valor diagnóstico en los macroadenomas hipofisarios y otros tumores de la región selar teniendo en cuenta el cuadro clínico del paciente.
The high prevalence of hypophyseal macroadenomas worlwide motivated us to carry out this research, whose fundamental aim was to demonstrate the value of CT in the presumptive diagnosis of the histological variety of hypophyseal macroadenomas, as well as of other less frequent tumours of the sellar region, considering the clinical picture. To this end, 124 patients operated on with a clinical and tomographic diagnosis of hypophyseal macroadenomas and other tumours were studied. Age, sex, hospital stay, tomographic signs, and postsurgical anatomopathological results were registered. The highest incidence was found in the hypophyseal adenomas (110), with predominance of the non-secreting adenomas (41.1 %). Most of the patients were 30-50. The female sex prevailed in the adrenocorticotropic adenomas and meningiomas, and the male sex in gonadotropin and prolactin-producing adenomas. Within the tomographic signs the erosion of the clinoid and sellar dorsum, and hydrocephalus, predominated in the non-secreting adenomas and in the non-adenohypohyseal tumours. The gonadotropin-producing adenomas stood out in the erosion of the floor and in sellar ballooning as well as the adrenocorticotropic adenomas. The calcifications were more common in teratomas and craniopharyngiomas, as well as and the non-homogenous capture of the contrast agent, which was characteristic in these cases, as in Rathke's pouch cysts. CT showed its great diagnostic value in hypophyseal macroadenomas, and other tumours of the sellar region, taking into account the patient's clinical picture.
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Objective To study the endoscopic anatomy of operative fissures in the sellar region related to pterional key-hole approach and to provide the anatomic basis for endoscope-assisted microneuro-surgery in the region. Methods Fifteen cadaver heads were dissected via pterional key-hole approach and the five operative fissures(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ) were studied with both microscope and endoscope, by which the outcomes observed were recorded and compared. Results The basic information obtained by the pterio-nalkeyhole approach was comparable to that of the classic ptefional approach. According to the anatomic guideposts under neuroendoscope, the microstructures of the five fissures and Willis' circle would be well demonstrated. It is better to display the various anatomic structures in sellar region by neuroendoscope rather than microscope, particularly some important microstructures. Angled endoscope can be used to inspec thidden but important structure behind the arteries and nerves. Conclusion According to the anatomic guideposts, an endoscopy can be used to enhance the visible field of an operative microscope related to pterional key-hole approach. The endoscope-assisted microsurgery can reduce complications and injury of the important structures and increase the curative effect on the lesions in the sellar region.
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OI To research the new interhemispheric approach treatments of removing different large or huge sellar region tumor. Methods To remove 36 cases of different infiltrated-growth large or huge sellar region tumors by interhemisphefic approach microsurgery. Results In the 36 cases, total removal was achieved in 29, subtotal in 5 and most-partly in 2, and without any severe complications or death occured. 12 in 18 functional pituitary adcnoma were followed up, 10 cases got recovery on hormone level, and the level in 2 cases reduced ob ously. 2 cases recurred, both received γ-knife treatment. Conclusion The new interhemispheric approach surgery is important for large or huge invasive sellar region tumor.
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Objective To discuss the methods of treatment of sellar region tumors by microsurgery via modified transpterional approach.Methods The clinical data of 326 patients with sellar region tumors were retrospectively analyzed. All of the patients(of them 158 patients with pituitary adenomas, 89 patients with craniopharyngiomas and 79 patients with meningiomas)were treated by microsurgery via modified transpterional in our hospital in recent 4 years. The most important part of preoperative arrangement was giving glucocorticoid and anti-epilepsy drugs. Modified transpterional craniotomy was performed, and the tumors were removed by employing microsurgical techniques via the 5 anatomy interspaces in sellar region after the subarachnoid cisterns were dissected carefully under surgical microscope. Consciousness, urine volume and serum electrolyte of the patients were observed strictly after surgery, and the complications such as diabetes insipidus, serum electrolyte disorder and epilepsy were remedied in time.Results The rate of intact frontal branch of facial nerve was 92.18% and that of intact supraorbital nerve was 95.72%. Atrophy of temporal muscle occurred in none of the patients. Total and/or subtotal resection of tumors was achieved in 95.26% patients and the rate of intact pituitary stalk was 62.44%. The major postoperative complications included diabetes insipidus and serum electrolyte disorder. Although the incidence of complications was high to 61.42%, complete restore was achieved in 97.12% of the patients with the complications within 1 month.Conclusion The modified transpterional approach for sellar region tumors may give a lower incidence of damage to frontal branch of facial nerve, super-orbital nerve and temporal muscle, and it can achieve higher total resection rate and a less postoperative complications by employing modified transpterional approach and the microsurgical techniques, combined with the active treatments of postoperative complications, therefore it is deserved to be spread to use in clinical works.
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Objective To investigate the anatomy of the skull base for minimally invasive keyhole approach to sellar lesions.MethodsSixty-seven samples of adult skull bone(134 sides) were collected and sawed at the levels of the supraorbital arch and anterior skull base.After inspecting the opening of the frontal sinus,we observed the appearance of the orbit roof(cerebral juga),and measured the maximum height of the two cerebral jugas.Afterwards,the operation distances and angles with regard to the anterior and posterior clinoid processes through the trans-upper orbit,trans-lateral front,trans-pterion,and trans-sub-temple keyhole approaches in 15 skull bone samples were measured.And then,we statistically analyzed the variance in these measurements among the four operative approaches.ResultsOf the 67(134 sides) adult skull bone samples,52 sides showed frontal sinus openness(38.8%,52/134).Most of the skull bases were clawed(multicuspidity or oblique ridge multicuspidity).The maximum height of the cerebral juga that was less than 2.50 mm was found in 36 sides(26.9%),and over 2.51 mm in 98 sides(73.1%).Among the four methods,the shortest distances between the keyhole and the anterior and posterior clinoid processes were found in the trans-sub-temple keyhole approach [(4.87?0.47) cm and(4.93?0.45) cm],and the longest were observed in the trans-lateral front keyhole approach[(6.45?0.30) cm and(7.83?0.54) cm],and trans-upper orbit keyhole approach[(6.47?0.28) cm and(8.31?0.34) cm].The angle between the sagittal section and the keyhole in the trans-lateral front keyhole approach [(40.83?1.11) ? and(37.86?1.37)?] was larger than that in the trans-upper orbit one [(10.23?0.90) ? and(12.29?0.86)?],while the angle between the cross section and the keyhole in the trans-sub-temple keyhole approach [(21.21?0.45) ? and(20.10?0.63)?] was larger than that in the trans-pterion one [(5.49?0.30)? and(9.84?0.58)?].ConclusionsThe size of the frontal sinus,shape and height of the cerebral juga,depth of the skull base operation,and angle between the operational and the skull base planes play important roles in the selection of minimally invasive keyhole approach for sellar lesions.
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The authors described a case of tuberculous brain abscess, located on the sellar area with as episode of tuberculous meningitis on the past history. Tuberculous brain abscess, encapsulated collection of pus, is quite rare. Especially, occurrence around the sellar area is extremely rare. On brain CT scan, tuberculous brain abscess on sellar region was differented from pituitary adenoma, craniopharyngioma, germinoma, pyogenic brain abscess, etc. The history of previous tuberculous meningitis was meaningful for the diagnosis of our case. So, we have reported this case with review of the articles.