Sporadic Hemangioblastoma in the Pituitary Stalk: A Case Report and Review of the Literature

Hemangioblastomas in the pituitary stalk are especially rare. Most pituitary stalk hemangioblastomas reported in the literature were associated with von Hippel-Lindau (VHL) disease. Here, we report only the 3rd case of sporadic pituitary stalk hemangioblastoma diagnosed in a 60-year-old woman. Despite the danger of potential complications due to excessive vascularity or proximity to important neural structures, the tumor in our case was successfully removed while preserving pituitary function. In this case, complete surgical excision was shown to be an effective treatment option for symptomatic pituitary stalk hemangioblastoma, and we suggest careful evaluation of any highly enhancing mass with a signal void in the pituitary stalk preoperatively, even if no VHL disease is evident.

Steroid-induced Spinal Epidural Lipomatosis after Suprasella Tumor Resection

Spinal epidural lipomatosis (SEL) is an abnormal localized accumulation of fat tissues in the epidural space. It is strongly related with steroid administration. The symptoms of SEL are various and range from back pain to paraplegia. In severe cases, decompressive laminectomy is the choice of treatment. A 32-year-old woman who had been under long-term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness. She was diagnosed with SEL and had a decompressive laminectomy. During the operation, we found the nerve roots were compressed by epidural fat tissues and engorged vessels. After the operation, her radiating pain was relieved and motor weakness was improved.

Bromocriptine for Control of Hyperthermia in a Patient with Mixed Autonomic Hyperactivity after Neurosurgery: A Case Report

Mixed autonomic hyperactivity disorder (MAHD) among patients with acquired brain injury can be rare. A delayed diagnosis of MAHD might exacerbate the clinical outcome and increase healthcare expenses with unnecessary testing. However, MAHD is still an underrecognized and evolving disease entity. A 25-yr-old woman was admitted the clinic due to craniopharyngioma. After an extensive tumor resection, she complained of sustained fever, papillary contraction, hiccup, lacrimation, and sighing. An extensive evaluation of the sustained fever was conducted. Finally, the cause for MAHD was suspected, and the patient was successfully treated with bromocriptine for a month.

Cupped disc with normal intraocular pressure: The long road to avoid misdiagnosis.

We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important differential diagnosis of NTG. Diagnosis of NTG should be by exclusion. Here the possible causes of misdiagnosis are discussed. We present an approach to distinguish glaucomatous from nonglaucomatous optic neuropathy. The article also emphasizes how important it is for the clinicians to consider the total clinical picture, and not merely the optic disc morphology, to avoid the mismanagement of glaucoma, especially the NTG.

Study on the Turnover and Treament of Postoperative Residues of Giant Nonfunctioning Pituitary Adenoma with Suprasellar Extension(SSE) / 中国肿瘤临床

Objective: To explore the turnover and treament of postoperative remainder of giant nonfunctioning pituitary adenoma with suprasellar extension(SSE). Methods: The clinical data of 68 cases suffering from giant nonfunctioning pituitary adenoma with suprasellar extension(SSE)admitted into our department were retrospectively analyzed.These patients underwent primary transsphenoidal surgery. Results: Twenty cases had SSE adenomas totally removed(20.6%).In other 48 cases(79.34%)，SSE residues were shown in MRI recheck at one day after surgery.After 3 months，the 3rd MRI scanning was performed only to find that tumor residues descended to sellar floor in 21 cases,into intrasella in 8 cases，and down to the level of stalk hypophysial and the entrance to the sella in 3 cases.All of Patients with residual tumors received retranssphenoidal resection(the total removal rate of desending SSE residues was 96.9%).There were 2 cases with adenoma residues with slight descending.Obvious SSE adenomas were treated with transtranial approach.The twelve cases with small SSE residues were consecutively observed and two of them received gamma knife treatment because of unobvious postoperative visual improvement.The surgical mortality was 0%.There was no death during follow up in all of these patients.There were no cases with rhinorrhea.meningitis or visual deterioration.Two patients had supradiaphragmatic bleeding detected by routine postoperative CT. Conclusion: Staged surgery with two or multiple transsphenoidal resections is an appropriate treatment for giant nonfunctioning pituitary adenoma with supresellar extension(SSE)，with few complications.Futher study is warranted to investigate the growth pattern of pituitary adenoma.

Craniopharyngioma : A review of 14 cases at Siriraj Hospital.

Objective: 1) To characterize clinical presentations of craniophryngioma in the hypothalamic- pituitary region. 2) To examine both pre-treatment and post-treatment endocrine dysfunction of patients with craniopharyngioma. Methods: Medical records of patients with craniopharyngiomas from the Endocrine Division, Department of Medicine from 1997 to 2005 (9 years) were retrospectively reviewed. Data were expressed as mean+ SD (range) or percent as appropriate. Results: There were 14 cases (7 males and 7 females) with histological-proven diagnosis of craniopharyngioma. Their mean age was 32.3 + 13.0 years (15-56). The major distinguishing feature leading to diagnosis was visual field defects (85.7%), and a quarter of them were blind. Other distinguishing symptoms were headaches (78.6%), and menstrual disorders (28.6%). Pre-operative evaluations of their pituitary function revealed hypogonadotropic hypogonadism (55.6%), diabetes insipidus (DI) (42.9%), secondary adrenal insufficiency (18%) and elevated prolactin levels (36.4%) with a mean level of 36.1+39.2 ng/ml (12-138). All tumors were confirmed by pituitary CT or MRI. Mean tumor size was 3.83+1.3 cm. (2-6), and hydrocephalus was found in 54.5% of all patients. Craniotomy was performed in 13 cases with one transphenoidal surgery. Post-operative endocrine evaluations revealed more frequent hypogonadotropic hypogonadism (90%), both secondary adrenal insufficiency and diabetes insipidus (85.7%). 50% of DI cases were permanent DI. Secondary hypothyroidism was found post-operatively (78%). All cases of elevated serum prolactin levels became normal post-operatively and 44% of all patients had visual field improvement within a follow up period of 2.1+2.3 years (0-7). Conclusion: Craniopharyngioma is associated with high morbidity pre and post-operation. Visual field tests should be carefully evaluated in all patients with headaches to make early diagnosis in order to improve the treatment outcome.

Clinical Study of Intra- and Suprasellar Tumor

Tumorous lesion of intra- and suprasellar area showed unique clinical pictures and also was very hazardous and difficult to remove surgically because of the surrounding important anatomical structures. Here, authors analyzed 28 confirmed tumor of this area during last two and half years retrospectively. Histopathologically, 28 cases were classified in 14 pituitary adenoma cases(6 cases of nonfunctioning adenoma, 1 GH-secreting adenoma and 7 cases of prolactinoma), 7 craniopharyngioma cases, 3 meninigioma cases and each one case of germinoma, Rathke's cleft cyst, pituitary abscess and hamartoma. Sexual incidence was 6:22 in male vs female ratio. Twenty two cases were measured its diameter over 2cm and they extended to suprasellar area in all cases. Five cases of microadenoma were analyzed and they were all enclosed in sella turcica. Visual impairment was the most frequent and prominent clinical symptom, of which incidence was 78.57%(22 cases). The next frequent symptoms were headache and generalized lethargy. Diabetes insipidus was a presenting symptom in 4 cases and hydrocephalus was noted in 4 cases preoperatively. Surgical intervention was carried out in 23 cases, by the way, the performed type of surgery in 21 cases was a conventional transcranial frontotemporal(pterional) microsurgical method. Post-operatively, diabetes insipidus was complicated in 78.26% and pituitary hypofunction was noted 34.78%. Two cases of intracranial hemorrhage was developed after surgery and one was died. Through 6 to 28 months follow up, 82.1% of cases were improved in its clinical status including 7 cured cases.