ABSTRACT
Objective:To evaluate the clinical effect of anterior clinoid process grinding in the treatment of ophthalmic / superior clinoid process aneurysms and sellar tumors.Methods:The clinical data of 16 patients who underwent anterior clinoid process grinding in Sanbo Brain Hospital, Capital Medical University from January 2015 to July 2021 were analyzed retrospectively. There were 1 patient with recurrent craniopharyngioma, 1 patient with recurrent pituitary adenoma, 13 patients with aneurysms, and 1 patient with suprasellar granulosa cell tumor combined with ophthalmic aneurysm of right internal carotid artery. The Modified Rankin Scale (mRS) score was used to evaluate the situation at discharge and in the medium-and-long term.Results:Sixteen patients underwent anterior clinoidprocess grinding. At discharge and the latest follow-up, the mRS scores of the patients were 0-2. A total of 15 aneurysms were treated, and there were no symptoms of visual loss or visual field defect after operation. No cerebrospinal fluid leakage occurred in all patients.Conclusions:The grinding of anterior clinoid process can effectively and fully stretch the optic nerve and internal carotid artery, and can observe the tumor neck at the lower end of pituitary stalk and the ocular segment/superior clinoid process of internal carotid artery under direct vision. It is one of the important auxiliary methods for the treatment of sellar lesions.
ABSTRACT
Objective To investigate the effect of growth hormone replacement therapy on life quality of patients with growth hormone deficiency after sellar tumor surgery.Methods The data of 13 patients undergoing sellar tumor resection and suffering postoperative hypopituitarism from Jun.2009 to Dec.2010.were collected.Each of them was given daily 0.5 units growth hormone (about 0.17 mg) as replacement therapy.The life quality of patients at different time points was evaluated with QoL-GDHA scale.SPSS 17.0 software was used for statistical analysis.Results 1,3,and 6 months after treatment,QoL-GDHA score of the patients was 3.91± 2.29,3.38 + 2.43,and 3.23 + 2.28 repectively,significantly lower than before ( 8.69 ± 2.66).The difference had statistical significance (P ＜0.05 ).Conclusion Growth hormone replacement therapy can significantly improve the life quality of patients with hypopituitarism after sellar tumor surgery.
ABSTRACT
INTRODUCTION: Activating mutations in exon 3 of the β-catenin gene are involved in the pathogenesis of adamantinomatous craniopharyngiomas. Recently, the interaction between β-catenin and PROP1 has been shown to be responsible for pituitary cell lineage determination. We hypothesized that dysregulated PROP1 expression could also be involved in the pathogenesis of craniopharyngiomas OBJECTIVES: To determine whether dysregulated gene expression was responsible for tumor pathogenesis in adamantinomatous craniopharyngiomas, the β-catenin gene was screened for mutations, and the expression of the β-catenin gene and PROP1 was evaluated. β-catenin gene was amplified and sequenced from 14 samples of adamantinomatous craniopharyngiomas. PROP1 and β-catenin gene expression was assessed by real-time RT-PCR from 12 samples, and β-catenin immunohistochemistry was performed on 11 samples. RESULTS: Mutations in the β-catenin gene were identified in 64 percent of the adamantinomatous craniopharyngiomas samples. Evidence of β-catenin gene overexpression was found in 71 percent of the tumors with β-catenin mutations and in 40 percent of the tumors without mutations, and β-catenin immunohistochemistry revealed a nuclear staining pattern for each of the analyzed samples. PROP1 expression was undetectable in all of the tumor samples. CONCLUSION: We found evidence of β-catenin gene overexpression in the majority of adamantinomatous craniopharyngiomas, and we also detected a nuclear β-catenin staining pattern regardless of the presence of a bcatenin gene mutation. These results suggest that WNT signaling activation plays an important role in the pathogenesis of adamantinomatous craniopharyngiomas. Additionally, this study was the first to evaluate PROP1 expression in adamantinomatous craniopharyngiomas, and the absence of PROP1 expression indicates that this gene is not involved in the pathogenesis of this tumor, at least in this cohort.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , Craniopharyngioma/genetics , Homeodomain Proteins/genetics , Pituitary Neoplasms/genetics , beta Catenin/genetics , Craniopharyngioma/pathology , DNA Mutational Analysis , Gene Expression , Pituitary Neoplasms/pathology , Signal Transduction/genetics , Transcriptional Activation/genetics , Wnt Proteins/geneticsABSTRACT
Objective To study the feasibility of trans-supraorbital keyhole approach microsurgery for sellar tumors.Methods The operation was conducted under combined intravenous general anesthesia and the patient was maintained at a dorsal position.A skin incision was made along the lateral eyebrow at 3.5~4.0 cm in length.The frontal muscle periosteous flap was draged upwards and the orbicularis muscle periosteous flap was dragged downwards.Then the tempotal muscle was dragged laterally.The position of the keyhole was located behind the temporal line.By using a milling cutter,a bone window 2 cm ? 3 cm in size was made medially.The inner margin of the supraorbital skull was shaped to expand the visual field of microsurgery.The cerebral dura mate was opened curvily,with the base directing to the orbital margin.The frontal lobe was elevated gently and the cerebrospinal fluid was drained.The tumor was fully exposed and resected.Results Total resection of tumor was achieved in 22 cases,and part of posterior tumor membrane remained in 2 cases of craniopharyngioma.Hypoadrenocorticism occurred in 1 case of ACTH adenoma after operation and a hormone replacement therapy was required. Temporary postoperative diabetes insipidus occurred in 8 cases and was relieved after 1 week.The postoperative urinary volume decreased significantly in 9 cases of preoperative diabetes insipidus.Visual disorder on the operational side was aggravated after operation in 1 case of tuberculum sellae meningioma,and was gradually improved after 1 week.No recurrence was observed under MRI examination in 18 cases at 3 months after operation.Conclusions Trans-supraorbital keyhole approach microsurgery is feasible,and it gives minimal operational trauma,thorough resection of tumor,and good cosmetic outcomes.
ABSTRACT
Objective To discuss the technique of supraorbital transeyebrow keyhole approach microsurgery for sellar tumors. Methods A total of 33 cases of sellar tumors were treated in this hospital from July 2001 to June 2004. The resection of the tumor was achieved by way of a supraorbital eyebrow minicraniotomy through a 2.0 cm ? 3.0 cm keyhole approach. The surrounding cisterns of the sellar area were opened to expose underlying structures under microscope at proper angles. Results Of 26 cases of hypophysoma, a total resection was performed 19 cases, and a subtotal resection in 7 cases. Of 4 cases of craniopharyngioma, a total resection was performed 3 cases, and a subtotal resection, 1 case. One case of meningioma received a total resection, and 1 case of optic chiasm glioma underwent a partial resection. Postoperatively, transitory diabetes insipidus was observed in 5 cases, and grand mal epilepsy occurred in 1 case. There were no infection or bleeding after the operation. All the 33 cases were followed for 4~36 months (mean, 27 months). No recurrence of tumors was seen in the 24 cases of total resection. Postoperative radiotherapy was given in 7 cases of subtotal resection of hypophysoma, 1 case of craniopharyngioma, and 1 case of optic chiasm glioma, and no apparent enlargement of tumors was found. Conclusions Supraorbital transeyebrow keyhole approach microsurgery minimizes the unnecessary exposure of the brain and postoperative complications.