ABSTRACT
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.
Subject(s)
Humans , Female , Adult , Sella Turcica/abnormalities , Epidermal Cyst/surgery , Epidermal Cyst/physiopathology , Epidermal Cyst/diagnostic imaging , Central Nervous System CystsABSTRACT
RESUMEN Introducción: diversos autores reflejan que la morfología de la silla turca constituye un factor predisponente para algunas enfermedades. Por ejemplo, se considera que existe correlación entre la morfología de esta estructura anatómica y varias patologías; como el síndrome de la silla turca vacía, síndrome de Williams, paladar hendido, entre otras. Objetivo: describir las variaciones anatómicas de la silla turca que se observan en las radiografías laterales de cráneo del Hospital Universitario "Faustino Pérez" de la ciudad de Matanzas, en el período de enero del 2017 a enero del 2018. Materiales y métodos: el universo fue 140 radiografías laterales de cráneo, de estas 85 pertenecieron al sexo femenino y 55 al masculino. Las variables estudiadas fueron edad, sexo y variaciones anatómicas de la silla turca. Se emplearon métodos teóricos y empíricos. Resultados: se observó un predominio de la variación anatómica de la silla turca en forma de U, en ambos sexos. Seguido de la forma de J, predominando la variación en forma de U en el grupo etario de 41 a 50 años y la forma de J en los pacientes mayores de 60 años. Conclusiones: es imprescindible el conocimiento de la anatomía normal de la silla turca y de sus variaciones anatómicas, tanto para las especialidades quirúrgicas como para las no quirúrgicas. Un análisis exhaustivo de la morfología de esta estructura es necesario para establecer parámetros que excluyan determinadas patologías.
ABSTRACT Introduction: several authors declare that sella turcica morphology is a predisposing factor to several diseases. For example, it is considered that there is a correlation between the morphology of this anatomical structure and several pathologies like empty sella turcica syndrome, Williams syndrome, cleft palate and others. Objective: to describe the anatomical variants of sella turcica observed in side cranial radiographies of the University Hospital ¨Faustino Perez¨ of Matanzas, in the period January 2017-January 2018. Materials and methods: the universe was 140 side cranial radiography: 85 belonged to female patients and 55 to male patients. The studied variables were age, sex and sella turcica anatomical variables. Theoretic and empirical methods were used. Results: it was observed a predominance of the U-shaped sella turcica anatomical variant in both sexes, followed by the J-shaped one. The U-shaped form predominated in the 41-50-years-old age-group and the J-shaped form in patients elder than 60 years. Conclusions: it is essential to know sella turcica normal anatomy and its anatomical variables, both for the surgical specialties and for the non-surgical ones. It is necessary the exhaustive analysis of this structure to establish parameters excluding several pathologies.
Subject(s)
Humans , Adult , Aged , Sella Turcica/abnormalities , Sella Turcica/pathology , Sella Turcica/diagnostic imaging , Stomatognathic Diseases/diagnosis , Stomatognathic Diseases/epidemiology , Williams Syndrome/epidemiology , Williams Syndrome/diagnostic imaging , Empty Sella Syndrome/epidemiology , Empty Sella Syndrome/diagnostic imaging , Endocrine System Diseases/diagnosis , Endocrine System Diseases/epidemiology , Epidemiology, Descriptive , Causality , Anatomy, Cross-Sectional , Genetic Predisposition to Disease , Observational StudyABSTRACT
Introduction Aneurysmal bone cysts (ABCs) are pseudotumoral bone lesions of unknown etiology that are also hypervascularized, benign, and locally destructive. They are rare in the base of the skull. The present case report describes a case of aneurysmal bone cyst in the sella turcica. Case Report The present study was developed at the department of neurosurgery of the Hospital Universitário Professor Alberto Antunes of the Universidade Federal de Alagoas (HUPAA-AL, in the Portuguese acronym), Maceió, state of Alagoas, Brazil, and is accompanied by a review of the literature from the PubMed database. A 17-year-old female patient with bitemporal hemianopia and intense left hemicranial headache associated with symptoms from the cranial nerves contained in the cavernous sinus. Neuroimaging evidenced a large lesion in the suprasellar region with calcification foci, sellar erosion, and extension to the cavernous sinus. The patient was submitted to a partial lesion resection and the histopathological analysis showed an aneurysmal bone cyst. Conclusion A rare case of intracranial aneurysmal bone cyst, with the important differential diagnosis from pituitary adenoma.
Subject(s)
Humans , Female , Adolescent , Sella Turcica/abnormalities , Sella Turcica/injuries , Bone Cysts/surgery , Bone Cysts, Aneurysmal/diagnostic imaging , Skull Base Neoplasms/diagnosis , Diagnosis, DifferentialABSTRACT
Anatomical variations in the shape and dimension of the dorsum sellae and posterior clinoid process are common. Most textbooks describe its shape as a median rectangular plate, a square plate, or a transverse ledge on a slope behind the sella turcica (hypophyseal fossa). This work aims to study the dorsum sellae of human skull. One hundred and twenty five dried adult human skulls, irrespective of age, were used for the study. Detailed features of the dorsum sellae were noted and classified into five types: crest like, thin plate, frail quadrilateral plate, heavy square plate, thick elongated plate. Fusion of the posterior and middle clinoid processes in one (unilateral) and all the clinoid processes (anterior, middle, and posterior) in three skulls (unilateral in one, bilateral in two) were also noticed. Findings are discussed in the light of the literature.
Son frecuentes las variaciones anatómicas de la forma y dimensión de dorsum sellae y de los procesos clinoides posteriores. La mayoría de los textos describen su forma como una placa rectangular mediana, una placa cuadrada, o un plano transversal en una pendiente detrás de la sella turcica (fosa hipofisaria). Este trabajo tiene como objetivo estudiar el dorsum sellae en cráneo humano. Para el estudio se utilizaron 125 cráneos humanos adultos secos, de diferentes edades. Se observaron características detalladas de dorsum sellae y se clasificaron en cinco tipos: cresta, al igual que la placa delgada, lámina cuadrilátera, placa cuadrada gruesa, placa alargada gruesa. En tres cráneos se observó fusión de la parte posterior y los procesos clinoides intermedios (unilateral) y los procesos clinoides (anterior, medio y posterior) (unilateral en uno de ellos, bilateral en dos). Los resultados se discuten en consideracion de la literatura.
Subject(s)
Humans , Anatomic Variation , Sella Turcica/abnormalities , Sella Turcica/anatomy & histology , Cephalometry , Sphenoid Bone/abnormalities , Sphenoid Bone/anatomy & histologyABSTRACT
The purpose for the present study was to determine the frequency of sella turcica bridge and clinoid enlargement on lateral cephalometric plain film radiography from peruvians patients who attended our radiological center and identify any possible genre or age group associations. The sella turcica from 417 lateral cephalometric plain film radiography was evaluated in order to determine the presence of sella turcica bridge (fusion between the anterior and posterior clinoid process) or clinoid enlargement related to the Sella (S) cephalometric point. The sella turcica bridge and clinoid enlargement frequency was 4.31percent (n=18), and 16.3 percent (n=68). Cramer´s V and ETA statistics found, by separately, non significant association (p > 0.05) between sella turcica bridge and clinoid enlargement with respect to sex, and age groups (under 18 and over 18). The sella turcica bridge and clinoid enlargement are not so infrequent findings in the population studied, our results are similar to those reported in the literature. The existence of a sella turcica bridge or a clinoid enlargement must be considered as a structural anomaly that may influence the prognosis of surgical procedures of the sella turcica.
El propósito del estudio fue determinar la frecuencia de puente selar y alargamiento clinoideo en radiografías laterales cefalométricas de pacientes peruanos que asistieron a nuestro centro radiográfico entre enero a mayo del 2011 e identificar posibles asociaciones de sexo ó edad. El área de la silla turca de 417 radiografías cefalométricas laterales fue evaluada para determinar la presencia de puente selar (fusión entre los procesos clinoides) o alargamiento de los procesos clinoides anterior o posterior en relación con el punto cefalométrico Sella (S). La frecuencia de puente selar fue de 4.31por ciento (n=18), la frecuencia de alargamiento clinoideo fue de 16.3 por ciento (n=68). Los análisis estadísticos V de Kramer y ETA no encontraron asociación significativa entre el puente selar y alargamiento clinoideo con respecto al sexo y a la edad (p>0.05). El puente selar y el alargamiento clinoideo no son hallazgos radiográficos tan infrecuentes en la población estudiada; nuestros resultados son similares a los encontrados en la literatura. La presencia del puente selar y alargamiento clinoideo debe tenerse en cuenta como una anomalía estructural que puede influir en el pronóstico de los procedimientos quirúrgicos en la zona de la silla turca.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child, Preschool , Child , Young Adult , Middle Aged , Calcinosis , Cephalometry , Ossification, Heterotopic , Sella Turcica/abnormalities , Sella Turcica , PeruABSTRACT
Septo-optic dysplasia (SOD), also referred to as de Morsier syndrome, is a rare congenital condition, characterized by two of the classic triad features: midline brain abnormalities, optic nerve hypoplasia (ONH) and pituitary endocrine dysfunction. We report 5 children with SOD, originally referred to be evaluated due to short stature, who also presented bilateral optic nerve hypoplasia, nystagmus and development delay. In 4 of the patients, we identified neuroimaging abnormalities of the hypothalamo-pituitary axis such as anterior pituitary hypoplasia (3/5), ectopic posterior pituitary (4/5), thin or absent stalk (3/5) and empty sella (1/5). We also encountered diverse pituitary deficiencies: growth hormone (3/5), adrenocorticotropic hormone (3/5), thyroid-stimulating hormone (2/5) and antidiuretic hormone (1/5). Only one child presented intact pituitary function and anatomy. Although rare, SOD is an important cause of congenital hypopituitarism and it should be considered in children with optic nerve hypoplasia or midline brain abnormalities for early diagnosis and treatment.
A displasia septo-óptica (DSO, síndrome de Morsier) é uma condição congênita rara definida por dois critérios da tríade: defeitos de linha média, hipoplasia de nervo óptico e insuficiência hipotálamo-hipofisária. Descrevemos 5 casos de DSO, encaminhados por baixa estatura, com hipoplasia dos nervos ópticos, nistagmo e atraso global do desenvolvimento. Destes, 4 possuem alteração na ressonância magnética de sela túrcica e insuficiência hipotálamo-hipofisária, tendo sido observada adeno-hipófise hipoplásica (3/5), neuro-hipófise ectópica (4/5), haste afilada/ausente (3/5) e sela vazia (1/5), além de déficit dos eixos somatotrófico (3/5), adrenocorticotrófico (3/5), tireotrófico (2/5) e do hormônio antidiurético (1/5). Apenas um paciente não apresenta alteração anatômica ou funcional do eixo hipotálamo-hipofisário. Embora rara, a DSO é causa importante de hipopituitarismo congênito, devendo ser considerada em crianças com hipoplasia de nervo óptico ou defeito de linha média para seu diagnóstico e tratamento precoces, evitando seqüelas graves.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Hypopituitarism/diagnosis , Hypothalamo-Hypophyseal System/pathology , Sella Turcica/abnormalities , Septo-Optic Dysplasia/diagnosis , Hypopituitarism/etiology , Magnetic Resonance Imaging , Septo-Optic Dysplasia/complicationsABSTRACT
A 43-year-old woman presented with headache, nausea, severe visual impairment and galactorrhea and decreased visual acuity. A 4 x 3.5 x 3 cm mass completely filling the sphenoid sinus, elevating the pituitary gland and stalk was observed. The patient underwent transsphenoidal removal of the lesion to alleviate visual loss. The tumor cells showed strong positivity for thyroglobulin and TTF-1. This patient was followed up for 2 years after the operation; the laboratory study and computed tomography showed no lesions. In conclusion, this is a rare benign finding in which complete surgical resection achieves a cure
Subject(s)
Humans , Female , Thyroid Gland/embryology , Choristoma/diagnosis , /diagnosis , Sella Turcica/abnormalities , Sella Turcica/surgery , Cytological Techniques/statistics & numerical data , Vision, Low/etiology , Pituitary Gland/abnormalities , ThyroglobulinABSTRACT
Entre cerca de 400 radiografias convencionais de seios paranasais foram encontrados 3 casos (menos de 1%) de duplo contorno e aumento de volume de sela túrcica: um secundário a adenoma (prolactinoma) hipofisário e dois por "síndrome da sela vazia". Enfatiza-se a necessidade de investigar esses achados casuais em rdiografias de seios paranasais, täo rotineiras ao otorrinolaringologista