Meningioma del Tubérculo Selar: Foraminotomía Óptica Precoz Por Vía Pterional Transsilviana / Sellar Tubercle Meningioma: Early Optic Foraminotomy By Transsylvian Pterional Route

Introducción: Los meningiomas constituyen aproximadamente el 10-15%1 de las neoplasias cerebrales, y el 7% de ellos presentan una inserción supraselar. Los meningiomas del tubérculo selar presentan adherencia en este, en el surco quiasmático o en el limbo esfenoidal2,3. Descripción del caso: Mujer de 45 años que consulta por cefalea y déficit severo de la visión del ojo izquierdo, constatado por campimetría visual. En RM se observa imagen extraaxial, en relación al tubérculo selar, con lateralización hacia la izquierda, ingresando al conducto óptico de ese lado. Se realizó abordaje pterional izquierdo, con acceso transsilviano a las cisternas óptica y carotídea izquierdas. Se individualiza la lesión color parduzca en el espacio interóptico, que desplaza hacia lateral y superior el nervio óptico izquierdo. Se retira duramadre que cubre el techo del conducto óptico y luego con fresa diamantada se descomprime4 el mismo de modo precoz, antes de la disección microquirúrgica del meningioma. Con aspirador ultrasónico se lleva a cabo el vaciamiento intratumoral, y luego separamos la capsula tumoral de la aracnoides y las estructuras neurales y vasculares. Luego de la exéresis completa de la lesión, se retira duramadre del tubérculo selar y se realiza fresado del mismo para evitar recurrencias en el sitio de implantación. Resultados: En RM postoperatoria se observa resección completa de la lesión; además la paciente refiere mejoría notoria de su visión que se constata en examen físico. Se confirma dicha mejoría en campimetría visual a los 3 meses postoperatorios. Conclusión: La descompresión precoz del conducto óptico en los meningiomas del tubérculo selar es una maniobra quirúrgica útil para prevenir una mayor lesión del nervio durante la extirpación del tumor; además permite resecar fragmentos intracanaliculares.

Introduction: Meningiomas constitute approximately 10-15%1 of the brain neoplasms and 7% of them present a suprasellar insertion. The meningiomas of the sellar tubercle present adherence in its, in the chiasmatic sulcus or sphenoid limbus2,3. Case description: A 45-year-old woman consulted for headache and severe vision deficit of the left eye, confirmed by visual field campimetry. In MRI an extraaxial image is observed, in relation to the sellar tubercle with lateralization to the left, entering the optic canal. A left pterional approach was performed, with transsylvian access to the left optic and carotid cisterns. The brownish lesion is individualized in the interoptic space, which displaces laterally and superiorly the optic nerve. The dura mater that covers the roof of the optic canal is removed at the beginning of the surgery, and then, with a diamond bur, the optic canal is decompressed4, before the microsurgical dissection of the meningioma. With an ultrasonic aspirator, the tumor debulking is carried out, and then the tumor capsule was separated from the arachnoid and the neural and vascular structures. Finally, the duramater of the tuberculum sellae was removed and the tubercle was drilled to avoid recurrences at the implantation site. Results: In a postoperative MRI, complete resection of the lesion was observed. The patient reported a noticeable improvement in her vision that was confirmed by a physical examination. Confirming this improvement in visual field campimetry was done 3 months postoperatively. Conclusion: Early decompression of the optic canal is essential to avoid further injury during tumor removal of a tuberculum sellae meningioma, as well as allowing the resection of intracanalicular fragments.

Hypopituitarism Secondary to an Arachnoid Cyst ­ Case Report

Arachnoid cysts (ACs) are a rare condition of mass effect injury and are usually found in the Sylvian fissure. However, rarely, they can appear in the sellar area, causing symptoms of compression. Due to the mass effect, the sellar arachnoid cyst (SAC) may cause headaches, visual disturbances, hypopituitarism, precocious puberty, and the "bobble-head doll" syndrome. We present the case of JNS, 61 years old, male. The patient presented with hypotestosteronism, hypothyroidism, hypocortisolism and bitemporal hemianopsia. The magnetic resonance imaging scans revealed a mass above the pituitary gland, compatible with a SAC. A surgical excision was performed with removal of the capsule and fenestration within the subarachnoid spaces for emptying the cyst. After the procedure, the patient presented great clinical improvement. The rarity of the case calls attention to the fact that SACs should be thought of as a differential diagnosis in cases of hypopituitarism.

Cistos aracnoides são uma condição rara de lesão de efeito de massa e que comumente aparecem na região da fissura silviana. No entanto, raramente, podem aparecer na região selar, ocasionando sintomas de compressão. Devido ao efeito de massa, podem causar dores de cabeça, distúrbios visuais, hipopituitarismo, puberdade precoce e síndrome da "bobble-head doll. " Apresentamos o caso de JNS, 61 anos, do sexo masculino. Paciente com hipotestosteronismo, hipotiroidismo, hipocortisolismo e hemianopsia bitemporal. As imagens de ressonância magnética (RM) revelaram uma massa acima da hipófise, mostrando um cisto aracnoide selar. O paciente foi submetido a excisão cirúrgica com fenestração dentro dos espaços subaracnoides para esvaziamento do cisto e apresentou grande melhora clínica após o procedimento. A raridade deste caso chama atenção para o fato de que o cisto aracnoide selar deve ser considerado como um diagnóstico diferencial em casos de hipopituitarismo.

Tuberculum sellae meningioma: Is there an ideal approach? / Meningioma de tubérculo selar: há uma abordagem cirúrgica ideal?

BACKGROUND: Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a Tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on their experience in comparison to previously reported data. METHODS: We report our personal case series of 38 patients with Tuberculum sellae meningiomas; 36 patients under went craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontals, and 2fronto-orbito-zygomatic); in two patients, the excision was performed through an endoscopic endonasal approach. The Simpson grade of meningioma resection as wellhe non-visual morbidity and the mortality rates were analyzed. RESULTS: Thirty-one patients had Simpson grades 1 and 2 excisions, while seven had Simpson grade 4 excisions. The overall rate of non-visual morbidity was 13.15% (5 of 38 patients) and mortality was 5.3% (2 of 38). CONCLUSION: The primary symptom leading to the diagnosis of a Tuberculum sellae meningioma is visual compromise and the main goal of surgeryo achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients in this scenario.

INTRODUÇÃO: Os meningiomas de tubérculo selar certamente representam um desafio para os neurocirurgiões no que se refere ao manejo cirúrgico. Estes tumores representam até 10% de todos os meningiomas intracranianos. A dificuldade em ressecar cirurgicamente estes meningiomas provém da sua relação com os nervos ópticos, com o quiasma óptico e com as artérias carótidas internas, cerebrais anteriores e suas perfurantes. Discutimos as principais abordagens e as complicações com base em nossa série de pacientes e numa revisão da literatura. CASUÍSTICA E MÉTODOS: Relatamos nossa série de casos pessoais de 38 pacientes com meningiomas de tubérculo selar. Trinta e seis pacientes foram submetidos a craniotomia para ressecção tumoral (12 bifrontal, 12 pterional, 6 supraciliar, 4 unilateral frontal e 2 fronto-orbito-zigomático) e 2 receberam abordagem endoscópica endonasal. A escala de Simpson, bem comoaxas de morbidade e mortalidade foram analisadas durante o período pós-operatório, em função das diferentes abordagens. RESULTADOS: Trinta e um pacientes foram submetidos a excisões de grau I e II da escala de Simpson; os demais foram submetidos a excisão de grau IV da mesma escala. A taxa global de morbidade sem acometimento visual foi de 13,15% (5 de 38 pacientes), enquanto a mortalidade evidenciada foi de 5,3% (2 dentre 38 pacientes). CONCLUSÃO: O principal sintoma que leva ao diagnóstico de meningioma de tubérculo selar é o comprometimento visual, de modo que o principal objetivo da cirurgia é alcançar a melhora da visão nestes pacientes. Os resultados alcançados foram favoráveis quando associados com a seleção apropriada da abordagem cirúrgica. Mais estudos são necessários para definir os fatores prognósticos para os pacientes com meningioma de tubérculo selar após intervenção cirúrgica.

Hipofisitis linfoplasmocitaria con expresión de IgG4 / IgG4- related lymphoplasmacytic hypophysitis

La hipofisitis linfoplasmocitaria con expresión de inmunoglobulina G4 (IgG4) es una entidad de reciente conocimiento. Pertenece al grupo de enfermedades relacionadas a IgG4 (IgG4-RD, del inglés: IgG4-related disease), donde uno o varios órganos pueden estar comprometidos, con síntomas compresivos u obstructivos, o disfuncionalidad por infiltración celular. La hipófisis puede estar afectada en forma aislada. Clínicamente, se presentan con diabetes insípida, hipopituitarismo y/o síntomas de masa ocupante selar, siendo los principales diagnósticos diferenciales los adenomas selares no secretantes, y otros tipos de hipofisitis. Para arribar al diagnóstico de este tipo patología es necesaria la presencia de una imagen de agrandamiento selar o engrosamiento del tallo pituitario en la resonancia magnética nuclear, una histopatología característica con inmunomarcación positiva para IgG4 en más de 10 células plasmáticas por campo de gran aumento y la presencia de IgG4 sérica elevada. Tienen una excelente respuesta a glucocorticoides, por lo que una sospecha diagnóstica oportuna evitaría una cirugía innecesaria en la mayoría de los pacientes con esta entidad.

Immunoglobulin G4 (IgG4)-related lymphoplasmacytic hypophysitis is a recently known entity. It belongs to the IgG4-related diseases (IgG4-RD), in which one or more organs may be involved, with compressive or obstructive symptoms, or dysfunctionality due to cellular infiltration. The pituitary gland can be isolatedly affected. Clinically, lymphoplasmacytic hypophysitis presents with diabetes insipidus, hypopituitarism and/or symptoms of an occupying sellar mass, being the non-secreting sellar adenomas and other types of hypophysitis the main differential diagnosis. In order to reach the diagnosis, the presence of pituitary enlargement or pituitary stalk thickening on an MRI scan, a distinctive histopathology with positive for IgG4 immunostaining in more than 10 plasma cells per high-powerfield, and elevated serum IgG4 levels, confirms this type of hypophysitis. As this entity has an excellent response to glucocorticoids, the diagnosis suspicion may avoid an unnecessary surgery in most patients.

Resonancia magnética en pacientes con tumores más frecuentes en la región selar / Magnetic resonance in patients with more frequent tumors in the selar region

La resonancia magnética constituye el examen ideal en pacientes con presunción clínica de tumores en la región selar, pues no emite radiaciones ionizantes y debido a su visión multiplanar y discriminación tisular, posibilita adoptar una conducta terapéutica adecuada y un seguimiento sin riesgos en estos casos. Se describen las imágenes obtenidas con esa técnica sobre los principales tumores selares, correspondientes a macroadenomas hipofisarios, meningioma intraselar, craneofaringioma supraselar y como caso interesante perteneciente a esta región: el cordoma del clivus, por poseer en la actualidad mejores posibilidades diagnósticas que en décadas anteriores

Magnetic resonance constitutes the ideal exam in patients with clinical presumption of tumors in the selar region, because it doesn't emit ionizing radiations and due to its multiplanar vision and tissular discrimination, it facilitates the adoption of an appropriate therapeutic behavior and a follow up without risks in these cases. The images obtained with that technique on the main selar tumors are described, corresponding to hypophysary macroadenomas, intraselar meningioma, supraselar craneopharyngioma and as an interesting case belonging to this region: the clivus chordoma, for having better diagnostic possibilities at the present time than in previous decades

Masa selar, no siempre un adenoma: presentación de 3 casos clínicos / A sellar mass, not always an adenoma: A report of 3 cases

El absceso hipofisario es un proceso infeccioso dentro de la silla turca, infrecuente, grave y de difícil diagnóstico debido a sintomatología variada e inespecífica. Presentamos 3 casos clínicos de abscesos hipofisarios, teniendo en común la presencia de lesiones preexistentes. Todos fueron intervenidos quirúrgicamente, 2 pacientes resultaron ser abscesos asépticos y en un paciente se aisló Aspergillus capsulatum. Presentaron buena evolución con el tratamiento médico pero con secuelas de hipopituitarismo. Es muy importante tener en cuenta el absceso hipofisario entre los diagnósticos diferenciales de las masas que se localicen en esa región debido a que el diagnóstico oportuno y el tratamiento correcto son relevantes para el pronóstico de estos pacientes.

Pituitary abscess is due to a severe and uncommon infection in the sella. It is difficult to diagnose due to varied and non-specific symptoms. A report is presented of 3 cases of pituitary abscess, which had the presence of pre-existing injuries in common. All were subjected to surgery, with aseptic abscesses found in 2 patients, and Aspergillus capsulatum was isolated in 1 patient. They showed good progress with medical treatment, but with sequelae of hypopituitarism. It is very important to consider the pituitary abscess in the differential diagnosis of the masses that are located in that region, as a timely diagnosis and proper treatment can be important for the prognosis of these patients.

Absceso hipofisiario como causa de meningitis crónica / Pituitary abscess as cause of chronicle meningitis

Se presenta el caso clínico de una paciente con un cuadro de Meningitis crónica recurrente en que el diagnóstico de absceso selar sólo se logró al operarla con el diagnóstico de Adenoma Hipofisiario. Siendo el absceso hipofisiario una patología de muy baja frecuencia, la presencia de una Meningitis crónica recurrente como forma de presentación es aún más infrecuente. La literatura en general presenta muy pocas series de abscesos hipofisiarios, siendo la mayoría sólo comunicaciones de casos clínicos.

We present the case of a patient with a history of Recurrent Chronic Meningitis, in which the diagnosis of Pituitary abscess was only made after surgery under the diagnosis of Pituitary Adenoma. Given the low frequency of the Pituitary Abscess, the presence of a Recurrent Chronic Meningitis as its presentation is even more infrequent. The common literature presents only a few series of pituitary abscess, which, in most cases, are only case reports.

Craneotomía mini-supraorbitaria transciliar para lesiones de la región selar / Transciliary mini-supraorbital craniotomy for lesions of sellar region

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.

Descripción de variantes del acceso transeptoesfenoidal para el abordaje de la patología selar / Description of transseptosphenoidal access variants to sellar pathology approach

El abordaje quirúrgico de la patología selar ha sufrido importantes cambios desde sus primeras descripciones. Inicialmente de manejo neuroquirúrgico, hoy en día el abordaje hipofisiario transeptoesfenoidal se ha transformado en una de las vías de acceso más utilizadas por el otorrinolaringólogo para lesiones a nivel de silla turca. Esta publicación describe un tipo de acceso transeptoesfenoidal utilizado por el otorrinolaringólogo en el Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA) en el abordaje de lesiones selares, tanto en cirugía primaria de hipófisis, cirugía secundaria o en casos con alteraciones anatómicas del septum nasal posterior.

The surgical approach to the sellar pathology has undergone significant changes since its first descriptions. Initially addressed by neurosurgical management, today the transseptosphenoidal pituitary approach has become one of the most used pathways by the otolaryngologist to reach sellar lesions. This publication describes one of the transseptosphenoidal approach used by the otolaryngologist at the Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA) in addressing sellar lesions and its variations in primary pituitary surgery, secondary surgery, multiple interventions and in cases of anatomical variations of the posterior nasal septum.

Pseudo-tumor pituitario e hipopituitarismo secundario a un papiloma invertido del seno esfenoidal / Pseudo-pituitary tumor and hypopituitarism secondary to a sphenoid sinus inverted papilloma

El papiloma invertido (PI) es un tumor epitelial benigno, poco frecuente, que se origina mayormente de la pared nasal lateral. A pesar de ser benigno, constituye una lesión altamente invasiva de tejidos vecinos y puede sufrir una transformación maligna. El PI primario del seno esfenoidal con extensión intracraneana e invasión dural, aun sin evidencia histológica de malignidad, ha sido excepcionalmente descrito. Describimos el caso de una mujer de 59 años de edad que fue evaluada por cefaleas intensas de 5 años de evolución y anormalidades del campo visual. Una resonancia magnética nuclear (RMN) mostró una masa selar heterogénea de 1.4 por 2 cm con extensión supraselar y al seno esfenoidal, con erosión del piso selar y compresión del quiasma óptico. Recibió 16 mg/día de prednisona durante aproximadamente 3 meses con una regresión casi total de la masa en la RMN. En la evaluación hormonal se halló insuficiencia gonadal, tiroidea y adrenal central. En una nueva RMN se observó crecimiento del tumor con compromiso total del seno esfenoidal. Una biopsia endoscópica confirmó el diagnóstico de PI. Se realizó una cirugía sinusal transnasal endoscópica con una resección completa evidenciada en una RMN un año más tarde.

nverted papilloma (IP) is a benign uncommon epithelial tumor, arising mostly from the lateral nasal wall. Though benign, this lesion is highly invasive into surrounding tissues and malignant transformation may occur. Primary IP of the sphenoid sinus and intracranial extension with dural invasion, even without histological evidence of malignancy, has only rarely been described. Hypopituitarism as a complication of this lesion has never been reported. We describe the case of a 59-year-old woman who was evaluated because of a 5-year-history of severe headaches and abnormalities in the visual field. Magnetic resonance imaging (MRI) showed a 1.4 per 2.0 cm heterogeneous sellar lesion with suprasellar and sphenoid sinus extension, eroding the sellar floor with optic chiasm compression. Otolaryngologists gave her 16 mg/day of prednisone during approximately 3 months with a near total regression of the mass on MRI. The endocrine biochemical evaluation showed pituitary gonadal, thyroid and adrenal insufficiency. A new MRI showed growth of the tumor with obliteration of the sphenoid sinus. An endoscopic sinus biopsy revealed an IP, so a transnasal endoscopic sinus surgery was performed with complete resection evidenced by MRI a year later.

Evaluación del olfato en pacientes con patología tumoral en la región selar, intervenidos mediante abordaje endoscópico transesfenoidal transnasal / Assessment of smell in patients with tumor pathology in the sellar region, operated by transnasal transsphenoidal endoscopic approach

Introducción: Para acceder a la región selar, podemos utilizar las técnicas transcraneal, transeptal, o transnasal endoscópica, pudiendo provocar diferentes grados de hiposmia. Se ha descrito menor morbilidad al utilizar la técnica endoscópica, pero faltan estudios dirigidos a los resultados olfatorios. Objetivo: Determinar la presencia de deterioro olfatorio en los pacientes sometidos a un abordaje transnasal endoscópico. Material y método: Se reclutaron 12 pacientes con tumores en la región selar durante 8 meses. Se les realizó un test de olfato preoperatorio, fueron intervenidos mediante abordaje transnasal endoscópico y controlados al mes posoperatorio. Resultados: Se logró seguimiento a 10 pacientes. Seis (60%) presentaron un test de olfato preoperatorio normal. Al mes posoperatorio, se constató mejoría olfatoria en 1 (10%) paciente, 8 (80%) se mantuvieron en la misma categoría y 1 (10%) presentó deterioro olfatorio. En suma, 9 de 10 pacientes (90%) mantienen o mejoran su olfato al mes posoperatorio. Conclusión: Nuestros resultados sugieren que el abordaje transnasal endoscópico utilizado en este estudio no produce deterioro olfatorio. Dado que además es una técnica de abordaje efectiva y relativamente segura, consideramos que constituye una alternativa factible para utilizar en pacientes con patología tumoral en la región selar.

Introduction: To access the sellar region we can use the transcranial, transeptal, or transnasal endoscopic approaches, which may cause different degrees of hyposmia. It has described less morbidity to use the endocopic technique, however, there are few studies directed at olfactory outcomes. Aim: To determine the presence of olfactory impairment secondary to endoscopic transnasal approach. Material and method: 12 patients with tumors in the sellar region were enrolled during 8 months. They were underwent a smell test preoperatively, operated by endoscopic transnasal approach, and controlled with postoperative retesting, after one month. Results: Follow-up was achieved to 10 patients. 6 (60%) presented a normal preoperative smell test. Within one postoperative month, olfactory improvement was found in 1 (10%) patient, 8 (80%) remained in the same category and 1 (10%) had olfactory impairment. In all, 9 out of 10 patients (90%) maintain or improve their sense of smell after surgery. Conclusions: Our results suggest that the transnasal endoscopic approach used in this study, doesn't produce olfactory impairment. Given that is also an effective and relatively safe approach, we believe that is a feasible alternative for use in patients with tumor pathology in the sellar region.

Metástasis selar y al seno cavernoso, de un carcinoma de células de Merkel: reporte de un caso / Sellar and cavernous sinus metastasis from a Merkel cell carcinoma: case report and literature review

El carcinoma de células de Merkel es un tumor maligno y muy raro de la piel. Este tumor emerge de las células epiteliales que presentan una diferenciación neuroendocrina. Ocurre más comúnmente en los adultos masculinos mayores. Las metástasis intracraneales de un carcinoma de células de Merkel son aun más raras. En este articulo, se presentara un caso de un paciente masculino de 70 años con antecedente de carcinoma de células de Merkel quien debuto con una ptosis que progresivamente presento una parálisis completa del tercer par craneal. En los estudios realizados al paciente, se encontró una lesión infiltrante al seno cavernoso y a la silla turca que resulto ser una metástasis por un carcinoma de células de Merkel. En esta publicación, se discutirá el caso clínico y se revisará la literatura al respecto de estas lesiones raras del sistema nervioso central.

Merkel cell carcinoma is a rare and malignant tumor of the skin. This lesion arises from epithelial cells that have undergone neuroendocrine differentiation. They are more commonly found in older male adults. Intracranial metastases from Markel cell carcinoma are even rarer. We will present a case of a 70 year old male with known history of Merkel cell carcinoma that suddenly presented with a right eye ptosis and progressively presented complete third nerve palsy. The patient was studied and was found to have an infiltrating lesion of the cavernous sinus and the sellar region. This tumor resulted in a metastasis from a Merkel Cell Carcinoma. In this article we will discuss the clinical case of this patient and we will review the literature concerning this rare lesion of the Central nervous system.

INFLUENCIA DE LA FASE LUNAR EN LAS TASAS DE CAPTURA DE Selar crumenophthalmus (CARANGIDAE) EN EL CARIBE DE COLOMBIA. UNA APROXIMACIÓN POR MODELOS LINEALES GENERALIZADOS / Moon Phase Influence on Catch Rates of Selar crumenophthalmus (Carangidae) in the Caribbean Sea off Colombia. A Generalized Linear Models Approach

Las tasas de captura de Selar crumenophthalmus provenientes de los desembarcos registrados en el norte del mar Caribe de Colombia fueron analizadas y estandarizadas mediante Modelos Lineales Generalizados (MLG). Se utilizó información colectada entre 1994 y 2001. Los factores que se utilizaron como predictores lineales fueron: año, mes, código lunar, sector geográfico, y estrato de profundidad. Las mayores tasas de captura fueron detectadas durante los dos días de luna nueva máxima en el sector del Parque Nacional Natural Tayrona, lo cual indica que la mayor disponibilidad del recurso, dado su hábito nocturno y fototaxis positiva, está muy localizada en el tiempo. Esta condición ha de incorporarse en los esquemas de ordenamiento, una vez que facilita la implementación de mecanismos de control pesquero. Se registró una disminución de la tasa de captura en los últimos dos años del periodo examinado, tendencia que sugiere el deterioro de la abundancia poblacional de este recurso, hasta ahora considerado fuera de riesgo de sobreexplotación. En pesquerías multiespecíficas, explicar la abundancia poblacional con tasas de captura estimadas incluyendo solo datos de lances que registren la especie analizada, puede derivar en una conclusión conceptual y cuantitativamente incorrecta.

Catch rates of Selar crumenophthalmus in the landings belonging from the north of the Caribbean Sea off Colombia were analyzed and standardized with Generalized Lineal Models (GLM). Information collected between 1994 and 2001 was used. The factors used as lineal predictors were: year, month, Moon phases, geographic sector, and depth. The highest catch rates were detected during the two days 100% New Moon in the Tayrona National Natural Park, which indicates that the availability of the resource, because its nocturne habit and positive phototaxis, is located in the time. This condition should be incorporates in management schemes, since facilitates the implementation of fishing control strategies. A diminution of the catch rate was registered in the last two years; tendency that suggests the deterioration of the population abundance of this species, until now considered without over-exploitation risk. In multispecies fishing grounds, explanation of the population abundance with catch rates estimated with only data of hauls that recorded the analyzed species can derive in a conceptual and quantitatively incorrect conclusion.

Cirugía en tumores de la región selar: informe de una serie de 15 casos / Surgery for tumors of the sellar region: report a series of 15 cases

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%.

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas / Minicraniotomia supra-orbitária superciliar no tratamento de meningiomas na fossa craniana anterior e para-selares

The improvement of surgical techniques as well as the introduction of new surgical instruments promoted the use of keyhole craniotomies in neurosurgery. We evaluated the technical aspects of the supra-orbital keyhole approach considering the indications, limitations, and complications of this approach to treat anterior cranial fossa and parasellar meningiomas. Twenty-four patients (21 females; mean age, 53±8.6 years) operated on between 2002 and 2006 through a supra-orbital eyebrow approach were studied. Maximal tumor diameter ranged from 1.6 to 6 cm. Gross total resection was done in 20 (83.3 percent). All tumors were histologically benign. Two patients (8 percent) experienced CSF rinorhea and another two patients suffered transitory diabetes insipidus (8 percent). One patient experienced transitory hemiparesis. There was one case of meningitis and one mortality. Follow-up ranged between 6 to 66 months (mean 31.5±20.1 months), with no recurrence. The supra-orbital keyhole craniotomy is a useful minimally invasive approach to treat selected anterior fossa and parasellar meningiomas.

A evolução técnica e a introdução de instrumentais cirúrgicos mais delicados proporcionaram o uso de craniotomias menores no tratamento de patologias intracranianas. Avaliamos os aspectos técnicos da minicraniotomia supra-orbitária superciliar, considerando as indicações, limitações e complicações no tratamento de meningiomas na fossa craniana anterior e para-selares. Vinte e quarto pacientes (21 mulheres; idade média, 53±8,6 anos) operados entre 2002 e 2006 foram estudados. O diâmetro tumoral máximo variou de 1,6 a 6 cm. Ressecção total foi obtida em 20 (83,3 por cento). Todos os tumores eram histologicamente benignos. Dois pacientes (8 por cento) apresentaram fistula liquórica pós-operatória e outros dois diabetes insipido transitórioa (8 por cento). Um paciente evoluiu com hemiparesia transitória. Houve um caso de meningite e um de evolução fatal. O seguimento variou de 6 a 66 meses (média 31,5±20,1 meses), não houve recidiva. A minicraniotomia supra-orbitária superciliar é uma via de abordagem eficaz para o tratamento de meningiomas da fossa craniana anterior e para-selares selecionados.

Tuberculum sellae meningiomas: surgical considerations / Meningiomas do tuberculo selar: aspectos cirúrgicos

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Apresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites.

Radioterapia como indicación post operatoria en macroadenomas hipofisiarios no funcionantes: a propósito de un caso / Surgical treatment of a non functioning pituitary macroadenoma without postoperative radiotherapy: report of one case

We report a 45 years old female that consulted for amenorrhea and galactorrhea after discontinuing oral contraceptives, that she used for several years. The patient had hyperprolactinemia, a hypogonadotrophic hypogonadism and a primary hypothyroidism. Sella turcica magnetic resonance showed a pituitary macroadenoma with a diameter of 23 mm and supraselar extension. The patient was subjected to a transsphenoidal excision of the tumor with good clinical and surgical results. Therefore radiotherapy was not used for the treatment of the tumor.

Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome / Adenomas hipofisários não-secretores: avaliações clínica, laboratorial, neuro-radiológica e evolução após tratamento

OBJECTIVE: This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome. DESIGN AND METHODS: Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment. RESULTS: Hypopituitarism and neuro-ophthalmological defects were observed in 89 percent. We observed GH deficiency (81.4 percent), hypogonadism (63.3 percent), adrenal hypofunction (59.5 percent), hypothyroidism (20.4 percent), high (38.5 percent) and low (16.7 percent) prolactin levels. Preoperative imaging classified 93 percent of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8 percent. Varying degrees of visual disturbance were observed in 74 percent. Primary treatment was transsphenoidal surgery (75 percent). Clinical control was achieved with one surgery in 37.5 percent of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43 percent. Improvement of neuro-ophthalmological symptoms was observed in 61 percent of the patients after treatment. CONCLUSIONS: Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common, which frequently leads to a second therapeutic option.

OBJETIVOS: Esse estudo é uma revisão atualizada em adenomas hipofisários não-secretores (AHNS), enfatizando características clínicas, avaliações laboratorial e neuro-radiológica, manejo terapêutico e desfecho. MÉTODOS: Estudo retrospectivo, em que 104 pacientes com AHNS foram avaliados pela mesma equipe de endocrinologistas e neurocirurgião. Os pacientes foram submetidos à avaliação bioquímica, a estudos radiológicos e à avaliação de campo visual. RESULTADOS: Hipopituitarismo e distúrbios neuro-oftalmológicos foram observados em 89 por cento. Observou-se deficiência de GH (81,4 por cento), hipogonadismo (63,3 por cento), hipofunção adrenal (59,5 por cento), hipotireoidismo (20,4 por cento), concentrações elevadas (38,5 por cento) e baixas (16,7 por cento) de prolactina. Imagens pré-operatórias classificaram os tumores em sua maioria como macroadenomas (93 por cento). Expansão extra-selar foi observada em 83,8 por cento. Graus variados de distúrbios visuais foram observados em 74 por cento. O tratamento de escolha foi a cirurgia transesfenoidal (75 por cento). O controle clínico foi alcançado com cirurgia em 37,5 por cento dos pacientes. A maioria dos pacientes precisou de segunda abordagem terapêutica, radioterapia ou outras cirurgias. A imunoistoquímica resultou negativa para hormônios hipofisários em 43 por cento. Melhora de sintomas neuro-oftalmológicos foi observada em 61 por cento dos pacientes após o tratamento. CONCLISÕES: Os dados do estudo confirmam elevada prevalência de efeitos de massa e hipopituitarismo em pacientes com AHNS. Recorrência causada por invasão ou ressecção incompleta do tumor é comum, levando frequentemente à segunda opção terapêutica.

Relação entre função hipofisária e síndrome metabólica com a pressão intrasselar em média em pacientes com adenoma de hipófise / Relationship between pituitary function and metabolic syndrome with the pressure intrasselar on average in patients with pituitary adenoma

Avaliar a relação entre a pressão intrasselar média e a ocorrência de síndrome metabólica e hipoituitarismo no pré-operatório e em reavalia-ção tardia.

To evaluate the relationship between pressure intrasselaraverage and the occurrence of metabolic syndrome andhipoituitarismo preoperatively and reevaluateding late.

Correlación topográfica y anatomopatológica en los tumores de la región selar / Topographic and anatomopathological correlation in the sellar region tumors

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.