Visual outcome after extended endoscopic endonasal transsphenoidal surgery for tuberculum sellae meningiomas.

BACKGROUND: The purpose of this study was to evaluate the visual outcome after extended endoscopic endonasal transsphenoidal surgery in patients with tuberculum sellae meningiomas (TSM). METHODS: A retrospective analysis was performed for 12 patients (4 men and 8 women) with TSMs who underwent extended endonasal transsphenoidal surgery with pure endoscopy between 2003 and 2008. Neuro-ophthalmic evaluation was performed preoperatively and postoperatively. Visual acuity, visual fields, and funduscopy results were documented during the preoperative and follow-up periods. RESULTS: There were three patients with bilateral optic foramen invasion and four patients with unilateral optic foramen invasion on radiologic findings preoperatively. Eleven patients had total tumor resection (Simpson grade I and II), and one patient had a subtotal tumor resection with a small asymptomatic tumor regrowth seen on magnetic resonance imaging at 14 months after surgery. Patients were observed for a mean follow-up time of 2.1 years (range 6 months-5 years), and the median was 28 months. Visual acuity improved in 92% of patients and was unchanged in 8% of patients. Eleven patients with visual field problems were better in various degrees at postoperative follow-up than before operation. No patients showed worsening of vision or visual field after surgery. CONCLUSIONS: In this small, selected series with a relatively short follow-up, the extended endoscopic endonasal transsphenoidal approach to TSMs was a feasible alternative to the transcranial approach with minimal manipulation of the optic nerve. Procedures in the subchiasmatic space can be performed effectively with excellent visualization of the blood network supply to the optic apparatus while preserving the optic nerve in most cases.

Reconstruction of the corneal epithelium with induced marrow mesenchymal stem cells in rats.

PURPOSE: To explore the feasibility of bone marrow mesenchymal stem cells (MSCs) transdifferentiating into corneal epithelial cells in a limbal stem cell deficiency (LSCD) model in rats. METHODS: Rat MSCs were isolated and purified using a gradient isolation procedure. The cells were induced by rat corneal stromal cells (CSCs) in a transwell co-culture system. The induced MSCs were identified by immunofluorescence staining, flow cytometry, and scanning electron microscopy (SEM). A corneal LSCD model was produced in the right eyes of 48 rats by alkali injury. The eyes of 12 rats without any transplant served as controls (Group 1). Amniotic membranes (AM; Group 2), uninduced MSCs (Group 3), or MSCs induced by CSCs (Group 4), were transplanted onto the cornea of the model (n=12 each). The therapeutic effects of the four groups were evaluated by slit lamp observation, hematoxylin and eosin staining, immunohistochemistry staining, and confocal laser corneal microscopy. RESULTS: Cultivated MSCs were positive for CD29, CD44, and CD90, but negative for CD34, CD45, CD133, and CK12, with typical MSCs characteristics revealed by SEM. After co-culture with CSCs, the induced MSCs expressed positive staining for CK12 with corneal epithelial cell characteristics confirmed by SEM; the induced MSCs were unchanged on the amnion. Compared with the other three groups, the corneal opacity, fluorescence staining, and neovascularization grades were significantly decreased in the induced MSCs group, both on postoperative week four and ten. CONCLUSION: MSCs induced by CSCs can transdifferentiate into corneal epithelial cells in vitro. The induced MSCs on an amniotic membrane have remarkable effects on the treatment of corneal alkali burn and the reconstruction of the corneal surface of rats.