[Ependymoma of the Sella Turcica and Suprasellar Region].

An ependymoma of the sella turcica and the suprasellar region has been described by only 10 reports in the available literature. We describe similar pathology in a 70-year-old woman who presented with dementia and visual disturbance. Magnetic resonance imaging with gadolinium revealed a mixed contrast-enhanced lesion(maximum diameter 3.5 cm)in the sella turcica and suprasellar area associated with a noncommunicating hydrocephalus. The patient was preoperatively presumptively diagnosed with a craniopharyngioma. The lesion was adherent to the hypothalamus, and the third ventricular floor was completely resected via an endoscopic endonasal transsphenoidal approach. Histopathological findings confirmed an ependymoma. Although her visual disturbance improved, the patient developed postoperative panhypopituitarism. She has had no recurrence for 7 years postoperatively. An ependymoma of the sella turcica and the suprasellar region is extremely rare; establishing the preoperative diagnosis is challenging in such patients. Maximum tumor resection and long-term follow-up are essential for good prognosis.

Preservation of Olfactory Function Following Endoscopic Single-Nostril Transseptal Transsphenoidal Surgery.

OBJECTIVE: Olfactory dysfunction is a significant postoperative complication related to endoscopic transsphenoidal surgery (TSS). This study aimed to determine the impact of endoscopic TSS on olfactory function. METHODS: We conducted a prospective study of 32 patients with sellar or parasellar tumors who were treated with endoscopic TSS between December 2013 and October 2016. TSS was performed via a right transseptal approach. We performed the Toyota and Takagi olfactometer test and the venous olfaction test for the evaluation of olfactory function preoperatively and at 1 and 3 months postoperatively. RESULTS: The results of the Toyota and Takagi test showed that olfactory function deteriorated in 4 of 32 (12.5%) patients 1 month postoperatively and improved to preoperative baseline levels in all patients 3 months after the procedure. Olfactory function deteriorated in 1 of 31 (3.2%) patients 3 months after the procedure. The venous olfaction test revealed no response in 1 of 31 (3.2%) patients 1 month postoperatively, with no improvement 3 months after the procedure. CONCLUSIONS: Endoscopic single-nostril transseptal TSS for sellar or parasellar tumor resection has minimal impact on olfactory function.

Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Parasellar Lesions.

OBJECTIVE: Although reports regarding the relationship between surgical complications and quality of life (QOL) exist, a general consensus regarding this issue is lacking. The aim of this study was to evaluate QOL after endoscopic transsphenoidal approach. METHODS: We assessed patients with sellar or parasellar lesions that were removed with endoscopic transsphenoidal approach or extended endoscopic transsphenoidal approach between January 2010 and December 2016. 36-Item Short Form Health Survey and 30-Item General Health Questionnaire QOL scores were obtained preoperatively and 1 month and 6 months postoperatively. RESULTS: We analyzed 89 patients with nonfunctioning pituitary adenoma (NFPA) and 39 patients with acromegaly. Physical QOL decreased 1 month after surgery but recovered after 6 months in both groups. Mental QOL improved postoperatively compared with preoperatively. Patients with acromegaly had a worse Physical Component Summary (PCS) on 36-Item Short Form Health Survey (48.7, 28.9, and 41.0) at 6 months than patients with NFPA. The low preoperative PCS group did not improve until 6 months postoperatively. Multiple regression analysis revealed the following factors were key to postoperative QOL: age (NFPA PCS 6 months postoperatively; correlation coefficient = -0.489), preoperative Mental Component Summary (MCS) (NFPA MCS 6 months postoperatively, correlation coefficient = 0.573), body mass index (acromegaly PCS 6 months postoperatively; correlation coefficient = -0.376), preoperative PCS (acromegaly PCS 6 months postoperatively; correlation coefficient = 0.905), and preoperative MCS (acromegaly MCS 6 months postoperatively; correlation coefficient = 0.726). CONCLUSIONS: Endoscopic transsphenoidal approach can improve QOL in patients by 6 months postoperatively. In patients with acromegaly with significant QOL impairments preoperatively, surgery sometimes may be unable to normalize QOL.

[A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach].

We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT.

Bilateral occlusion of the foramina of Monro after endoscopic third ventriculostomy for aqueductal stenosis--a case report.

CASE REPORT: Bilateral occlusion of the foramina of Monro is an extremely rare clinical condition. We present the case of a 10-year-old girl who complained of frequent headaches. METHODS: Magnetic resonance imaging showed triventricular hydrocephalus due to aqueductal stenosis, so endoscopic third ventriculostomy was performed successfully. The headaches subsequently disappeared, but the patient presented with exacerbation of headaches 32 months postoperatively. Magnetic resonance imaging demonstrated bilateral hydrocephalus of the lateral ventricles, implying bilateral occlusion of the foramina of Monro. We again performed endoscopic surgery, confirming bilateral occlusion of the foramina of Monro. RESULTS: The foramina of Monro were apparently obstructed by normal ependyma, and no tumor masses or other structures were detected around the foramina, so we diagnosed the occlusion of the foramina as secondary after endoscopic third ventriculostomy. We fenestrated the septum pellucidum using a monopolar micro endoscopic electrode, and a ventriculoperitoneal shunt was placed for the management of hydrocephalus. The postoperative course was uneventful, and the headaches were completely resolved.

[Bilateral thalamic glioma in an adult: a case report and review of the literature].

We report a case of a 36-year-old woman who had a rare bilateral thalamic glioma (BTG). She complained of memory disorder T1-weighted magnetic resonance imaging revealed enlarged bilateral thalami with homogenous isointensity and no contrast enhancement. Histological examination of the biopsy specimen identified diffuse astrocytoma (WHO grade II). BTG is a rare variant of thalamic neoplasms, which can be distinguished clinically and radiologically from other gliomas. In most of the reported cases, the presenting symptoms were cognitive impairment varying from personality changes to frank dementia. Death usually occurs within two years after onset, independently of adjuvant therapy such as radiotherapy and chemotherapy. On neuroimaging, all of the BTG had a similar appearance, with both thalami being symmetrically enlarged. Our patient has been given radiotherapy and concominant and adjuvant temozolomide in Stupp's regimen. At the time of this writing (5 months after the consultation), there are no neurological symptoms, and no changes on neuroimaging.