Cognitive function in pituitary adenoma patients: A cross-sectional study.

Various factors may affect cognition in patients with pituitary adenoma, including size and extension of the tumor, degree of pituitary hormone deficiencies, and treatment of the tumor, most often being transsphenoidal surgery (TSS). The aim of this cross-sectional study was to evaluate cognitive function in patients with clinically significant pituitary adenoma and to identify factors influencing cognition. Sixty-eight patients with pituitary adenoma were included. Of these, 31 patients were evaluated before TSS and 37 patients 12 months following TSS. Cognitive function was evaluated by using the Repeatable Battery for the Assessment of Neuropsychological Status. Patients had lower mean scores on cognitive assessment compared to age-adjusted normative data. Variability in cognition, analyzed by linear regression analysis, was explained by sex, educational level, and self-perceived fatigue, but not by pituitary hormone deficiencies, diabetes insipidus, or surgical treatment. Our results are in line with previous findings, namely that pituitary adenoma affects cognition. To better evaluate the factors affecting cognition, longitudinal studies are recommended. Such studies would allow for within-individual comparisons, effectively controlling for the considerable influence of sex and education on test results.

Consensus guidelines for the management of craniopharyngioma in low- and middle-income countries.

Craniopharyngiomas are benign, extra-axial epithelial tumours originating from the pituitary stalk, impacting areas such as the hypothalamus, optic chiasm, and various cranial nerves. These tumours present unique surgical challenges due to their proximity to critical neurovascular structures. Management typically involves maximal safe resection as the primary approach. However, in low- and middle-income countries (LMICs), factors like late presentation, higher risks of endocrine and visual complications, frequent recurrence, and potential for incomplete resection complicate treatment. These challenges are exacerbated by limited access to specialised expertise and surgical equipment, increasing the risk of damage during surgery compared to High- Income Countries. This manuscript outlines management guidelines tailored for LMICs, emphasizing that a combination of surgical resection and chemoradiation therapy, as advised by a neuro-oncology tumour board, often yields the best outcomes.

[Visual rehabilitation treatment for a patient with hemifield slide after pituitary adenoma resection: a case report].

The patient is a 28-year-old male who presented with hemifield slide for 10 months following surgery for a large pituitary adenoma. A comprehensive ophthalmological examination and visual function tests were conducted, including best corrected visual acuity, visual field, stereopsis, accommodative convergence, Worth four-dot test, and prism cover test for quantifying strabismus, along with assessments using a depression scale and a visual function questionnaire. Rehabilitation plans included applying press-on prisms to correct vertical strabismus, binocular vision training, and saccadic training. After rehabilitation, the patient was able to maintain binocular single vision at near and intermediate distances, experienced improved visual comfort, and showed significant improvements in scores on the depression scale and visual function questionnaire.

Risk factor analysis and prediction model to establish recurrence or progression of non-functioning pituitary adenomas in men after transnasal sphenoidal surgery.

This paper aims to analyze the risk factors for the recurrence or progression of non-functioning pituitary adenomas (NFPAs) in male patients after transnasal sphenoidal surgery and to develop a predictive model for prognosis. Clinical and follow-up data of 126 male patients with NFPAs treated by transnasal sphenoidal surgery from January 2011 to January 2021 in Fuzhou 900th Hospital were retrospectively analyzed. Lasso regression analysis was used to screen the best predictors, and the predictors were further screened by multivariate logistic regression analysis, and the nomogram prediction model was constructed. The performance of the model was verified by three aspects: discrimination, calibration and clinical utility by using the consistency index (C-index), receiver operating characteristic curve (ROC), calibration curve, clinical decision curve (DCA) and Clinical impact curve (CIC). Out of 126 cases, 7 (5.56%) showed postoperative tumor recurrence, and 18 (14.29%) exhibited postoperative residual regrowth (progression). Age (P = 0.024), maximum tumor diameter (P < 0.001), modified Knosp grade (P < 0.001), resection extent (P < 0.001), Ki67 (P < 0.001), pressure symptom (P < 0.001), Pre-op hypopituitarism (P = 0.048), Post-op new hypopituitarism (P = 0.017) showed significant differences among the recurrence group, the progression group, and the alleviation group. Three independent risk factors (Ki67, modified Knosp grade, and resection extent) affecting postoperative remission were used to construct a predictive model for long-term postoperative failure to remit. The C-index of the nomogram model was 0.823, suggesting that the model had a high discriminatory power, and the AUC of the area under the ROC curve was 0.9[95% CI (0.843, 0.958)]. A nomogram prediction model based on modified Knosp grading (grades 3B-4), resection extent (partial resection), and Ki-67 (≥ 3%) predicts the recurrence or progression of NFPAs in men after transnasal sphenoidal surgery.

AB064. Two case reports & review of literature: perioperative surgical management of symptomatic large non-functioning pituitary masses in early pregnancy.

BACKGROUND: Pituitary masses during pregnancy pose many challenges, requiring inputs from multidisciplinary teams. Where surgery is required, such as in cases of impending pituitary apoplexy, timing must be carefully selected. Several case reports have suggested good outcome with surgery in later trimesters or postpartum. However, insufficient data exists on surgical strategies for such patients with severe visual symptoms in early pregnancy. We report two patients with pituitary masses requiring surgical excision. METHODS: Review of patients' notes and imaging, with literature review. RESULTS: A 35-year-old gravida 2 para 1 female at 9 weeks gestational age (GA) presented with chronic bitemporal hemianopia, with acute left eye blurring of vision, identified during a pre-employment screening test. Imaging revealed a 38 mm × 29 mm × 33 mm sellar mass with compression onto the optic chiasm. She had no significant hormonal imbalances other than hyperprolactinemia and newly diagnosed Hashimoto's thyroiditis. She underwent transsphenoidal resection, with histology showing pituitary adenoma with blood clots. Similarly, our second patient was a 37-year-old gravida 4 para 2 female at 12 weeks GA with worsening bitemporal hemianopia with a 25 mm × 21 mm × 18 mm sellar mass displacing and compressing the optic chiasm. After resection she had marked objective improvement in her vision, but developed diabetes insipidus, and final histology revealed pituicytoma. Preoperative considerations for timing of surgery include pituitary apoplexy or acutely worsening visual field deficit. The pituitary physiologically increases in size during pregnancy, which can compress the optic chiasm and worsen visual deficit. In the case of apoplexy, delayed identification can have devastating consequences. However, major surgery in the first trimester may increase spontaneous miscarriage. The effects of imaging investigations from radiation, or gadolinium contrast administration, are also uncertain. While surgical positioning remains unaffected, other intraoperative considerations include strictly avoiding hypotension and using pregnancy-safe agents. Postoperative considerations include correcting hormonal deficiencies of hypopituitarism, including acute central hypocortisolism, diabetes insipidus and interruption of gonadotrophin production which could negatively affect pregnancy. Fetal heart rate must also be assessed. CONCLUSIONS: Determining timing of surgery to ensure well-being of both mother and fetus involves a difficult balance of risks. In our two cases, a thorough discussion with multidisciplinary input was required to achieve good outcomes.

Post-craniopharyngioma surgery hypocalcemia due to denosumab use for osteoporosis: A case report.

RATIONALE: Denosumab, a fully humanized IgG monoclonal antibody, is commonly employed in the management of different types of osteoporosis. Up to now, hypocalcemia linked with denosumab has been predominantly reported in dialysis patients suffering from chronic kidney disease. Interestingly, there have been no reports of hypocalcemia following craniopharyngioma surgery with the use of denosumab. PATIENT CONCERNS: A 65-year-old male received a subcutaneous injection of denosumab (60 mg) as a treatment for osteoporosis following the resection of a craniopharyngioma. Remarkably, the patient developed hypocalcemia within 4 days post-injection. However, 6 months subsequent to the initial treatment, the patient underwent another subcutaneous injection of desmuzumab and once again experienced hypocalcemia. DIAGNOSES: Hypocalcemia. INTERVENTIONS: The hypocalcemia was successfully managed with intravenous calcium gluconate and oral calcium carbonate D3 tablets, leading to the alleviation of symptoms. OUTCOMES: Hypocalcemia following the use of denosumab after craniopharyngioma surgery is rare, and its occurrence may be associated with the primary disease and concomitant medications. LESSONS: It underscores the necessity for clinicians to perform a thorough evaluation of the patient's overall health status, complete all requisite testing, pay particular attention to those in high-risk categories, and ensure serum calcium levels are monitored, along with conducting other essential tests, prior to and following each administration of denosumab.

AB022. Management of first recurrence or progression of craniopharyngioma after resection alone: a systematic review and individual-participant data meta-analysis.

BACKGROUND: The initial management of craniopharyngioma is generally either gross total resection (GTR) or subtotal resection (STR) with adjuvant radiotherapy (RT). However, the optimal management strategy for recurrent/progressive craniopharyngioma remains unclear. METHODS: PubMed and Embase were systematically reviewed for studies that compared the outcomes of surgery and/or RT for the first recurrence/progression of craniopharyngioma after resection alone. The exposure was the treatment that was administered for the first recurrence/progression, and the outcomes were tumor regrowth and overall survival (OS). Subgroup analyses were performed by age at the treatment for the first recurrence/progression (<18 or ≥18 years old), duration between the first treatment and the first recurrence/progression (<2 or ≥2 years), and the initial treatment that was administered (STR or GTR). RESULTS: Of the 2,932 studies screened, 11 studies reporting a total of 80 patients were included. Across almost all subgroups, patients who received RT for the first recurrence/progression had a significantly lower risk of tumor regrowth than those who did not, regardless of whether surgery was performed and the extent of resection. There was no significant association between the treatment administered for the first recurrence/progression and OS, except for patients with a recurrence/progression <2 years after the first treatment, where GTR was associated with a higher risk of mortality. CONCLUSIONS: For patients with the first recurrence/progression of craniopharyngioma after resection alone, RT should be considered for better local control. In cases where RT is not administered, GTR is preferred over STR provided it can be safely performed, for improved local control.

AB024. Preoperative and postoperative clinical manifestation, hormonal, and imaging profile of sellar region tumor in Dr. Saiful Anwar General Hospital, East Java: a 1-year cross-sectional study.

BACKGROUND: Due to their location, sellar region tumors can affect a patient's quality of life by mass compression effect and disrupting pituitary function. The treatment choice is determined by some factors, including the presence of mass effect and whether the tumor is secreting or non-secreting. This study assessed the preoperative and postoperative clinical manifestation, hormonal, and head magnetic resonance imaging (MRI) profile of sellar region tumor in Dr. Saiful Anwar General Hospital, East Java. METHODS: This study used a descriptive, cross-sectional design. Data were taken from sellar region tumor registry of Dr. Saiful Anwar General Hospital from March 2023 to April 2024. RESULTS: Twenty-five patients were included in the study, with 18 (72%) women and 22 patients (88%) aged 41-60 years old. The most frequent neurological symptom was blurred vision (23 patients; 92%). Hormones checked were thyroid hormones [free T4 (FT4), T3, thyroid-stimulating hormone (TSH)], prolactin, cortisol, growth hormone, and gonadotropic hormone [testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)], but not all patients were checked for all these hormones. Patients were further classified into having low, normal, or high level of the respective hormones, and patients mostly had normal levels. Pituitary macroadenoma was the frequently suspected tumor from head MRIs (11 patients; 44%). Eleven patients underwent tumor excision. Ten patients showed pituitary adenoma and one patient showed pituicytoma on histopathological examination. Mean levels of FT4, T3, and prolactin were decreased after surgery, but TSH and cortisol levels were increased. On postoperative head MRI, four patients showed reduced mass size and one patient showed no residual lesion. CONCLUSIONS: While pituitary macroadenoma was suspected in most head MRIs in this study, most of them were likely non-secreting. Therefore, surgical approach remained the mainstay of treatment. The need for medical management for hormonal disturbances was minimal. While postoperative data were incomplete, some findings from our patients showed that surgical approach could indeed reduce mass effect by improving bitemporal hemianopsia and pituitary deficit.

AB031. Endoscopic transsphenoidal surgery for functional pituitary adenoma: shifting paradigms towards pseudocapsule-based resection.

BACKGROUND: Functional pituitary adenomas (PAs) manifest as intricate clinical syndromes, and surgery emerges as the principal intervention to mitigate associated morbidity and mortality. The endoscopic transsphenoidal surgery (ETS) approach stands as the preferred method for addressing PAs, with postoperative remission acting as a pivotal prognostic factor. METHODS: This study seeks to evaluate the influence of different surgical techniques and complications of ETS on functional PAs, focusing on both Acromegaly and Cushing's disease (CD). Patient records, including characteristics, perioperative assessments, postoperative complications, and follow-up data, were systematically gathered. Tumor resection methods were categorized into: (I) complete pseudocapsule resection; and (II) complete piecemeal resection. Post-surgery, daily monitoring of serum cortisol levels continued for a consecutive 3-day period until values of 2 µg/dL or less were achieved. Growth hormone levels were reassessed 12 weeks later, targeting a level of <0.14 g/L. A follow-up enhanced magnetic resonance imaging examination was conducted 3 months post-surgery to confirm the absence of residual tumors. RESULTS: The study identified 46 patients (23 with acromegaly and 13 with CD) who underwent endoscopic surgery between 2020 and 2023. Twenty-six patients underwent piecemeal resection (January 2020 to December 2022), while 10 patients underwent complete pseudocapsule removal (January to December 2023). No significant changes in surgical complications were observed between the two techniques. No instances of carotid artery injury, epistaxis, intracranial infection, or loss of olfaction were reported. In the pseudocapsule group, one patient experienced transient vision loss. Notably, 80% of patients in the pseudocapsule group achieved remission as compared to 57.7% in the piecemeal group. CONCLUSIONS: Pseudocapsule-based resection exhibited a remarkable remission rate, a low complication rate, and an absence of recurrence in functional adenoma patients. Despite the limited number of cases and our early experience, further studies are warranted to validate its effectiveness and safety.

AB054. Pituitary abscess: a case report of patient after two-time endonasal endoscopic transphenoid approach for pituitary adenoma.

BACKGROUND: Endonasal endoscopic approach (EEA) has become an integral part of neurosurgery, particularly for managing various pathologies involving the sellar and parasellar region and removing lesion in that area. But there is a rare condition in this area that not so common in literature is pituitary abscess (PA) after EEA for pituitary adenoma. CASE DESCRIPTION: A healthy 57-year-old man presented with a recurrent of bitemporal hemianopsia, persistent hypoadrenocorticism. In the history, he underwent two times of endonasal endoscopic transphenoid to remove pituitary adenoma. Magnetic resonance imaging (MRI) showed a sphenoid and sellar lesion with suprasellar extension and compression of the optic chiasm, with homogenous signal inside. Endoscopic transphenoid surgery was performed and the lesion was found is an abscess inside sphenoid and sellar with frank pus was obtained. But culture of the fluid was negative. After the operation, the patient was treated with antibiotics. His symptoms resolved after EEA, he improved visual field at this time but still in hypoadrenocorticism condition. An MRI was obtained after the operation to reveal that the lesion in sphenoid and sellar totally removed. We report on a rare case of a PA after two times of endonasal endoscopic transphenoid surgery of pituitary adenoma, and discuss the management of these conditions. We report a patient that came with us with recurrent of bitemporal hemianopsia and persistent hypoadrenocorticism. The patient undergone endonasal endoscopic sphenoid two times in the past. He didn't have clinical signs of infection. Imaging feature on MRI was high T2 and also high on T1 with homogenous signal inside with size 3.2 cm × 3.2 cm. Another EEA for this patient was performed to remove abscess and obtain pus from the lesion, but the result of culture was negative. He improved visual field but still in hypoadrenocorticism. CONCLUSIONS: In this case we report on a rare complication of transphenoid surgery, a PA progresses after EEA for a pituitary tumor. With this clinical experience, the correct diagnosis of PA before surgery, so it is a key leading to an exactly treatment for this condition. endonasal endoscopic transphenoid approach to drainage and removing abscess, and using antibiotics are necessary to improve the outcome of PA.

How to manage Cushing's disease after failed primary pituitary surgery.

The first-line treatment for Cushing's disease is transsphenoidal adenomectomy, which can be curative in a significant number of patients. The second-line options in cases of failed primary pituitary surgery include repeat surgery, medical therapy, and radiation. The role for medical therapy has expanded in the last decade, and options include pituitary-targeting drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. Bilateral adrenalectomy is a more aggressive approach, which may be necessary in cases of persistent hypercortisolism despite surgery, medical treatment, or radiation or when rapid normalization of cortisol is needed. We review the available treatment options for Cushing's disease, focusing on the second-line treatment options to consider after failed primary pituitary surgery.

Rathke's cleft cysts: from pathophysiology to management.

Rathke's cleft cysts (RCCs) are benign, non-neoplastic lesions located in the sellar and suprasellar regions of the brain, originating from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. Although RCCs are frequently asymptomatic and discovered incidentally during imaging studies, they can present with a variety of symptoms, including headaches, visual disturbances, and endocrine dysfunction due to the compression of adjacent neural structures. The management of RCCs is particularly challenging, as the decision to pursue conservative monitoring or surgical intervention depends heavily on the cyst's size, growth potential, and the severity of symptoms. Transsphenoidal surgery is the primary treatment for symptomatic RCCs, offering effective relief from symptoms through decompression of the cyst. However, recurrence remains a significant issue, with rates reported up to 33%, prompting debates about the extent of cyst wall removal during surgery. Recent advancements in minimally invasive endoscopic techniques have improved surgical outcomes, yet the risk of postoperative complications such as hypopituitarism and cerebrospinal fluid leaks persists. Additionally, stereotactic radiosurgery has emerged as a potential alternative for patients with recurrent RCCs or those who are not suitable candidates for repeat surgery. Despite its promise, the long-term safety and efficacy of radiotherapy in RCC management require further investigation. This narrative review aims to provide a comprehensive overview of RCCs, integrating the latest research and clinical guidelines to discuss pathophysiology, clinical presentation, and management strategies, emphasizing the need for a personalized approach to treating this complex condition.

Application of the semidiving technique in fully endoscopic microvascular decompression.

Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).

Simultaneous combined keyhole mini-transcranial approach and endoscopic transsphenoidal approach to remove multi-lobulated pituitary neuroendocrine tumor with suprasellar extension.

BACKGROUND: Transsphenoidal surgery (TSS) is the main method to remove pituitary neuroendocrine tumor (PitNET), but large or multi-lobulated one is still challenging. OBJECTIVE: The less invasive simultaneous combined keyhole mini-transcranial approach and standard transsphenoidal approach was used to remove multi-lobulated or hourglass-shaped non-functioning PitNET to avoid the specific complications related to extended TSS. METHODS: Twenty-one patients of large multi-lobulated or hourglass-shaped PitNET (6 patients were recurrent cases after TSS or transcranial approach) were treated by this simultaneous combined approach. The supraorbital or midline keyhole approach was performed under the operating microscope so that the fine arteries feeding optic apparatus were dissected from the tumor capsule safely and securely and the suprasellar part of the tumor was removed in the extra-capsular fashion in combination with transsphenoidal approach. RESULTS: Visual function improved after the surgery in 14 (74 %) of 19 patients with preoperative disturbance of the visual fields. Four patients (19 %) developed postoperative deterioration of pituitary endocrine functions requiring permanent hormonal replacement. One patient (4.2 %) suffered cortical laminar necrosis without permanent disorders and another patient (4.2 %) suffered cerebrospinal fluid rhinorrhea but neither was permanent. Postoperative computed tomography detected no subarachnoid hemorrhage in any patient. Gross total removal was achieved in 15 patients (71 %). Five patients (24 %) with subtotal removal and one patient (4.2 %) with partial removal had lateral tumor extension with Knosp classification 3 or 4. CONCLUSION: The combined method is an effective treatment option to remove complex PitNET safely and securely with dissecting fine arteries on the tumor capsule.

Pediatric abscessed craniopharyngioma: A case report and review of literature.

BACKGROUND: Craniopharyngiomas are rare sellar and suprasellar tumors affecting children and adults. The spontaneous abscessation of this lesion is an extremely rare occurrence with a total of 10 cases reported in the literature including 2 cases in the pediatric population. OBSERVATION: We report a case of abscessed craniopharyngioma in a 10-year-old girl, revealed by intracranial hypertension and diabetes insipidus with a double component (solid and cystic) lesion of the sella visualized on cerebral MRI. The patient underwent surgical decompression via endoscopic endonasal transsphenoidal approach coupled with antibiotic treatment with an uneventful postoperative course and improvement of her symptoms. CONCLUSION: Abscessed craniopharyngiomas are rare and challenging entities. We highlight through our case and literature review the importance of an in-depth patient's history as well as a clinical-radiological correlation in allowing for a positive preoperative diagnosis even in patients with no meningeal or infection signs.

Contralateral Transmaxillary Corridor Used in Endoscopic Endonasal Approach for Resecting Adenoma Invading the Retrocarotid Area of the Cavernous Sinus and Beyond: Surgical Anatomy, Patient Selection Algorithm, and Illustrative Cases.

BACKGROUND AND OBJECTIVES: The cavernous internal carotid artery (cICA) and its branches can make it challenging to approach the lateral portion of the retrocarotid area of the cavernous sinus (RcACS) and surrounding areas during the endoscopic endonasal approach (EEA). This can sometimes require more invasive transcranial approaches, causing a higher risk of complications. We sought to explore the feasibility of adding a contralateral transmaxillary (CTM) corridor to improve access to the RcACS during EEA. METHODS: We performed EEA and CTM extensions on 6 cadavers (12 sides) using image guidance. The depth of the surgical corridor, the surgical exposure, the angle of attack, and the trajectory to the anterior genu of the cICA were measured. Two illustrative clinical cases are presented. RESULTS: Compared with the contralateral transnasal approach, the CTM corridor provided a 10.76 (5.32)-mm shorter distance ( P < .001), 36.23% (20.70%) larger surgical exposure ( P < .001), and a 24.6° (3.4°) more parallel trajectory to the anterior genu of the cICA ( P < .001). The mean angle of the lateral nasal wall line and the middle eye line was equal to the mean angle of the contralateral transnasal ( P = .075) and CTM ( P = .262) approaches, respectively. The CTM corridor allowed us to achieve near-total resection of the RcACS and beyond in 2 invasive adenomas with significant lateral extension. CONCLUSION: The CTM corridor is a feasible addition to standard EEA to access the RcACS and beyond, providing a more medial-to-lateral trajectory and improved access. The middle eye line can be used as a reference to help select patients for this approach.

[Clinical observation of 7 cases of functional pituitary neuroendocrine tumor treated by endoscopic transnasal selective resection of the cavernous sinus medial wall].

The clinical data of 7 patients (3 males and 4 females) with functional pituitary neuroendocrine tumor treated by endoscopic transnasal resection of the cavernous sinus medial wall from May to October 2023 in the Department of Neurosurgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. They ranged in age from 29 to 60, with an average age of 45. The clinical diagnosis was acromegaly in 5 cases and Cushing's disease in 2 cases. There were 1 cases of microadenoma and 6 cases of macroadenoma. Knosp grade: Grade 1 adenoma in 3 cases, grade 2 adenoma in 3 cases and grade 3A adenoma in 1 case. Intraoperative resection of cavernous sinus medial wall was performed on the side of tumor. Five cases were determined to be invaded by tumor, and 2 cases were uncertain. No internal carotid artery injury occurred in all patients. The average intraoperative blood loss was 156 ml, and no patient was transfused. Postoperative endocrine remission was found in 6 cases, and tumor cells were found in 6 cases by pathological examination of the medial wall of cavernous sinus. No serious complications occurred in all patients. For Knosp grade 1-3 functional pituitary neuroendocrine tumor surgery, if there is no clear false envelope or normal pituitary between the tumor and the cavernous sinus medial wall during the operation, the cavernous sinus medial wall should be actively removed to improve the postoperative endocrine remission rate.

Solitary isolated disseminations of glioblastoma to sellar and suprasellar regions: two case reports.

Herein, we present two cases of isolated suprasellar dissemination of glioblastoma in patients with well-controlled primary lesions. A 22-year-old woman and a 56-year-old woman developed rapid growth of suprasellar glioblastoma dissemination 26 and 17 months after initial surgery, respectively. Both patients presented with acute visual impairment (decreased acuity and visual field disturbances) but lacked severe pituitary dysfunction. During surgery for the disseminated tumors, gross total tumor resection was difficult due to intraoperative findings suggesting optic pathway invasion. Both patients developed further intracranial dissemination within several months post-surgery. The presence of solitary sellar and suprasellar dissemination may indicate a terminal stage.

Hypopituitarism after gamma knife radiosurgery for pituitary adenomas: long-term results from a single-center experience.

OBJECTIVE: The aim of this study was to investigate the incidence and risk factors of new-onset hypopituitarism after gamma knife radiosurgery (GKRS) for pituitary adenomas in a single center. METHODS: In this retrospective study, 241 pituitary adenoma patients who underwent GKRS from 1993 to 2016 were enrolled. These patients had complete endocrine, imaging, and clinical data before and after GKRS. The median follow-up time was 56.0 (range, 12.7-297.6) months. RESULTS: Fifty patients (20.7%) developed new-onset hypopituitarism after GKRS, including hypogonadism (n = 22), hypothyroidism (n = 29), hypocortisolism (n = 20), and growth hormone deficiency (n = 4). The median time to new-onset hypopituitarism was 44.1 (range, 13.5-141.4) months. The rates of new-onset hypopituitarism were 7%, 16%, 20%, 39%, and 45% at 1, 3, 5, 10, and 15 years, respectively. For those patients treated with a single GKRS, sex (p = 0.012), suprasellar extension (p = 0.048), tumor volume (≥ 5 cm3) (p < 0.001), tumor progression (p = 0.001), pre-existing hypopituitarism (p = 0.011), and previous surgery (p = 0.009) were significantly associated with new-onset hypopituitarism in univariate analysis. In the multivariate analysis, tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism (hazard ratio [HR] = 3.401, 95% confidence interval [CI] = 1.708-6.773, p < 0.001 and HR = 3.594, 95% CI = 1.032-12.516, p = 0.045, respectively). For patients who received 2 or more times GKRS, no risk factors associated with new-onset hypopituitarism were found. CONCLUSION: New-onset hypopituitarism was not uncommon after GKRS for pituitary adenomas. In this study, large tumor volume (≥ 5 cm3) and tumor progression were associated with new-onset hypopituitarism after a single GKRS.

Cutis verticis gyrata in a patient with acromegaly: an unusual case and review of literature.

Acromegaly is a rare systemic syndrome induced by the overproduction of growth hormone (GH) and insulin-like growth factor type one (IGF1). It is responsible for changes in the skeletal and soft tissue systems and it almost always occurs because of a pituitary adenoma. Amongst the skin complications related to acromegaly, cutis verticis gyrate (CVG) is occasionally found. It is a skin condition characterized by excessive growth of the skin of the scalp, resulting in furrows and folds. Only a few cases of this uncommon association have been reported in the literature. The present clinical case illustrates typical CVG associated with acromegaly. Imaging revealed a pituitary macroadenoma lesion and hormonal evaluation revealed elevated IGF1 and hypopituitarism. The patient underwent a transsphenoidal resection of the pituitary adenoma and the histopathological examination confirmed the diagnosis. The diagnosis of CVG is clinical, so radiologic assessments are generally not necessary. The management of acromegaly associated with CVG depends on controlling the serum levels of GH and IGF1. In some cases, specific injections or surgery can be used to minimize CVG.