Introduction: As a result of the increased utilization of neurosurgical arthroscopic techniques, investigations into population and sex-specific trends of anatomical considerations have become increasingly important. This study aimed to investigate and describe aspects of the neuroanatomical morphometry of lumbar spines in a cadaveric and magnetic resonance imaging (MRI) sample. Materials and Methods: Twenty white adult (>18 years) cadavers (9 males; 11 females) were obtained under Ethical clearance. The lumbar regions were dissected and the position of the dorsal root ganglion (DRG) and dimensions of Kambin's triangle were determined. Twenty-six black adult (>18 years) MRI scans (17 males; 9 females) were obtained from an Academic Hospital and were used to determine the dimensions of the neural foramen and the DRGs within. Results: The ganglia were mostly at the midline of the caudal pedicle. Similar to previous studies, the diagonal measurement from Kambin's triangle was the largest and the vertical measurement the shortest. Skeletal and soft-tissue measurements indicated distinct trends when moving caudolaterally in the spine. Soft-tissue parameters from the current study were within the upper limits of those from previous studies, whereas skeletal parameters were in agreement with those reported by previous authors. Conclusions: Results from this study suggest a variation of certain parameters between studies with varying population groups and therefore supports the need for and the importance of possible population-specific trends of anatomical parameters considered during surgical procedures.
Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. In most cases, a pre-existing pituitary macroadenoma is present. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered state of consciousness and variable endocrine deficits. Case historyA 49-year-old man presented to the emergency department with headaches, visual disturbances and severe hypotension. On examination, a left temporal hemianopia was found. His GCS was 15/15 and there were no other cranial nerve deficits. Laboratory investigations revealed decreased cortisol, thyroid stimulating hormone, prolactin, testosterone and adreno-cortico-thyrotropic hormone levels. He was also hyponatraemic.A clinical diagnosis of pituitary apoplexy with severe hypopituitarism was made, and the patient had immediate fluid and electrolyte replacement, hydrocortisone and T4 replacement. The patient was reluctant to undergo surgery and was initially managed with medical therapy. Imaging findingsOn MR investigation, a sella and supra-sella mass showing mixed signal intensity was found (Figs 1 -3). Subsequent imaging to plan for transsphenoidal surgery included a CT scan of the skull base and brain, done 3 months after the initial diagnosis, and it was then discovered that the sella mass had decreased in size. Further MR imaging a week after the CT scan and again 2 months later (Figs 4 -6)
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