Brainstem cavernous malformations are challenging due to the critical anatomy and potential surgical risks. Anterolateral, lateral, and dorsal surgical approaches provide limited ventral exposure of the brainstem. The authors present a case of a midline ventral pontine cavernous malformation resected through an endoscopic endonasal transclival approach based on minimal brainstem transection, negligible cranial nerve manipulation, and a straightforward trajectory. Technical and reconstruction technique advances in endoscopic endonasal skull base surgery provide a direct, safe, and effective corridor to the brainstem.
Objective?Report a modification of the ?rescue flap? technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution.
Design?Prospective study.
Setting?Hospital Universitario ?Dr. Jos? Eleuterio Gonz?lez,? Universidad Aut?noma de Nuevo Le?n.
Main Outcome Measures?Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below.
Results?Nineteen patients were included in this report. Six patients presented transoperatory cerebrospinal fluid (CSF) leak, so a nasoseptal rescue flap was harvested. No patients developed postoperative CSF leak in this group. Two patients were submitted to a second surgical procedure. Nasoseptal flap was harvested without complications. In both patients, the size of the flap was enough to cover the dural defect and avoid CSF leak.
Conclusion?Direct endonasal approach with a partial posterior septectomy allows enough exposition of the sphenoidal sinus while preserving the nasoseptal septum with the possibility of a successful rescue flap when needed.
Introduction: Hypophysitis is a rare, inflammatory disorder of the pituitary that mimics neoplastic lesions resulting in anterior and posterior pituitary dysfunction.
Presentation of case:We present a 36-year-old woman who presented with chronic headaches and was found to have a pituitary mass on MRI, suggested of craniopharyngioma, and the histological inspection showed a piloide gliosis, one year ago. She continuing with visual disturbance and recurrence was suspected and she was operated to craniopharyngioma. After that, she showed clinical and radiologically symptoms of recurrence and was reopeated which biopsied was reported as xantogranulomatosous hypophysitis.Discussion: This woman illustrates a rare pituitary pathology presented with a literature review of published patients describing xanthomatous hypophysitis. In this case we describe a patients with xanthogranulomatous hypophysitis (XGH) demonstrating post-surgical procedure of craniopharyngioma resection.
Conclusion:Xantomagranulomatous reaction was due to rupture of cyst walls of craniopharyngioma or natural immunological and inflammatory mechanism of reduction of tumor growth and progression of disease caused by extravased cyst content into the adjacent gland and favoring the reduction or regression of tumor.
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