Pituitary adenomas are very common lesions, constituting between 10 and 20% of all primary brain tumors(1,2). Epidemiological studies have demonstrated that nearly 20% of the general population has a pituitary adenoma(2). Pituitary adenomas are broadly classified into two groups. The first category consists of tumors that secrete excess amounts of normal pituitary hormones, The second category of pituitary adenomas is composed of tumors that do not secrete any known biologically active pituitary hormones For both types of pituitary adenomas, a recurrence resulting from tumor invasion into surrounding structures or in complete tumor resection is quite common. Longterm tumor control rates after microsurgery alone vary from 50 to 80%(3-5). Radiation therapy or radiosurgery can be administered postoperatively as adjuvant therapy to inhibit recurrent growth or later when clinical symptoms or neuroimaging findings indicate a recurrence. These therapies may also be used postoperatively to treat known residual tumor following incomplete resection.
Transoral odontoidectomy followed by occipitocervical fixation is a widely used approach to relieve ventral compressions at the craniovertebral junction. Despite the large amount of literature on this approach and its complications, odontoid process regeneration and causing the worsening of symptoms of brainstem dysfunction and upper cervical cord were not found in the English literature. We report the case of odontoid regeneration in a 12-year-old girl. She presented with torticollis and symptoms of brainstem dysfunction and upper cervical cord compression with syringohydromyelia and underwent transoral resection of dens and posterior occipitocervical fusion at the age of 7 years. Post surgery, clinically and radiologically, the resolution was evident till the age of 11 years when the child started to have relapse and worsening of the previous symptoms. The computed tomography/magnetic resonance imaging shows regeneration of the odontoid process compressing the brain stem with an increase in syringohydromyelia. We suggest that there is a need for the removal of the complete odontoid process with periosteum and also beyond the dentocentral synchondrosis to prevent late recurrences of odontoid regeneration.
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