Pituitary apoplexy is a life-threatening clinical syndrome which is caused by the fulminant expansion of pituitary mass due to hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or the adjacent tissues of pituitary gland. Since first introduced by Bailey in 1898, the incidence of pituitary apoplexy varies from 0.6% to 22.8% 7,11,12,17) . However, pituitary apoplexy due to tumor infarction is very rare. We report two cases of pituitary apoplexies, caused by pituitary tumor infarction after surgery by transsphenoidal approach (TSA) for pituitary macroadenomas. These cases showed pathologic findings of tumor infarction without any signs of related hemorrhage or hemorrhagic infarction. CASE REPORT Case 1A 44-year-old male patient was admitted via emergency room due to sudden onset of severe headache, nausea, vomiting and visual disturbance. These symptoms were developed 5 days prior to admission. He had no specific previous medical history. Subarachnoid hemorrhage (SAH) was ruled out on brain computed tomography (CT), however sella magnetic resonance imaging (MRI) showed a mass lesion in the sella and suprasellar area which was measured about 3.1×2.3×2.2 cm. On T1 weighted images, there was hyperintense peripheral portion and an isointense central portion. With gadolinium (Gd) enhancement, the mass showed peripheral rim enhancement but there was no enhancement in the hypointense central portion (Fig. 1). Diffusion MR images were not obtained due to emergency operation. The optic chiasm was compressed by the mass which resulted in bitemporal hemianopsia and the worsening of the visual acuity of the right eye to 0.4 and maintaining that of the left, 1.1. There was a decrease in the levels of free T4 (4 µg/dl), TSH (0.28 µU) and cortisol (2 µg/dl). Steroid was administered before the operation. The mass was totally resected by TSA and there was no evidence of remaining enhancing tumor or hemorrhage seen in the postoperative first day follow-up sella MRI (Fig. 2). Microscopic examination of the resected mass showed total infarction without viable tumor cells (Fig. 2). The cells showed pale appearance and maintained cellular architecture. These findings led to the diagnosis of pituitary apoplexy due to total tumor infarction of a nonfunctioning pituitary macroadenoma. Clinical symptoms and

Trunk MCSAs were significantly larger for a fusion group than a nonfusion group. As trunk MCSAs increased, fusion timing decreased.

No abstract

No abstract

Background/AimsThe purpose of this study was to provide anatomical data on the dimensions and location of the subaxial transverse foramen (TF) in relation to surgical landmarks routinely used during anterior cervical procedures. MethodsA total of 116 patients who underwent preoperative computed tomography (CT) evaluations for degenerative cervical disease were enrolled. Axial and coronal CT images of the cervical vertebrae from C3 to C6 were analyzed to measure interforaminal distance, the TF distance from the anterior and posterior vertebral body margin, TF dimensions, and the TF medial margin from the tip and medial margin of the uncus. Comparative and correlative analyses were also performed according to age, body mass index (BMI), and sex. ResultsAll measurement values in male patients were larger than those in their female counterparts. The interforaminal distance gradually increased from C3 to C6. The distance of the TF medial margin from the tip of the uncus was found be above approximately 3 mm in all vertebrae except C6. Correlation analysis revealed that age had a significant negative relationship with the transverse diameter of TF. In contrast, BMI had a significant positive correlation with interforaminal distance. Moreover, the distances of the TF medial margin from the tip and medial margin of the uncus showed strong negative correlations with age. ConclusionUseful morphometric data were obtained that may help the operating surgeon to avoid vertebral artery injury. The safe distance from the tip of the uncus to the TF medial margin was found to be approximately 3 mm, and this distance should not be violated during lateral decompression. In addition, this value may decrease with age.