Pre‐morbid morphological conditions of the human pituitary

Rittierodt, Marion; Hori, Akira

doi:10.1111/j.1440-1789.2006.00745.x

Cited by 15 publications

(9 citation statements)

References 21 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17 Rathke cleft cysts are found frequently at autopsy, and have been reported to occur in 5%-27% of the population. [11][12][13][14] Although RCCs are nonfunctioning, they can result in neurological and endocrine deficits via mass effect on the pituitary axis, optic chiasm, and surrounding anatomy. 6,7,18 As a result, surgical intervention is recommended in symptomatic and at-risk patients, most commonly via a transsphenoidal approach.…”

mentioning

confidence: 99%

Symptomatic Rathke cleft cysts: extent of resection and surgical complications

Higgins¹,

Gompel²,

Nippoldt

et al. 2011

FOC

View full text Add to dashboard Cite

Object Rathke cleft cysts (RCCs) are benign masses arising from the embryological Rathke pouch, and are commonly treated by transsphenoidal surgery. The authors retrospectively compared RCC extent of resection—either gross-total resection (GTR) or decompression—to the primary outcome measure, which was recurrences resulting in repeat surgery, and the secondary outcome measure, which was complications. Methods Seventy-four patients presenting to the neurosurgical department with RCC were analyzed retrospectively. Sixty-eight patients had a total of 78 surgical procedures, with the diagnosis of RCC confirmed by histological investigation; of these, 61 patients had adequate operative notes for the authors to evaluate extent of resection. Groups were separated into GTR (32 patients) or decompression (subtotal resection or fenestration into the sphenoid sinus; 29 patients) based on operative notes and postoperative imaging. The mean follow-up duration was 60.5 ± 72.1 months (the mean is expressed ± SD throughout). Results The average age at the time of the initial surgery was 42.8 ± 17.4 years, and 70% of patients were female. The mean cyst diameter preoperatively was 16.9 ± 17.8 mm. Eight patients had repeat surgery, our primary outcome measure; 3 repeat operations occurred in the GTR group, and 5 in the decompression group. There was no significant difference in recurrence when comparing groups (GTR 9%, decompression 17%; p = 0.36). There were no major complications; however, analysis of postoperative minor complications revealed that 11 (34%) GTRs resulted in surgical complications, whereas the decompression cohort accounted for only 3 complications (10%) (p = 0.03), with diabetes insipidus (6) and CSF leaks (5) being the most common. Gross-total resection also resulted in an increase in postoperative hyperprolactinemia compared with decompression (p = 0.03). Conclusions It appears that RCCs require repeat surgery in 13% of cases, and attempted GTR does not appear to reduce the overall rate of recurrence. However, more aggressive resections are associated with more complications in this series.

show abstract

mentioning

confidence: 99%

Symptomatic Rathke cleft cysts: extent of resection and surgical complications

Higgins¹,

Gompel²,

Nippoldt

et al. 2011

FOC

View full text Add to dashboard Cite

show abstract

“…They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.…”

mentioning

confidence: 99%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

View full text Add to dashboard Cite

R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

show abstract

“…Primary salivary gland‐like tumors of the sella are believed to arise from sero‐mucinous glands entrapped in the infundibulum during pituitary development. These remnants can be found incidentally in the pars intermedia and posterior pituitary in about 3–8% of postmortem children and adults . They only rarely become symptomatic due to cyst formation and chronic inflammation .…”

Section: Discussionmentioning

confidence: 99%

“…They seem to derive from serous and mucinous glands trapped in the infundibulum during pituitary embryogenesis . Such remnants are usually clinically silent and found incidentally in about 3%–8% of post‐mortems …”

Section: Introductionmentioning

confidence: 99%

Primary epithelial‐myoepithelial carcinoma of the pituitary gland

et al. 2020

View full text Add to dashboard Cite

Primary salivary gland‐like tumors of the sella are rare and often challenging to diagnose. They reportedly derive from serous and mucinous glands that remain trapped in the infundibulum during embryogenesis. We report a 68‐year‐old man who presented with partial left third cranial nerve palsy, visual loss in the left eye without visual field defects, headache, weight loss and reduced muscle bulk. Neuroimaging studies demonstrated a solid and cystic, avidly enhancing lesion expanding the pituitary fossa and extending to the left cavernous sinus. The patient underwent craniotomy and the tissue removed showed features of epithelial‐myoepithelial carcinoma similar to the salivary gland, skin and breast counterpart. No primary tumor was found outside the sella. The lesion behaved aggressively despite radio‐chemotherapy and the patient died 22 months from the onset. The tumor showed a novel TP53 in‐frame deletion (Gly154del) while no variants were found in H‐RAS hotspot regions (codons 12, 13 and 61). Our report expands the spectrum of salivary gland‐like tumors primarily occurring in the sella and emphasizes the need for specialist review of rare, non‐neuroendocrine tumors of the pituitary and sella regions.

show abstract

Pre‐morbid morphological conditions of the human pituitary

Cited by 15 publications

References 21 publications

Symptomatic Rathke cleft cysts: extent of resection and surgical complications

Symptomatic Rathke cleft cysts: extent of resection and surgical complications

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Primary epithelial‐myoepithelial carcinoma of the pituitary gland

Contact Info

Product

Resources

About