Surgical therapy of lesions within the hypothalamic region

Fahlbusch, Rudolf; Schrell, U.

doi:10.1007/bf01406333

Cited by 12 publications

(3 citation statements)

References 22 publications

(10 reference statements)

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“…These include Rathke's cleft cysts, optic chiasm or posterior optic nerve gliomas, hypothalamochiasmatic tumors of childhood, germinomas, granular cell tumors, meningiomas, pituitary adenomas, hemangioblastomas, metastatic lesions, and even certain aneurysms in critical positions. 9,17,40 The limitations of the approach will become more apparent with increasing experience. Among those evident from the cases presented here are: 1) lateral extension beyond the site of intracranial dural penetration by the ICAs or by the optic nerves into the optic canals; and 2) a tumor lying behind the pituitary stalk in a patient with normal pituitary function in whom tumor removal may be successful with preservation of pituitary function when a lateral approach is used.…”

Section: Potential Applications Of the Modified Transsphenoidal Approachmentioning

confidence: 97%

Resection of suprasellar tumors by using a modified transsphenoidal approach

Kouri¹,

Chen²,

Watson³

et al. 2000

Journal of Neurosurgery

187

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Generally accepted contraindications to using a transsphenoidal approach for resection of tumors that arise in or extend into the suprasellar region include a normal-sized sella turcica, normal pituitary function, and adherence of tumor to vital intracranial structures. Thus, the transsphenoidal approach has traditionally been restricted to the removal of tumors involving the pituitary fossa and, occasionally, to suprasellar extensions of such tumors if the sella is enlarged. However, conventional transcranial approaches to the suprasellar region require significant brain retraction and offer limited visualization of contralateral tumor extension and the interface between the tumor and adjacent structures, such as the hypothalamus, third ventricle, optic apparatus, and major arteries. In this paper the authors describe successful removal of suprasellar tumors by using a modified transsphenoidal approach that circumvents some of the traditional contraindications to transsphenoidal surgery, while avoiding some of the disadvantages of transcranial surgery. Four patients harbored tumors (two craniopharyngiomas and two hemangioblastomas) that arose in the suprasellar region and were located either entirely (three patients) or primarily (one patient) within the suprasellar space. All patients had a normal-sized sella turcica. Preoperatively, three of the four patients had significant endocrinological deficits signifying involvement of the hypothalamus, pituitary stalk, or pituitary gland. Two patients exhibited preoperative visual field defects. For tumor excision, a recently described modification of the traditional transsphenoidal approach was used. Using this modification, one removes the posterior portion of the planum sphenoidale, allowing access to the suprasellar region. Total resection of tumor was achieved (including absence of residual tumor on follow-up imaging) in three of the four patients. In the remaining patient, total removal was not possible because of adherence of tumor to the hypothalamus and midbrain. One postoperative cerebrospinal fluid leak occurred. Postoperative endocrinological function was worse than preoperative function in one patient. No other new postoperative endocrinological or neurological deficits were encountered. This study demonstrates the feasibility of using a modified transsphenoidal approach for resection of certain suprasellar, nonpituitary tumors.

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Section: Potential Applications Of the Modified Transsphenoidal Approachmentioning

confidence: 97%

Resection of suprasellar tumors by using a modified transsphenoidal approach

Kouri¹,

Chen²,

Watson³

et al. 2000

Journal of Neurosurgery

187

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“…The majority of intradural spinal arachnoid cysts occur in the thoracic region (80%), with only 15% in the cervical region and 5% in the lumbar region. Most are dorsal to the neural elements (80%) in the canal and only 20% are ventrally located [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. In our literature research of the Medline database, comprising reports published between 1966 and April 2001, we retrieved only 11 cases in which the intradural arachnoid cyst was located anterior to the cervical spinal cord [4, 9, 11, 18, 20, 21, 22], of which 8 were in the pediatric age group, like our case 2 (table 1) [4, 18, 21, 22, 23, 24].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature

Lee

Cho²

2001

Pediatr Neurosurg

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Spinal arachnoid cysts are a relatively uncommon lesion that may be either intra- or extradural, and intradural spinal arachnoid cysts are even less common. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. We present three cases in the pediatric age group with spinal intradural arachnoid cysts without a preceding history of trauma. Three patients with symptomatic intradural arachnoid cysts were investigated with conventional T1- and T2-weighted magnetic resonance imaging (MRI). The MRI scans demonstrated the intradural arachnoid cysts with slightly lower CSF signal intensity on the gradient echo images and slightly higher signal intensity on T1-weighted images. The first cyst was located at the level T12–L1 and compressed the conus medullaris, with neurogenic bladder and cauda equina syndrome for 2 months. The second was located at the level C5–T1 ventrally, with spastic gait and neurogenic bladder for 4 years. The other was located at T2–3 ventrally, with sudden onset of quadriplegia after jumping rope. The combined treatment of total resection and wide fenestration in our three patients produced an excellent return of neurologic function in each one, except for residual urinary disturbance in case 2. Intradural spinal arachnoid cysts appear to result from an alteration of the arachnoid trabeculae; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and congenital. The majority of intradural spinal arachnoid cysts occur in the thoracic region and most are dorsal to the neural elements. Only 10 cases have been reported in which the intradural arachnoid cysts were located anterior to the cervical spinal cord, of which 8 were in the pediatric age group, like our case 2. Myelography, postcontrast CT myelography and MRI have been demonstrated as useful for the diagnosis of intradural arachnoid cysts. MRI is the imaging modality of choice, and the extent, size and nature of the lesion in our cases were well demonstrated by MRI. Surgical treatment is necessary if progressive neurological dysfunction appears in the course of spinal cord compression. Complete surgical excision of the cysts is the best choice of treatment, and wide fenestration and shunting of the cyst to the peritoneum, pleural cavity or right atrium were the modalities of choice. MRI offers a noninvasive and effective means to make the diagnosis of arachnoid cysts easier. Intradural arachnoid cysts may cause progressive myelopathy; however, the postoperative prognosis is good if the operation is performed prior to neurologic deficits.

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“…Surgical excision is the primary modality of therapy followed by adjuvant chemotherapy and/or radiotherapy, and is associated with a good outcome (90% survivors at the end of 4 years of follow-up) 13 , 14. Poor prognostic factors include younger age of the patients (<5 years) and site of tumour (cerebellar and cerebral tumours having better outcomes) 14.…”

Section: Discussionmentioning

confidence: 99%