The Mixed Sellar Barrier: A New Subtype of this Novel Concept

Villalonga, Juan F.; Ries-Centeno, Tomas; Saenz, Amparo; Solari, Domenico; Cervio, Andrés; Campero, Álvaro

doi:10.1016/j.wneu.2019.09.027

Cited by 7 publications

(19 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar to our previous reports, we found more frequently strong sellar barriers in the clinical cases, 73.69%; (14) (Campero et al, ; Villalonga et al, ).…”

Section: Discussionsupporting

confidence: 92%

“…We considered the barrier strong if it was constituted by dura and/or gland and weak if it was constituted only by arachnoid tissue. Recently, we proposed a new subtype, the mixed sellar barrier that is already validated in our recent article (Villalonga et al, ). It is a combination of both types, with parts that resemblance the strong sellar barrier and parts that are more similar to the weak sellar barrier.…”

Section: Discussionmentioning

confidence: 90%

“…After we described these two types of sellar barriers, we found a third subtype, the mixed sellar barrier, which was introduced recently. The mixed sellar barrier consists of a roof with parts that resemblance the strong sellar barrier and parts that are more similar to the weak sellar barrier (Villalonga et al, ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. Methods We provided anatomical models in six fresh‐frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. Results We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. Conclusion We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.

show abstract

“…Similar to our previous reports, we found more frequently strong sellar barriers in the clinical cases, 73.69%; (14) (Campero et al, ; Villalonga et al, ).…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…In our initial publication, we demonstrated the correlation between the intraoperative classification of the sellar barrier and the presence of intraoperative CSF leak ( 12 ). Later, in a second publication, we found a correlation between the MRI classification of the sellar barrier and the presence of CSF leak ( 13 ). In a recent multicentric study ( 14 ), this relation has been confirmed: albeit without ML analysis, patients assessed as at higher risk of intraoperative CSF leakage would benefit most from a gentle dissection of the most superior aspects of the tumor, paying attention to preserve as much as possible the layer of the gland to cover the diaphragm.…”

Section: Discussionmentioning

confidence: 88%

“…The sellar barrier concept and its role in predicting the risk of intraoperative CSF leakage was recently introduced ( 12 , 13 ) and confirmed in a clinical multicentric study ( 14 ).…”

Section: Discussionmentioning

confidence: 93%

Clinical application of the “sellar barrier’s concept” for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning analysis

et al. 2022

View full text Add to dashboard Cite

BackgroundRecently, it was defined that the sellar barrier entity could be identified as a predictor of cerebrospinal fluid (CSF) intraoperative leakage. The aim of this study is to validate the application of the sellar barrier concept for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning approach.MethodsWe conducted a prospective cohort study, from June 2019 to September 2020: data from 155 patients with pituitary subdiaphragmatic adenoma operated through endoscopic approach at the Division of Neurosurgery, Università degli Studi di Napoli “Federico II,” were included. Preoperative magnetic resonance images (MRI) and intraoperative findings were analyzed. After processing patient data, the experiment was conducted as a novelty detection problem, splitting outliers (i.e., patients with intraoperative fistula, n = 11/155) and inliers into separate datasets, the latter further separated into training (n = 115/144) and inlier test (n = 29/144) datasets. The machine learning analysis was performed using different novelty detection algorithms [isolation forest, local outlier factor, one-class support vector machine (oSVM)], whose performance was assessed separately and as an ensemble on the inlier and outlier test sets.ResultsAccording to the type of sellar barrier, patients were classified into two groups, i.e., strong and weak barrier; a third category of mixed barrier was defined when a case was neither weak nor strong. Significant differences between the three datasets were found for Knosp classification score (p = 0.0015), MRI barrier: strong (p = 1.405 × 10−6), MRI barrier: weak (p = 4.487 × 10−8), intraoperative barrier: strong (p = 2.788 × 10−7), and intraoperative barrier: weak (p = 2.191 × 10−10). We recorded 11 cases of intraoperative leakage that occurred in the majority of patients presenting a weak sellar barrier (p = 4.487 × 10−8) at preoperative MRI. Accuracy, sensitivity, and specificity for outlier detection were 0.70, 0.64, and 0.72 for IF; 0.85, 0.45, and 1.00 for LOF; 0.83, 0.64, and 0.90 for oSVM; and 0.83, 0.55, and 0.93 for the ensemble, respectively.ConclusionsThere is a true correlation between the type of sellar barrier at MRI and its in vivo features as observed during endoscopic endonasal surgery. The novelty detection models highlighted differences between patients who developed an intraoperative CSF leak and those who did not.

show abstract

The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study

et al. 2020

View full text Add to dashboard Cite

The Mixed Sellar Barrier: A New Subtype of this Novel Concept

Cited by 7 publications

References 11 publications

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room

Clinical application of the “sellar barrier’s concept” for predicting intraoperative CSF leak in endoscopic endonasal surgery for pituitary adenomas with a machine learning analysis

The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study

Contact Info

Product

Resources

About