The pituitary fossa, and the methods of surgical approach thereto

Cope, V. Zachary

doi:10.1002/bjs.1800041312

Cited by 37 publications

(14 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Table 1 features a summary of data corresponding to the fundamental epidemiological, surgical, and pathological variables selected and analyzed for the 160 CPs. 1,2,6,7,[9][10][11]13,[15][16][17]19,20,[22][23][24][25]27,[29][30][31][32][34][35][36]40,41,[44][45][46][47][48][49][50][51][52][54][55][56]64,66,68,69,71,72,[74][75][76]78,82,84,…”

Section: Epidemiological Diagnostic and Cp Pathological Featuresmentioning

confidence: 99%

See 1 more Smart Citation

Development of intracranial approaches for craniopharyngiomas: an analysis of the first 160 historical procedures

Pascual

Prieto

Castro-Dufourny

et al. 2014

FOC

View full text Add to dashboard Cite

Object The development of surgical procedures for the removal of craniopharyngiomas (CPs) was greatly influenced by the enormous topographical and morphological heterogeneity displayed by these lesions. In this study the authors reviewed the intracranial approaches designed to treat CPs during the early historical period (1891–1938) with the aim of finding the CP topographical and pathological features that influence patient outcomes. Methods The authors conducted a systematic retrospective review of well-described cases of surgically treated CPs in publications from the period 1891–1938. Valuable information regarding the diagnosis of the lesion, type of craniotomy performed, CP topography, and outcome was selected from 418 reports included in medical publications from this period. The type of surgical procedure used, degree of tumor removal, CP position and histological variety, and clinical evidence of postoperative hypothalamic injury were the variables analyzed with the aim of defining their influence on the final patient outcome. Results A collection of 160 cases was eligible for analysis. Craniopharyngioma topography was significantly related to the existence of postoperative hypothalamic damage and the degree of tumor removal achieved (p < 0.001). The infundibulo-tuberal, or not strictly intraventricular, topography was associated with the highest rate of hypothalamic injury (84%) and impossibility of tumor removal (51%). This topography also showed the worst prognosis (p = 0.001). Additional variables correlated with patient outcome were the presence of hypothalamic damage, type of surgical approach used, and degree of tumor removal. Patients having a poor outcome, suffering from permanent coma, or dying after surgery presented with symptoms of hypothalamic injury in 40% of cases (p < 0.001). The surgical approach associated with the best outcome was the transsphenoidal (58%), followed by the subfrontal (45%) and the transcallosal (45%). Subtotal resection of the lesion yielded the best postoperative results, with only 17% of patients dying or suffering from a poor outcome, in contrast to the 39% reported for gross-total removal of the lesion (p = 0.001). Conclusions Two major variables influenced the results of early surgical experience with CPs for the period from 1891 to 1938: 1) the inaccuracy in defining CP topography with the diagnostic methods available at that time; and 2) the ignorance about the risks associated with the dissection of lesions showing tenacious adherence to the hypothalamus. The degree of functional and morphological disturbance of the hypothalamus caused by a CP remains a fundamental variable helping the surgeon to predict the risks associated with the radical excision of the tumor and patient outcome.

show abstract

Section: Epidemiological Diagnostic and Cp Pathological Featuresmentioning

confidence: 99%

“…24 Forty-five of the tumors were adenomas. The other lesions were classified in multiple categories, such as endothelioma, teratoma, mixed tumor, calcifying chondroma, epithelial cancer, or sarcoma, evidence of the confusing terminology still used for heterogeneous pituitary tumors during the first 15 years of the 20th century.…”

mentioning

confidence: 99%

Development of intracranial approaches for craniopharyngiomas: an analysis of the first 160 historical procedures

Pascual

Prieto

Castro-Dufourny

et al. 2014

FOC

View full text Add to dashboard Cite

show abstract

“…Certainly, the subject represented a very novel, exciting field to investigate at that time, when transsphenoidal approaches to the pituitary had proved to be a successful route of access to one of the most mysterious and intricately hidden of the ductless glands. 11,14 Nevertheless, Verga's main focus was on Horsley's series of pituitary operations, all performed through a transcranial approach. He even reported that Horsley's surgical work on the pituitary was his major source of inspiration.…”

Section: Giovanni Verga and His Report On Horsley's Pituitary Surgeriesmentioning

confidence: 99%

Sir Victor Horsley: pioneer craniopharyngioma surgeon

Pascual

Prieto

Mazzarello

2015

JNS

View full text Add to dashboard Cite

In the published version of this lecture, Horsley mentioned his surgical experience with pituitary tumors up to that time, encompassing a total of 10 cases. 24 However, he did not report the operative details of such procedures, nor did he show evidence of the pathological nature of the pituitary lesions operated upon. Although a few of Horsley's trainees and colleagues knew about his intention to publish his series of pituitary tumors, the time he spent on his political career and his premature death due to heatstroke during the military campaign in Mesopotamia prevented him from giving a full account of these cases. 40 The only mention of verified pituitary tumor operations performed by Horsley at the National Hospital in London was included in the review of the first 500 brain tumors operated on at that institution in the 1900s, published by Tooth in 1912. 58 Tooth's appraisal provides information about neither the results of these procedures nor the microscopic appearances of the tumors.In 2003 The descriptions of the topographical and macroscopic features of two of the lesions correspond unmistakably to the features of craniopharyngiomas, one of the squamous-papillary type and one of the adamantinomatous type. The former lesion was found on necropsy after the patient's sudden death following a temporal osteoplastic craniectomy. Surgical removal of the lesion in the latter case, with the assumed nature of an adamantinomatous craniopharyngioma, was successful. According to the evidence provided in Giovanni Verga's monograph, it can be claimed that Sir Victor Horsley was not only the pioneer of pituitary gland surgery but also the pioneer of craniopharyngioma surgery.

show abstract

“…Included among these cases was the first pituitary surgery performed for acromegaly, conducted in Vienna in 1908 by Julius von Hochenegg, who modified the procedure by adding the resection of the frontal sinuses. 10,41 His patient not only survived the surgery and immediate postoperative period but lived for many years afterward. 30 In 1909, using Schloffer's superior nasal approach as a foundation, Harvey Cushing performed his first transsphenoidal resection of a pituitary tumor in a patient with acromegaly.…”

Section: Impact On the Neurosurgical Communitymentioning

confidence: 99%

“…Of those 5 patients, 4 succumbed to the infection. 10 Furthermore, Schloffer's procedure and the variations performed by Hochenegg, Cushing, and others resulted in severe facial deformities. While patients may have experienced some symptomatic relief, the stigma associated with the severe aesthetic defects would greatly affect their quality of life postoperatively.…”

Section: Impact On the Neurosurgical Communitymentioning

confidence: 99%

Hermann Schloffer and the origin of transsphenoidal pituitary surgery

Schmidt

Choudhry

Takkellapati

et al. 2012

FOC

View full text Add to dashboard Cite

A little over a century ago, in 1907, at the University of Innsbruck, Hermann Schloffer performed the first transsphenoidal surgery on a living patient harboring a pituitary adenoma. Schloffer used a superior nasal route via a transfacial lateral rhinotomy incision. This was perhaps his greatest academic contribution to neurosurgery. Despite the technological limitations of that time, Schloffer's operation was groundbreaking in that it laid the foundation for future development and refinement of transsphenoidal pituitary surgery, influencing prominent surgeons such as Oskar Hirsch and Harvey Cushing. Even after undergoing multiple modifications and a brief fall into obscurity, the transsphenoidal approach has endured through generations of surgeons and remains the preferred approach for lesions of the sella turcica to this day. Although Schloffer performed primarily abdominal surgery in his practice, his contributions to the transsphenoidal approach have had a lasting impact in the field of pituitary and skull base surgery. The authors review the life and career of Hermann Schloffer, the surgical details of his transsphenoidal operation, and the legacy that it has left on the field of pituitary surgery.

show abstract

The pituitary fossa, and the methods of surgical approach thereto

Cited by 37 publications

References 3 publications

Development of intracranial approaches for craniopharyngiomas: an analysis of the first 160 historical procedures

Development of intracranial approaches for craniopharyngiomas: an analysis of the first 160 historical procedures

Sir Victor Horsley: pioneer craniopharyngioma surgeon

Hermann Schloffer and the origin of transsphenoidal pituitary surgery

Contact Info

Product

Resources

About