Pituitary Stalk Stretch Predicts Postoperative Diabetes Insipidus After Pituitary Macroadenoma Transsphenoidal Resection.

Background: Manipulation of the pituitary stalk, posterior pituitary gland, and hypothalamus during transsphenoidal pituitary adenoma resection can cause disruption of water electrolyte regulation leading to diabetes insipidus (DI).

Objective: To determine whether pituitary stalk stretch is an independent risk factor for postoperative DI after pituitary adenoma resection.

Methods: A retrospective review was performed of patients undergoing endoscopic endonasal resection of pituitary macroadenoma between July 2010 and December 2016 by a single neurosurgeon.

A Surgical Perspective on the Association between Cystic Lesions of the Pineal Gland (Descartes' Seat of the Soul) and the Pituitary (the Master Gland).

 Rene Descartes (1596-1650), the famous philosopher and scientist, identified the pineal gland as the only cerebral structure not represented bilaterally, the "seat of the soul"; and the source of rational thought. Pineal cysts (PCs) are often incidentally identified in MRI studies, with a reported prevalence of 1 to 4.3%.

Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya.

Objective: Ivy sign is a radiographic finding on FLAIR MRI sequences and is associated with slow cortical blood flow in moyamoya. Limited data exist on the utility of the ivy sign as a diagnostic and prognostic tool in pediatric patients, particularly outside of Asian populations. The authors aimed to investigate a modified grading scale with which to characterize the prevalence and extent of the ivy sign in children with moyamoya and evaluate its efficacy as a biomarker in predicting postoperative outcomes, including stroke risk.

Professor Rathke's gift to neurosurgery: the cyst, its diagnosis, surgical management, and outcomes.

Purpose: Rathke cleft cysts (RCC) are a target for transsphenoidal surgery when symptomatic; however, the surgical techniques and outcomes continue to be of interest. Our goal is to highlight nuances in diagnosis, surgical philosophy and techniques, and outcomes.

Methods: We retrospectively reviewed a single surgeon experience in a contemporary series of RCC from April 2008 through December 2019.

Collagen Matrix With Mucoperiosteum Graft as an Effective Fatless Flapless Reconstruction After Endoscopic Pituitary Adenoma Resection.

Background: Proper skull base reconstruction after endoscopic endonasal pituitary surgery is of great importance to decrease the rate of complications.

Objective: To assess the safety and efficacy of reconstruction with materials other than fat graft and naso-septal flaps (NSF) to avoid their associated morbidities.

Methods: The authors' institutional database for patients who underwent endoscopic endonasal approach for pituitary adenoma was reviewed.

Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques.

Background: Transorbital and subtemporal keyhole approaches have recently been proposed to approach lesions in the lateral wall of the cavernous sinus (CS) and Meckel's cave (MC). Our goal was to compare these approaches and suggest indications for each of them.

Methods: Five cadaver heads (10 sides, 40 procedures) were used.

Extended Endoscopic Endonasal Clipping of Intracranial Aneurysms: An Anatomic Feasibility Study.

Background: Intracranial aneurysms (IAs) located in the midline region represent formidable challenge owing to their deep location. The objective of this study was to assess feasibility and identify the limitations of endoscopic endonasal clipping of IAs. We further aimed to describe the locations and characteristics of aneurysms that may be amenable for endoscopic endonasal clipping; thus outlining the indications of these approaches.

Erratum: Endoscopic Endonasal Transplanum-Transtuberculum Sellae Approach for the Resection of a Diaphragma Sellae Meningioma.

[This corrects the article DOI: 10.1055/s-0038-1624587.].

Pituitary carcinomas: review of the current literature and report of atypical case.

Pituitary carcinomas are poorly understood, rare entities. They are distinguished from adenomas not by histopathological features but rather by the presence of metastases. We discuss the diagnosis, mechanism of dissemination and pathogenesis based on a review of the literature and illustrated by a singular case.

Erratum: Endoscopic Endonasal Transtuberculum Sellae Approach for the Resection of Suprasellar Epidermoid Cyst.

[This corrects the article DOI: 10.1055/s-0038-1624590.].

Role of Endoscopy in Resection of Intracanalicular Vestibular Schwannoma via Middle Fossa Approach: Technical Nuances.

Background: Surgical resection of vestibular schwannomas (VS) located within the internal auditory canal (IAC) is challenging, especially those located very laterally in the IAC. Various transcranial approaches have been described for resection of intracanalicular VS including retrosigmoid, translabyrinthine, and middle fossa approaches. Each approach has its indications, advantages, and limitations.

Predictors of Postoperative Diabetes Insipidus Following Endoscopic Resection of Pituitary Adenomas.

Context: The development of diabetes insipidus (DI) following transsphenoidal resection of pituitary adenomas has been associated with higher postsurgical morbidity and longer hospitalizations. Identifying these patients promptly and efficiently can lead to improved health care outcomes.

Objective: We evaluated our institution's incidence of DI following pituitary adenoma resection and assessed for preoperative risk factors that were associated with postoperative DI.

Endoscopic Endonasal Focal Transclival-Medial Condylectomy Approach for Resection of a Foramen Magnum Meningioma: 2-Dimensional Operative Video.

The endoscopic endonasal approach (EEA) provides direct access to foramen magnum meningiomas; however, it often requires extensive exposure including septal flap elevation with septum removal, complete sphenoidotomy, and panclivectomy.We present a case of a 54-yr-old-female with an incidental foramen magnum lesion followed up with serial imaging who presented 10 mo later with progressive neck discomfort and episodes of dizziness, with confirmed tumor progression and further brainstem compression. A focal transclival EEA with medial condylectomy was performed preserving the upper two-thirds of the clivus, the nasal septum, and the sphenoid sinus.

Giant Olfactory Groove Meningioma-2-Staged Approach: 2-Dimensional Operative Video.

A 42-yr-old female presented with an olfactory groove meningioma causing progressive vision loss and anosmia. Given the size of the tumor, we opted for a 2-stage surgery: endoscopic endonasal approach (EEA) followed by a craniotomy. Stage I surgery was a transcribriform transplanum EEA using a binostril 4-hand/2 surgeons (ENT and neuro) technique, with the patient positioned supine with the head slightly turned to the right side and tilted to the left, fixed in a 3-pin head clamp, under imaging guidance, in which we drilled out all the affected skull base bone, devascularized and debulked the tumor.

Endoscopic Endonasal Resection of a Suprasellar Pituitary Adenoma Mimicking Tuberculum Sellae Meningioma in a Patient with an Intrasellar Persistent Trigeminal Artery.

A 50-year-old female with an incidentally diagnosed suprasellar lesion was initially managed conservatively due to the presence of an intrasellar persistent trigeminal artery going through the dorsum sellae and fundamentally forming the blood supply of the entire posterior circulation. Serial follow-up brain magnetic resonance imaging (MRI) revealed progressive enlargement of the suprasellar lesion over 4 years period. Surgery was indicated after the initial tumor growth; however, the patient refused surgery for fear of complications related to the persistent trigeminal artery.

Endoscopic Endonasal Transtuberculum Sellae Approach for the Resection of Suprasellar Intrainfundibular Epidermoid Cyst.

A 49-year-old female presented with intense headaches of 3 months duration. Brain magnetic resonance imaging (MRI) was performed and showed a sellar-suprasellar lesion extending into the third ventricle. A presumptive diagnosis of a craniopharyngioma was made.

Endoscopic Endonasal Transplanum-Transtuberculum Sellae Approach for the Resection of a Diaphragma Sellae Meningioma.

The endoscopic endonasal approach (EEA) provides a direct access to diaphragma sellae meningiomas. We present a case of a 56-year-old-female with an incidentally diagnosed sellar/suprasellar lesion with no hormonal deficit; thus, she opted for conservative management initially. During her annual follow-up appointment with her ophthalmologist, it was noticed that the patient had right eye peripheral deficit on formal visual field testing.

Endoscopic Endonasal Resection of Tuberculum Sellae Meningioma with Utilization of Indocyanine Green.

We present the case of a 67-year-old female with an incidental finding of a left-sided tuberculum sellae meningioma on a brain magnetic resonance imaging (MRI) for an unrelated complaint. Formal visual field testing showed a small defect in the inferior nasal and temporal fields of the left eye, compatible with mass effect on the optic nerve by the tumor. An endoscopic endonasal transtuberculum approach with decompression of the left optic nerve was performed using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance.

Endoscopic Endonasal Approach to a Suprasellar Craniopharyngioma.

We present the case of a 57-year-old male who presented with progressive right side vision loss whose workup revealed a large suprasellar lesion with invasion of the third ventricle. The pituitary stalk was not visible. Hormonal panel showed no hormonal deficits.

The limits of the endoscopic endonasal transclival approach for posterior fossa tumors.

Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas.

Limits of endoscopic endonasal surgery for III ventricle craniopharyngiomas.

Craniopharyngiomas represent one of the most challenging brain tumors for the neurosurgeon. For most of the 20th century, these parasellar lesions have been approached via the classic open approaches of neurosurgery such as pterional, frontobasal, interhemispheric, and transpetrosal craniotomies. The endoscopic endonasal approach to these tumors, rather than craniotomy, has risen in popularity over the last two decades.

Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel's cave.

The endoscopic endonasal approach (EEA) to the ventral skull base has greatly increased in popularity over the last two decades. So-called expanded EEA have opened corridors to pathology off-midline, including lesions within the cavernous sinus and Meckel's cave. A standard EEA exposure into the sphenoid sinus allows visualization of the medial cavernous sinus; a transpterygoid approach allows for surgical manipulation of the lateral cavernous sinus and Meckel's cave contents.

Endoscopic endonasal pituitary gland hemi-transposition for resection of a dorsum sellae meningioma.

A 69-year-old female with incidental diagnosis of a dorsum sellae meningioma had shown significant tumor growth after initial conservative management. The procedure started with a microscopic sublabial transsphenoidal approach to the sella and the suprasellar space. Due to limitations to a safe dissection and removal of the retrosellar component, the surgery was converted to a purely endoscopic endonasal approach with left hemi-transposition of the pituitary gland, followed by drilling of the dorsum sellae and removal of the left posterior clinoid process.

Posterior Reversible Encephalopathy Syndrome Causing Vision Loss After Endoscopic Endonasal Resection of Pituitary Adenoma.

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual changes, and seizure combined with brain imaging consistent with cerebral edema without infarction. To the best of our knowledge, we report the first case of PRES after an endoscopic endonasal resection of a pituitary macroadenoma.

Case Description: A 59-year-old woman was diagnosed with a pituitary macroadenoma, for which she underwent endoscopic endonasal extracapsular resection.