GLIOMAS.WS

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Cushing Diease and Nelson Syndrome

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Essentials in Cushing's disease and Nelson's syndrome:. Nelson's syndrome take place only after bilateral adrenalectomy. Cushing disease is serious and if untreated, the main survival rate is 5 years. The best initial treatment of Cushing's disease and Nelson's syndrome is transsphenoidal elective resection of the tumour, regardless of the size. Subsequent clarification of the different biochemical factors involved in the development of Cushing's syndrome has permitted development of therapies specific f...

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Pituitary Carcinoma

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Essentials in pituitary carcinomas:. Only 1% of pituitary adenomas are carcinomas. Pituitary carcinomas showing nearby or distant mts, such as seeders and to the lung. ACTH-secreting pituitary carcinomas have tendency to metastases outside CNS. Histologic verification solely in clinico-morphologic background. Spread along the spinal subarachnoid space may lead to metastases in the spinal cord or cauda equina. Clinical Features and Therapy. The onset of diabetes insipidus early in the course of the diseas...

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Lymphoid Hypophisitis

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Essentials in lymphoid hypophysitis:. It is an autoimmune disease. Preoperative diagnosis is almost impossible. High dose corticosteroids alleviate the course of the disease. Other autoimmune diseases with panhypopituitarism hold the suspicion about the diagnosis. Histological verification is mandatory. Histopathology and Current Concepts of Pathogenesis. Ultrastructural features studied by electron microscopy reveal degranulated, inactive secretory granules. There is an inflammatory cellular infiltr...

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Pituitary Adenomas

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Empty Sella Syndrome

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Essentials for empty sella syndrome:. Empty sella syndrome is not a rare finding and it can be seen in 30% of population over the age of 30 years. This finding must be considered with context with other pathological features. The most common cause is a wide aperture in the diaphragma sella, which is a normal anatomical variation. Little clinical attention was initially paid to Busch's interesting findings. Both radiologists and neurosurgeons usually regarded nontumoral sellar enlargement as reflectin...

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Microanatomy of the Sellar Region

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Essentials in microanatomy of the sellar region:. The length of the optic nerves is variable and in conjunction with the tuberculum sellae variation, govern the type of approach to the chiasmal region. Absence of the sphenoid sinus in children make the trans-sphenoidal approach more difficult. The presence of diverticulum under the diaphragma sellae could complicate the trans-sphenoidal surgery with CSF leak. Chiasmatic Configuration and Tuberculum Sellae. The posterior communicating artery arises from t...

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Transcranial Approaches to Sellar Region

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Three transcranial approaches were used in the surgical treatment of lesions of the pituitary gland and sellar region: subfrontal, pterional, and subtemporal. The subfrontal approach was devised at the turn of the century by Krause and later modified by Frazier. Cushing. in his later years, used only this approach, to the exclusion of transsphenoidal surgery. A transcranial operation is indicated if residual tumor has been left during a transsphenoidal operation and total resection is still desired. ...

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Benign Pituitary Cysts

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Essentials in benign pituitary cysts:. Benign pituitary cysts are a common finding in autopsy studies and can occasionally become large enough to cause symptoms by compression of the intrasellar or suprasellar structures. Although cysts in the sella and suprasellar region are a diverse group of entities, they are often indistinguishable on the basis of clinical and radiographic findings, and a diagnosis can often be made only by gross and histologic examination. CT typically shows an enlarged sella turci...

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Perioperative Treatment of Pituitary Adenomas

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Essentials in perioperative treatment of pituitary adenomas:. Preoperative hormonal correction is mandatory. Strict intraoperative recordings of fluids and electrolytes in long operations with high dose cover of corticosteroids is essential. Short and long-term postoperative hormonal replacement therapy is integral part of treatment protocols. Immediate Postoperative Replacement Therapy. Patients with an ACTH-secreting microadenoma (Cushing's disease) are not totally withdrawn from steroids. Rather, ...

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Acromegaly

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When occurs in childhood gigantism take over. Surgery and radiation is the best choice of treatment. Sandostatin is not effective as substitute for other modalities of treatment. Pathogenesis and Natural History. Radiation therapy for acromegaly also began in 1909 and has been applied with considerable success. Most patients have been treated with conventional photon therapy, currently best delivered by a linear accelerator using multiple ports and appropriate shielding of the eyes. Interstitial ...Y sou...