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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic endonasal trans-sphenoidal surgery has become the gold standard for the surgical treatment of pituitary adenomas and many other pituitary ...

University Hospital of Lausanne

Diagnostic dyspraxia by disrupted fiber connections of the posterior corpus callosum after distal anterior cerebral artery aneurysm rupture.

We performed a systematic literature review to analyze the clinical application and the safety of mifepristone, a prominent antiprogesterone agent, in meningioma patients.

The Role of Mifepristone in Meningiomas Management: A Systematic Review of the Literature.

Spinal hemangioblastomas are benign and highly vascular tumors accounting for 1-5% of intramedullary spinal tumors in surgical series. Surgery is curative in sporadic cases. We present the description of a surgical technique to safely resect an intramedullary hemangioblastoma. A dorsal midline myelotomy provides an excellent exposure of the tumor and identification of the feeding arteries. Interruption of these arteries and precise dissection of the tumor from the cord tissue followed by division of the venous drainage allow the in toto excision of the tumor. Closure of the dorsal myelotomy may be achieved with sequential fusion of the pial and arachnoid edges using a "welding" technique.

Intramedullary hemangioblastoma: Microsurgical resection technique.

Gangliocytoma of the sellar region are extremely rare and often coexist with pituitary adenoma. Aim of this review is to collect all the cases reported in literature and to summarize the most recent literature evidences on the subject. A systematic review was performed through PubMed searching for articles describing gangliocytoma of the sellar region in the adult population, up to September 2015. An analysis of epidemiological data, clinical presentation, histochemical and radiological features and follow-up data was performed. A total of 55 articles were included in our analysis, reporting 129 cases of gangliocytoma of the sellar region. One case identified in our institution was also included. 85% of cases presented in association with pituitary adenomas. A female prevalence was evident. Patients presented most frequently with symptoms of hyperprolactinemia (44%) or visual disturbances (47%) when the sellar gangliocytoma was isolated, or with acromegalic manifestations (67%) when the gangliocytoma was associated with a pituitary adenoma. Immunohistochemistry showed a higher prevalence of mixed GH-PRL adenomas in association with sellar gangliocytomas, followed by GH adenomas. A purely intrasellar localization was found in about 25% of cases and a suprasellar extension in 30% of cases. A more extensive infiltration was present in about 40% of cases. A complete resection was obtained in 56% of collision lesions. The follow-up period was variable but endocrine remission was reported in 81% of cases of associated gangliocytoma and pituitary adenoma. Sellar gangliocytomas are rare lesions and an association with pituitary adenomas should always be searched. Mixed GH PRL adenomas are most frequently isolated. Collision lesions seem to have a behavior similar to isolated adenoma but a more important aggressiveness should be excluded at a molecular level. Further studies will allow advancements in clarifying the pathogenesis of this association.

Gangliocytomas of the sellar region: A challenging diagnosis.

Cerebral abscesses are a rare complication after therapeutic neuro-endovascular procedures.

Cerebral abscess after neuro-vascular embolization: Own experience and review of the literature.

Intramedullary tumors constitute approximately 5% of spinal tumors and about 80% are of neuroglial origin. We reviewed our series of adult patients with spinal neuroglial intramedullary tumors operated on between 1984 and 2011 at the neurosurgical department of Bicêtre hospital. The histopathological records for 196 patients were retrospectively analyzed. The majority of tumors were ependymomas (68%) and astrocytomas (27.5%). The importance of a proper and detailed neuropathological diagnosis is the key to define patient management. The available literature data about the genetic profiles of these rare tumors are summarized and reviewed.

Neuroglial intramedullary tumors: The collaboration between neurosurgeons and neuropathologists.

Delayed post-traumatic mucoceles are rare. We describe the surgical treatment of a post-traumatic ethmoidal mucocele with intra-orbital extension.

Endoscopic approach for a delayed post-traumatic ethmoidal mucocele: a technical note.

Cerebral palsy and Adeli method: is it worth a try?

Refractory frontal lobe epilepsy has been traditionally treated through a frontal lobectomy. A disconnective technique may allow similar seizure outcomes while avoiding the complications associated with large brain resections. The aim of this study was to describe a new technique of selective disconnection of the frontal lobe that can be performed in cases of refractory epilepsy due to epileptogenic foci involving 1 frontal lobe (anterior to the motor cortex), with preservation of motor function. In addition to the description of the technique, an illustrative case is also presented. This disconnective procedure is divided into 4 steps: the suprainsular window, the anterior callosotomy, the intrafrontal disconnection, and the frontobasal disconnection. The functional neuroanatomy is analyzed in detail for each step of the surgery. It is important to perform cortical and subcortical electrophysiological mapping to guide this disconnective procedure and identify eloquent cortices and intact neural pathways. The authors describe the case of a 9-year-old boy who presented with refractory epilepsy due to epileptogenic foci localized to the right frontal lobe. MRI confirmed the presence of a focal cortical dysplasia of the right frontal lobe. A periinsular anterior quadrant disconnection (quadrantotomy) was performed. The postoperative period was uneventful, and the patient was in Engel seizure outcome Class I at the 3-year follow-up. A significant cognitive gain was observed during follow-up. Periinsular anterior quadrantotomy may thus represent a safe technique to efficiently treat refractory epilepsy when epileptogenic foci are localized to 1 frontal lobe while preserving residual motor functions.

Giulia Cossu

Department of Neurosurgery

University Hospital of Lausanne

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Giulia Cossu

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Neurosurgery

University Hospital of Lausanne

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Department of Neurosurgery