- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
OBJECTIVE: This study was designed to evaluate the possibility of predicting the minimum size of septal resection for safe tumor extraction in transnasal paraseptal pituitary adenoma resection from preoperative computed tomography scans. METHODS: A retrospective CT scan analysis was performed on 20 patients who underwent endoscopic pituitary surgery at the University Hospital in Ostrava. Virtual insertion of the straight instrument into the sphenoid cavity was simulated using a CT scan. The minimum septal resection size was predicted and compared to various diameters in the nasal cavity. The results were then compared with cadaveric dissections, in which septal resections were performed at 1 cm and 2 cm distances from the anterior sphenoid wall. The association between cadaver dissections and CT scan results was studied. RESULTS: A total of 20 patients who underwent endoscopic transnasal surgery for pituitary adenoma between the years 2020 and 2021 were enrolled in the study. The mean virtual posterior septal size resection needed to reach the medial edge of the ICA with the straight instrument, without infracturing the nasal septum, was 13.2 mm. In cadavers with a 1 cm posterior septal resection, the medial edge of the ICA was reached with the straight instrument. In 2 cm resections, it was possible to reach beyond the lateral edge of the ICA. CONCLUSION: There is no significant correlation between the minimum septal size resection and measured diameters in the nasal cavity. According to our study, a 1 cm resection is sufficient for a non-extended pituitary tumor extraction. More extensive septal resections allow for better maneuverability and overview in the surgical field.
- MeSH
- adenom * diagnostické zobrazování chirurgie patologie MeSH
- endoskopie metody MeSH
- lidé MeSH
- nádory hypofýzy * diagnostické zobrazování chirurgie patologie MeSH
- nosní dutina diagnostické zobrazování chirurgie patologie MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Spontaneous regression of cysts of the cavum septi pellucidi (CSP) and cavum vergae (CV) is rare and little discussed. The authors present their case report of this phenomenon following a severe headache in a 23-year-old woman, in whom magnetic resonance imaging (MRI) had previously confirmed significant thinning of the left lateral cyst wall. We consider this finding to be a possible predisposing factor to rupture and the spontaneous regression of such cysts. In addition to the mechanism of cyst regression, the interrelated causes of their expansion and formation will be discussed.
- MeSH
- cysty * diagnostické zobrazování chirurgie MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mladý dospělý MeSH
- septum pellucidum * diagnostické zobrazování chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: The aim of this study was to present the indications for a combined endoscopic transnasal and sublabial transantral approach for the surgical treatment of orbital lesions. MATERIAL AND METHODS: This case study enrolled 10 patients scheduled for endoscopic transnasal surgery for treating orbital lesions from 2009 to 2020. When the tumour was localised to the medial part of the orbit, patients underwent endoscopy with a transnasal mononostril approach. Alternatively, when the tumour was localised to the mediocaudal part of the orbit, and when instrument manoeuvreability was limited, the transnasal approach was combined with a sublabial transantral approach. Herein, we evaluate the indications, complications, and advantages of monoportal and combined two-portal approaches. RESULTS: 8/10 patients (80%) underwent surgery with the transnasal mononostril approach, and 2/10 (20%) underwent surgery with the combined transnasal mononostril and sublabial transantral approach. In the two latter cases, visualisation of the operation field was excellent, and there was adequate room for manipulating instruments. CONCLUSIONS: The combined mononostril-transantral approach provided the space necessary to manoeuvre instruments and to visualise the surgical field in treating mediocaudal orbital lesions. CLINICAL IMPLICATIONS: This two-portal approach enables extensive resections of intraconal lesions. It should be considered to be a suitable and safer alternative to the binostril approach.
- MeSH
- endoskopie * metody MeSH
- lidé MeSH
- nádory orbity * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Iatrogenic injury of the internal carotid artery (ICA) is a rare, and probably underreported, complication of transnasal endoscopic skull base surgery. Although treatment algorithms have been suggested, there is no definite consensus or guideline for the management of this severe complication. We describe a case of ICA injury that occurred during a transsphenoidal biopsy of a tumor in the cavernous sinus and we present a treatment algorithm for managing this complication. We reviewed the articles published from 1998 to 2021, reporting on major vascular injury during transnasal endoscopic skull base surgery and endonasal endoscopic surgery, and we compare the methods and results of ICA injury management reported in the literature with the presented case. The most promising treatment for ICA injury might be packing with a muscle graft initially, then performing an endovascular intervention.
- Publikační typ
- kazuistiky MeSH
Calcifying pseudoneoplasm of neuroaxis (CAPNON) is a rare lesion of the central nervous system with uncertain histogenesis. We further explored phenotypic spectrum of the entity with respect to possible histogenesis. We collected 5 cases of CAPNONs, performed a detailed morphological assessment, and performed an extensive immunohistochemical analysis (EMA, progesterone receptors, MUC4, SSTR2A, cytokeratin AE1/3, cytokeratin 18, GFAP, neurofilaments, desmin, nestin, synaptophysin, S100 protein, SOX10, CD56, Podoplanin, SATB2, ERG, CD45, and CD163) to elucidate the histogenesis. Furthermore, we performed NGS analysis of one case. The clinical course was benign in all cases. All lesions showed extensively calcified matrix in multilobular arrangement, with a palisade of osteoblast-like cells. Characteristic fibrohyaline matrix was notable in 4/5 cases, while one case was myxoid with rod-like calcifications. Metaplastic lamellar bone was present in 4/5 cases and psammoma bodies were present in 2/5 cases. In 4/5 cases, areas of entrapped glial tissue were present. Expression of EMA was focally present in 3/5 cases, SSTR2A and nestin in 2/5 cases, and progesterone receptor in 2/5 cases in rare cells. We did not observe concomitant expression of EMA, SSTR2A, and progesterone receptor in the same cellular subsets. In one case, NGS showed multiple chromosomal alterations and missense mutation in PIK3CA, attributable to the admixed meningothelial population compatible with meningioma. In another case, biphasic proliferation with myoepithelial phenotype was present. The lesions showed no lineage-specific immunoprofile. Additional pathology was identified in two cases, furthermore suggestive of a possible reactive origin of the lesion.
- MeSH
- kalcinóza * patologie MeSH
- lidé MeSH
- meningeální nádory * MeSH
- meningeom * MeSH
- nestin MeSH
- receptory progesteronu MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The clinical management of parasellar meningiomas (PM) is challenging due to their intimate association with critical neurovascular structures. Consensus regarding the recommended treatment protocol is lacking. This study will evaluate patients' visual outcomes following endoscopic transnasal optic nerve decompression (ETOND) and will investigate the possibility of reducing the rate of complications associated with stereotactic radiosurgery (SRS). METHODS: Retrospective analysis was conducted on all patients who underwent ETOND for PM between 2013 and 2020. The study comprised 12 patients (7 women and 5 men aged 36-75 years; mean, 55.2 years; median, 57.6 years) in which 14 optic nerve decompression procedures were carried out. Patients were followed up for 6 to 86 months (mean, 29.3 months; median, 25 months). There were five cases of spheno-orbital meningioma, four cases of cavernous sinus meningioma, and one case each of petro-clival meningioma, optic nerve sheath meningioma, and planum sphenoidale/tuberculum sellae meningioma. Visual outcome was evaluated and any postoperative complications noted. RESULTS: Improvements in visual acuity were noted in 10 of 14 eyes (71.4%) 3 to 6 months postoperation. Visual acuity remained stable in the remaining four eyes. No deterioration of visual acuity was noted during the follow-up period. In total, 9 of the 12 patients underwent SRS. No tumor growth was determined, while reduction in tumor volume was noted in five patients following SRS. No complications associated with SRS or the surgical procedure were noted. CONCLUSIONS: ETOND appears to be a promising technique for increasing rates of improved visual function, while reducing the risk of post SRS-related complications. In combination with subsequent SRS, it is an ideal treatment modality in the management of parasellar meningiomas. Confirmation of our findings would require a larger, prospective multicenter study.
- MeSH
- dekomprese MeSH
- lidé MeSH
- meningeální nádory * komplikace radioterapie chirurgie MeSH
- meningeom * komplikace radioterapie chirurgie MeSH
- nádory baze lební * komplikace patologie chirurgie MeSH
- nervus opticus chirurgie MeSH
- prospektivní studie MeSH
- radiochirurgie * škodlivé účinky metody MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess. METHODS: This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. RESULTS: MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P<0.0005). CONCLUSIONS: Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses - a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.
Cíl: Čich je často podceňovaným smyslem, jeho ztráta vede ke snížení kvality života se zvýšenou náchylností k depresím. Cílem práce je zhodnotit, zda po transnazálních endoskopických operacích hypofýzy dochází ke zhoršení čichu a nosní průchodnosti. Soubor a metodika: U pacientů s adenomem hypofýzy, indikovaných k endoskopické transnazální exstirpaci, byly předoperačně a čtyři měsíce pooperačně hodnoceny čich (test parfémovaných fi xů, čichový dotazník, Vizuální analogová škála), nosní průchodnost (Vizuální analogová škála) a pooperační nosní komplikace (synechie, perforace septa) pomocí endoskopie nosní dutiny. Výsledky: Do studie bylo zařazeno 42 žen a 40 mužů, průměrný věk byl 56 let. Předoperačně byla zjištěna anosmie u 11/ 82 (13,4 %) pacientů. K pooperačnímu zhoršení čichu došlo u 2/ 71 (2,8 %) pacientů. Subjektivní zhoršení čichu bylo pozorováno u 9/ 82 (10,9 %) pacientů a subjektivní zhoršení nosního dýchání po operaci bylo pozorováno u 3/ 82 (3,6 %) pacientů. Pooperačně bylo 76/ 82 (92,7 %) pacientů bez nosní komplikace. Synechie byla pozorována u 6/ 82 (7,3 %) pacientů, perforace septa nebyla pozorována u žádného z pacientů. Závěr: V této retrospektivní studii bylo prokázáno velmi nízké riziko vzniku poruchy čichu a zhoršení nosní průchodnosti po transnazálních operacích adenomu hypofýzy. Nosní komplikace byly pozorovány ojediněle a neměly vliv na nosní funkce.
Aim: Smell is often an underestimated sense; its loss leads to a decrease in quality of life with an increased susceptibility to depression. The aim of this work is to evaluate whether smell and nasal breathing deteriorate after trans-nasal endoscopic pituitary surgery. Patients and methods: In patients with pituitary adenoma indicated for endoscopic trans-nasal extirpation, smell (perfumed fixation test, olfactory questionnaire, Visual Analogue Scale), nasal breathing (Visual Analogue Scale) and postoperative nasal complications (synechia and septal perforation) using nasal endoscopy were evaluated preoperatively and four months postoperatively. Results: The study included 42 females and 40 males, with a mean age of 56 years. Anosmia was detected preoperatively in 11/ 82 (13.4%) patients. Postoperative olfactory deterioration occurred in 2/ 71 (2.8%) patients. Subjective deterioration of smell was observed in 9/ 82 (10.9%) patients and subjective deterioration of nasal breathing after surgery was observed in 3/ 82 (3.6%) patients. Postoperatively, 76/ 82 (92.7%) patients had no nasal complications. Synechia was observed in 6/ 82 (7.3%) patients, and septal perforation was not observed in any of the patients. Conclusion: This retrospective study showed a very low risk of olfactory disorders and impaired nasal breathing after trans-nasal pituitary adenoma surgery. Nasal complications were observed infrequently and did not aff ect nasal functions.
