Abstract
In the clinical practice of neurosurgery, the endoscopic endonasal approach (EEA) has been the mainstream approach in the management of sellar region diseases. However, clinicians have come to realize that EEA procedure is associated with intraoperative hemorrhage. Due to the limited surgical field and poor proximal control under endoscope, massive hemorrhage always leads to severe complication or even perioperative death. Previously, intraoperative hemorrhage used to be attributed to endoscopic intervention of cavernous sinus or internal carotid artery, but our recent understanding of EEA indicated that preoperatively complicated intracranial aneurysms (IAs) may play a role. In this article, we retrospectively reviewed the baseline characteristics, treatment strategy, pathology, intraoperative findings, as well as radiological profiles of sellar region lesions complicated with IAs. With the focus put on the high comorbidity rate of sellar region lesions and IAs, we did further statistical analysis to sketch the outline of this coexisting circumstance and to emphasize the importance of computed tomography angiography (CTA) as routine EEA preoperative examination. Thorough patient-surgeon communication should be proceeded before the formulation of an individualized treatment strategy.
Highlights
Sellar region lesions are a group of rare diseases in the clinical practice of neurosurgery, with various pathological classifications including pituitary adenomas, craniopharyngioma, Rathke’s cyst, meningioma, pituitary abscess, glioma, and so on
On the basis of the electronic health records, the detailed inclusion criteria were as follows: [1] age ≥ 18 years; [2] sellar region lesions diagnosed with the composite of clinical presentations, laboratory tests, histological investigations, and enhanced sellar magnetic resonance imaging (MRI); [3] complicated with intracranial aneurysms (IAs) diagnosed by computed tomography angiography (CTA), digital subtraction angiography (DSA), or intraoperative findings; [4] be capable to offer informed consent independently or with the help of relatives
A total of 515 continuous patients diagnosed with “sellar mass” by enhanced sellar MRI were reviewed through medical records. 110 of them were either endocrine-negative pituitary microadenomas with normal visual function or had surgical contradictions, 405 patients were further evaluated
Summary
Sellar region lesions are a group of rare diseases in the clinical practice of neurosurgery, with various pathological classifications including pituitary adenomas, craniopharyngioma, Rathke’s cyst, meningioma, pituitary abscess, glioma, and so on. EEA has become an established treatment for sellar region lesions by the benefit of its minimal invasiveness and improved surgical field [6, 7]. A few studies focused on this coexisting circumstance and reported the prevalence varied between 0.9% and 8.3% [10,11,12,13,14],while the realworld prevalence data of sellar region lesions complicated with IAs among Chinese population is limited. We presented a retrospective observational study to sketch the clinical and radiological characteristics of patients diagnosed with sellar region lesions co-existed with IAs, with the emphasis on the discussion of preoperative evaluation and individualized formulation of treatment strategy under the high comorbidity rate
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