Sellar Region Tumors Research Articles

Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility.

OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8-15 years) over an 8-year period (2007-2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.

Pediatric Sellar: Suprasellar Tumors

Tumors of the sellar region are not infrequent in pediatric population and differ notably from the adult sellar tumors. Craniopharyngiomas represent almost half of sellar region tumors in children, followed by hypothalamic-chiasmatic gliomas, hypothalamic hamartomas, and germinomas. Other tumors or tumoral lesions are more infrequent. This article provides an overview of the imaging characteristics of pediatric sellar/suprasellar tumors on conventional magnetic resonance (MR) imaging that can orient the diagnosis or limit the differential diagnostic range. Furthermore, the physiologic characteristics assessed by advanced MR imaging techniques are also described in detail, providing a better preoperative characterization of pediatric sellar/suprasellar pathology.

Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas

The effect of intraoperative magnetic resonance imaging (iMRI) on the extent of sellar region tumors treated endonasally has been described in previous research. However, the effects of iMRI on endocrinologic outcome of growth hormone-secreting adenomas have been studied in only a few small cohort studies. Inclusion criteria were primary transsphenoidal surgery for growth hormone-secreting adenoma from January 2009 to December 2014, a minimum follow-up of 1 year, complete endocrinologic data, at least 1 iMRI, and at least 2 postoperative magnetic resonance images. The cohort consisted of 105 patients (54 females, 51 males) with a mean age of 48.3 years (range, 7-77 years). There were 16 microadenomas and 89 macroadenomas. Endocrinologic remission in the whole cohort was achieved in 64 of the patients (60.9%). Resection after iMRI was attempted in 22 of the cases (20.9%). Resection after iMRI led to hormonal remission in 9 cases (8.6%). Endocrinologic postoperative deficit was observed in 10 cases (12.5%). Postoperative cerebrospinal fluid leakage indicated the necessity to reoperate in 3 cases (3.8%). No neurologic deterioration was observed. iMRI influences not only the morphologic extent of pituitary adenomas resection but also the endocrinologic results. We encourage the routine application of iMRI in pituitary adenoma surgery, including hormone-secreting pituitary tumors.

Epithelial and organ-related marker expression in pituitary adenomas.

The histologic expression of epithelial and organ-related immunohistochemical markers in primary sellar region tumors has received little attention to date. This lack of empirical data may lead to mistaken assumptions in the evaluation of sellar region neoplasms. To address this issue, the frequency and specificity of epithelial (cytokeratin 7(CK7), CK20) and organ-related differentiation markers (gross cystic disease fluid protein-15 (GCDFP-15), thyroid transcription factor-1 (TTF-1), Napsin A, paired box8 (PAX-8), hepatocyte paraffin 1 (HepPar1) and estrogen receptor (ER)) were studied in 40 patients with adenomas comprising five hormonal sub-types. Non-parametric statistical procedures were used to examine associations between marker expression and tumor sub-type. CK7 and CK20 immunoreactivity were seen in 48% and 8% of tumors, respectively, although never in a diffuse pattern. CK20 expression was nearly exclusive to corticotrophs, whereas CK7 frequently highlighted cells with dendritic-type morphology. The specificity of organ-related differentiation markers was 100% (monoclonal Napsin A, GCDFP-15 and TTF-1), 97% (HepPar1 and PAX-8), 90% (polyclonal Napsin A) and 72% (ER); no tumors demonstrated significant co-expression of these organ-related markers with either CK7 or CK20. The first major conclusion of this study is that CK7 staining in adenoma is more frequent than has been previously than has been previously described. CK7 immunoreactive cells often displayed a dendritic-type morphology, including within large macroadenomas, which raises the question as to whether these represent tumor cells with folliculo-stellate cell-type differentiation, as these also have dendritic cell-type morphology and express CK7 in non-neoplastic glands. The second major conclusion, which confirms earlier findings, is that CK20 staining is a very infrequent immunohistochemical finding in adenomas that is virtually limited to corticotrophs and thus is helpful in diagnostic confirmation of that sub-type. The final conclusion is in regard to those features that separate adenomas from sellar region metastases: adenomas do not demonstrate significant expression of TTF-1, monoclonal Napsin A, PAX-8, HepPar1 or GCDFP-15, nor do they exhibit diffuse expression of CK7 and CK20.

"Intrasellar Balloon Technique" in intraoperative MRI guided transsphenoidal endoscopic surgery for sellar region tumors. Usefulness on image interpretation and extent of resection evaluation. Technical note.

Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures. In this article we present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon's intraoperative assessment by iMRI. Eighteen patients with pituitary macroadenomas underwent transsphenoidal surgery during 2013-2014 under low-field iMRI control (PoleStar N20, 0.15T). Intrasellar balloons were used in all of them to assess the presence of tumoral remnants. We compared the findings in iMRI and postoperative high-field MRI control scans and also analyzed the number of intermediate imaging controls needed during surgery using this technique. In total, of the 18 patients, 14 underwent a complete resection. In the remaining four patients, a safe maximal resection was performed, leaving a remnant because of cavernous sinus invasion. In all cases, the balloons were a major help in distinguishing the anatomical structures from the tumoral remnants. Fewer imaging controls were required, and there were no false-positives or negative intraoperative findings. No complications related to the technique were registered. The "intrasellar balloon technique" is a useful tool that facilitates surgeons' intraoperative decision making. It is an important contribution to overcome the limitations of low-field iMRI as it provides a precise delineation of the resection margins, reduces false-positives and -negatives, and decreases the number of intermediate imaging controls required.

Pituitary adenoma with gangliocytoma: Report of two cases.

Worldwide, cases of pituitary adenoma with gangliocytoma are rarely reported. The current study reports the cases of two 47-year-old females who presented with masses in the sellar region following a general examination and radiological imaging. The two patients underwent sellar region tumor resection via the trans-naso-sphenoid approach. The histopathological examination confirmed the diagnosis of a hormone-free pituitary adenoma with gangliocytoma. The two patients were in good condition and experienced no specific discomfort subsequent to the follow-up after surgery. Gangliocytoma is a slowly growing and non-metastasizing tumor. A biopsy is required to differentiate a gangliocytoma from a malignant neuroblastoma, and excision is usually curative.

Identification and protection strategy of pituitary stalk during microsurgery of sellar region tumors

Objective To study the protection strategy of pituitary stalk via transcranial approach for sellar tumors resection.Methods Retrospective analysis of the clinical data of 110 patients with sellar region tumors was performed.Craniotomy was performed via the pterional approach in 34 cases,the subfrontal approach in 21 cases,the supraorbital keyhole approach in 20 cases,the interhemispheric approach in 35 cases (the fronto-basal interhemispheric approach in 26 patients,and the anterior interhemispheric approach through the lamina terminalis in 9 patients).Results In 47 cases with pituitary adenoma,the tumors were totally resection in 42 cases,the pituitary stalks were preserved in 44 cases,partly retained in 2 and not founded in 1.In 38 cases with craniopharyngioma,the tumors were totally removed in 32 cases.The pituitary stalks were preserved in 27 cases,and partly retained in 7 cases and not founded in 4.In 25 patients with Meningioma,the tumors were totally removed in 23 cases,the pituitary stalks were preserved in 24 cases (P ＜ 0.05).Conclusions The nature of tumors directly affect the retention rate of pituitary stalk,so we should choose appropriate surgical approach and skilled microsurgical techniques which play an important role in the identification and protection of pituitary stalk. Key words: Pituitary stalk ; Sellar region tumor ; Craniotomy; Microsurgery

Suprasellar Approaches: New Techniques and Old Tricks for Cerebrospinal Fluid Leaks

ascarenhas et al. elegantly summarize their surgical experience with a total of 122 patients, done in a M two-stage report, the first part a total of 63 patients were included and the second had 59 patients. The patients underwent to a transsphenoidal transplanum sphenoidale approach for sellar and suprasellar region tumors. The article focused on complication incidence and proves that the learning curve is an important factor for success for this complex approach. Results from the first group showed four patients with cerebrospinal fluid (CSF) leak, the rest of the patients did not experience any other complication. Mascarenhas et al. describe the development a packing technique using fascia, contained by a plaque of porous polyethylene (Medpore [Stryker Corporation, Kalamazoo, Michigan, USA]), covered by a nasoseptal pedicle flap, and finally all covered with fibrin sealant. Using this novel packing technique, they report 0 incidence of CSF leak. The tumors treated by the approach included pituitary adenomas (51.6%), craneopharingioma (20.6%), and meningiomas (15.9%). The main symptom was visual disturbances in 73% of the cohort. Patient selection has an extra credit from my point of view, proving that the learning curve has a direct influence in patient outcome using this novel approach.

An updated nationwide epidemiology of primary brain tumors in republic of Korea.

ObjectiveThe aim of this report is to provide accurate nationwide epidemiologic data on primary brain and central nervous system (CNS) tumors in Republic of Korea. In 2010, we had reported first nationwide epidemiologic data on primary brain tumors diagnosed in 2005. In this report, we updated the data by analyzing primary brain and CNS tumors diagnosed in 2010 using the data from national cancer incidence database.MethodsData on primary brain and CNS tumors diagnosed in 2010 were collected from the Korean Central Cancer Registry. Crude and age-standardized rates were calculated in terms of gender, age, and histological type.ResultsA total of 10,004 patients diagnosed with primary brain and CNS tumors in 2010 were included in this study. Brain and CNS tumors occurred in females more often than in males (female to male, 1.59 : 1). The most common tumor was meningioma (35.5%). Pituitary tumors (18.7%), gliomas (15.1%), and nerve sheath tumors (10.3%) were followed in incidence. Glioblastoma accounted for 34.6% of all gliomas. In children (<20 years), sellar region tumors (pituitary and craniopharyngioma), embryonal/primitive/medulloblastoma, and germ cell tumors were the most common tumors.ConclusionData from this study should provide valuable information regarding the primary brain tumors epidemiology in Republic of Korea.

Segmentation of pituitary adenoma: A graph-based method vs. a balloon inflation method

Among all abnormal growths inside the skull, the percentage of tumors in sellar region is approximately 10–15%, and the pituitary adenoma is the most common sellar lesion. A time-consuming process that can be shortened by using adequate algorithms is the manual segmentation of pituitary adenomas. In this contribution, two methods for pituitary adenoma segmentation in the human brain are presented and compared using magnetic resonance imaging (MRI) patient data from the clinical routine: Method A is a graph-based method that sets up a directed and weighted graph and performs a min-cut for optimal segmentation results: Method B is a balloon inflation method that uses balloon inflation forces to detect the pituitary adenoma boundaries. The ground truth of the pituitary adenoma boundaries – for the evaluation of the methods – are manually extracted by neurosurgeons. Comparison is done using the Dice Similarity Coefficient (DSC), a measure for spatial overlap of different segmentation results. The average DSC for all data sets is 77.5±4.5% for the graph-based method and 75.9±7.2% for the balloon inflation method showing no significant difference. The overall segmentation time of the implemented approaches was less than 4s – compared with a manual segmentation that took, on the average, 3.9±0.5min.

Stereoscopic virtual reality models for planning tumor resection in the sellar region

BackgroundIt is difficult for neurosurgeons to perceive the complex three-dimensional anatomical relationships in the sellar region.MethodsTo investigate the value of using a virtual reality system for planning resection of sellar region tumors. The study included 60 patients with sellar tumors. All patients underwent computed tomography angiography, MRI-T1W1, and contrast enhanced MRI-T1W1 image sequence scanning. The CT and MRI scanning data were collected and then imported into a Dextroscope imaging workstation, a virtual reality system that allows structures to be viewed stereoscopically. During preoperative assessment, typical images for each patient were chosen and printed out for use by the surgeons as references during surgery.ResultsAll sellar tumor models clearly displayed bone, the internal carotid artery, circle of Willis and its branches, the optic nerve and chiasm, ventricular system, tumor, brain, soft tissue and adjacent structures. Depending on the location of the tumors, we simulated the transmononasal sphenoid sinus approach, transpterional approach, and other approaches. Eleven surgeons who used virtual reality models completed a survey questionnaire. Nine of the participants said that the virtual reality images were superior to other images but that other images needed to be used in combination with the virtual reality images.ConclusionsThe three-dimensional virtual reality models were helpful for individualized planning of surgery in the sellar region. Virtual reality appears to be promising as a valuable tool for sellar region surgery in the future.

Intracranial meningiomas managed at Memfys hospital for neurosurgery in Enugu, Nigeria

Introduction:The epidemiology and pathology of meningioma in Nigeria are still evolving and little has been published about this tumor in Nigeria, especially in the southeast region. The aim of this paper is to compare the characteristics of intracranial meningioma managed in our center with the pattern reported in the literature worldwide.Materials and Methods:Retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2002 and December 2010 at a Private neurosurgery Hospital in Enugu, Nigeria. We excluded patients whose histology results were inconclusive.Results:Meningiomas constituted 23.8% of all intracranial tumors seen in the period. The male to female ratio was 1:1.1. The peak age range for males and females were in the fifth and sixth decades, respectively. The most common location is the Olfactory groove in 26.5% of patients followed by convexity in 23.5%. Presentation varied with anatomical location of tumor. Patients with olfactory groove meningioma (OGM) mostly presented late with personality changes and evidence of raised ICP. Tuberculum sellar and sphenoid region tumors presented earlier with visual impairment with or without hormonal abnormalities. Seizures occurred in 30.9% of all patients and in 45% of those with convexity meningiomas. Only 57.4% of the patients were managed surgically and there was no gender difference in this group. WHO grade1 tumors were the most common histological types occurring in 84.6%. One patient had atypical meningioma and two had anaplastic tumors.Conclusion:The pattern of meningioma in our area may have geographical differences in location and histology. Childhood meningioma was rare.

Surgery for craniopharyngioma

Craniopharyngiomas are rare benign sellar region tumors, which are diagnosed either in childhood or adolescence due to local mass effects on visual pathways, pituitary and hypothalamus, or because of an increased intracranial pressure resulting from obstructive hydrocephalus. The neurosurgeons challenge is to achieve tumor control without aggravating the symptoms. There are essentially two different surgical philosophies. Although only gross tumor resection has been proven to provide cure, the accompanying surgical hazard is substantial. Thus, less aggressive operations with partial or subtotal tumor resection or drainage of cystic portions followed by irradiation may relieve the patient's symptoms and benefit the patient more than a heroic tumor resection-since to date several variants of radiation therapy are available which also serve to control tumor progression. In the present brief review, the surgical techniques and outcomes of operations in craniopharyngiomas with special focus on the resulting morbidity and mortality are summarized.

Insights revealed by high-throughput genomic arrays in nonglial primary brain tumors

Primary CNS tumors (PCNSTs) encompass a broad and heterogeneous group of tumors, including gliomas, meningiomas, embryonal tumors, primary CNS lymphomas, CNS germ cell tumors and sellar region tumors. In recent decades, research has focused on understanding the clinical and biological significance of molecular abnormalities detected in PCNSTs. The emergence of genomic arrays, including comparative genomic hybridization and SNP arrays, have helped in the discovery of novel critically important genes and novel genomic biomarkers involved in PCNST oncogenesis (e.g., BRAF duplication in pilocytic astrocytoma). Since a summary of data from genomic arrays using gliomas has been described in a previous review, in this article we will focus on the insights provided by genome-wide DNA arrays in the genetics and genomics of nonglial PCNSTs in adults. The high-throughput assessment of gene copy-number abnormalities has improved our knowledge of molecular pathogenesis in nonglial PCNSTs, allowing for the identification of new candidate genomic regions and genes involved in tumorigenesis. These chromosome imbalances provide a promising insight into potential targets for innovative drugs and new interesting diagnostic and prognostic biomarkers for clinical practice.

Intra-abdominal hypertension in patients with sellar region tumors

BackgroundData on intra-abdominal hypertension [IAH] and secondary abdominal compartment syndrome [ACS] due to neurological insults are limited.MethodsThis was a prospective observational study conducted between January 2010 and January 2011 in the neurological ICU [NICU]. Forty-one consecutive patients with sellar region tumors [SRT] were enrolled into the study. If conservative therapy was ineffective in patients with ACS, thoracic epidural anesthesia [EA] was performed. Primary endpoint was defined as the efficacy of conservative treatment and EA in patients with IAH and ACS; secondary endpoint, the influence of IAH and ACS on outcomes.ResultsOf the 41 patients, 13 (31.7%) had normal intra-abdominal pressure and 28 (68.3%) developed IAH, of whom 9 (22%) had ACS (group II). On average, IAH developed on the second postoperative day, while ACS, between the third and the fifth day. Multiple organ dysfunction developed in 3 (23.1%) patients of group I and in 23 (82%) patients of group II (p = 0.0003). Ileus due to gastrointestinal dysmotility was present in 6 (46.2%) patients of group I and in all patients of group II (p = 0.0001). Significant risk factors for ileus were diencephalon dysfunction (whole group - in 33 patients (80.5%); group I - in 6 patients (46.2%); group II - in 27 patients (96.4%), p = 0.0002) and sepsis (whole group - in 8 patients (19.5%); group I - no cases; group II - in 8 patients (28.6%), p = 0.03). Conservative treatment was effective in the majority of patients (78.9%) with IAH and only in 3 (33%) patients with ACS. Thoracic EA was performed in four patients with ACS with success. Length of stay in the NICU was 6.5 ± 4.6 days in group I and 24.1 ± 25.7 (p = 0.02) days in group II. Five out of nine (55.6%) patients with ACS died. None of these patients received EA. All patients with EA had favorable outcomes.ConclusionThe development of IAH is common after SRT surgery. If conservative treatment is ineffective, EA can be considered in patients with secondary ACS. Further studies are warranted.

Preoperative and postoperative assessment of intelligence for intracranial tumor patients

Objective To analyze the effects of intracranial tumors and tumor resection on patients' intelligence.Methods Chinese modified WAIS-RC was used to assess intelligence of 79 intracranial tumor patients and 18 health controls (HC) and then intelligence quotient (IQ),verbal IQ (VIQ) and performance IQ (PIQ) were calculated by short form algorithm (4 in 1).Results Intracerebral tumor patients presented a lower preoperative IQ (P＜0.01) and VIQ (P＜0.01) than control group.Dominant hemispheric tumor group's preoperative IQ,VIQ were much lower than those of control group and nondominant hemispheric tumor group.Patients with sellar region tumors had no significance on intelligence compared with control group.Transsphenoidal approach had no effect on IQ.Extra-cerebral tumor group presented with lower IQ and PIQ after tumor resection.Conclusions Intracranial tumors could result in intelligence impairment,especially in VIQ impairment.Dominant hemispheric tumors patients have more serious intelligence deficits than non-dominant hemispheric tumors patients.Neurosurgeon should pay more attention to the effects of brain tumors and surgery on intelligence. Key words: Intelligence; Neuropsychology; Intracranial tumor

Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy

Endonasal approaches have become the gold standard intervention for many anterior and middle skull base tumors. The authors aimed to define some of the existing limitations of these approaches by reviewing their experience with complex sellar region tumors that were initially considered for both transsphenoidal and open skull base approaches and were thus deemed tumors at "the edge of the envelope." Between April 2008 and April 2010, 250 transsphenoidal operations were performed at Brigham and Women's Hospital. All cases were retrospectively reviewed to identify patients with complex sellar region tumors that were initially considered for, or soon thereafter required, an open craniotomy as the definitive treatment. The anatomical tumor characteristics that posed limitations to performing safe and effective endonasal skull base operations were reviewed. Thirteen cases exemplifying some of the existing limitations to achieving optimal surgical outcomes via transsphenoidal-based approaches are presented. The following 8 factors are separately discussed that repeatedly limited the extent of resection, increased the risk of the operation, and contributed to perioperative complications: significant suprasellar extension, lateral extension, retrosellar extension, brain invasion with edema, firm tumor consistency, involvement or vasospasm of the arteries of the circle of Willis, and encasement of the optic apparatus or invasion of the optic foramina. Although the ability to approach and resect complex tumors using endonasal skull base techniques has evolved dramatically in recent years, several inherent tumor characteristics mandate extensive preoperative consideration. In selected cases these characteristics may lend support to selecting an open craniotomy as the initial operation.

Surgical treatment of tumors in sellar region through transbasal interhemispheric approach

Objective To explore the surgical therapeutic efficacy of tumors in sellar region through transbasal interhemispheric approach. Method Fifteen sellar region tumor cases was treated through transbasal interhemispheric approach from January 2008 to May 2009. These cases included four craniopharyngiomas, four tuberculum sellae meningiomas, three olfactory grave meningiomas, two nofunction pituitary adenomas,one stalk hypophysial abscess and one frontal lobe glioma. The first symptom of ten cases was disturbance of vision or field of vision,four headace,one insipidus. All the fifteen cases underwent head MRI before and after operation. The diameter of the biggest tumor was 5 cm. All the tumors located around sellar region and grew upward. Result Total resection was achieved in all cases. Hyperosmotc dehydration was observed in 3 patients after operation. One craniopharyngioma patient died after leaving hospital because of electrolyte disturbance. Two craniopharyngioma patients leaved hospital normally after the electrolyte disturbance had been corrected. The original symptoms of rest cases were relieved and there was no nervous dysfunction. One craniopharyngioma patient received Gamma knife radiosurgery after operation because of tumor recurrence. There was no recurrence in the rest cases. There was no intracranial infection or cerebrospinal fluid rhinorrhea. The facial outlook wasn't affected. Conclusions Transbasal interhemispheric approach could provide much more surgical visible angle. Through this approach the third ventricle chould be reached ,the midbrain aqueduct chould be revealed backward and sellar region downward and better outcome of surgery chould be achieved. Key words: Sellar region; Tumor; Neurosurgical procedures; Transhasal interhemispheric approach

Spindle cell oncocytoma with late recurrence and unique neuroimaging characteristics due to recurrent subclinical intratumoral bleeding

Spindle cell oncocytoma (SCO) is a rare sellar-region tumor recently codified in the World Health Organization (WHO) 2007 Classification as a grade I neoplasm. Despite this grading, recurrences have been demonstrated but, to date, extensive recurrent bleeding into these tumors has not been documented. A 70-year-old woman first presented in 1996 with visual difficulties and was found to have a sellar-region mass with heterogeneous neuroimaging features, leading to preoperative diagnosis of craniopharyngioma. Transsphenoidal, gross total resection was achieved despite extensive intraoperative bleeding; pathology showed an unusual spindle cell neoplasm which could not be further classified. She received no further treatment and was lost to our follow-up until 2009, when she again presented with visual deterioration. Neuroimaging demonstrated recurrence of a large sellar-region tumor with heterogeneous signal characteristics, prompting re-resection. Review of her original and recurrent tumor allowed diagnosis of SCO; extensive intratumoral hemorrhage of varying ages and widespread hemosiderin accounted for her complex neuroimaging features. Vimentin, S100, and galectin-3 immunoreactivity was consistent with SCO. EM demonstrated abundant mitochondria, short intercellular junctions, and absence of neurosecretory granules. Thyroid disease was documented clinically. SCOs are sufficiently rare that documentation of unusual features is important. Recurrent bleeding with resultant complex neuroimaging is unique to this case, but appears to overlap with a related sellar-region tumor, pituicytoma. The presence of thyroid disease also links SCO with pituicytoma. The 13-year interval to recurrence is the longest reported to date in SCO; WHO grade I designation may be premature for this neoplasm.

Preoperative and postoperative assessment of memory function for intracranial tumor patients

To analyze the effects of intracranial tumors and tumor resection on patients' memory functions. Four different memory scales were employed to evaluate 58 intracranial tumor patients' memory functions including short-term memory, delayed memory, clue memory and long-term memory. Thirty-five patients received postoperative follow-ups. There were also 18 healthy controls. The extra-cerebral tumor patients presented with delayed memory and long-term memory disorders while intra-cerebral tumor patients suffered from short-term, delayed and severe long-term memory disorders. Patients with dominant hemispheric tumors had more serious memory disorders in all types. Scores obtained after surgery showed an aggravated long-term memory disorder. Sellar region tumors and transsphenoidal tumor resection had no effects upon memory functions. Intracranial tumors cause memory disorders. Tumors with different locations and characters have different memory impairments. Intra-cerebral tumors result in more severe memory impairment than extra-cerebral tumors. And dominant hemispheric tumors are worse than non-dominant hemispheric tumors. Tumor resection decreases long-term memory functions.