Transsphenoidal Microscopic Surgery Research Articles

Treatment of Rathke's Cleft Cyst:Technical Note for Preservation of Pituitary Function

Pituitary dysfunction, such as panhypopituitarism or diabetes insipidus(DI), is often found in patients with Rathke's cleft cyst. Patients were treated with transsphenoidal microscopic surgery; however, pituitary dysfunction did not usually recover. Recently, endoscopic transsphenoidal surgery(eTSS)has enabled minimally invasive surgery for patients with Rathke's cleft cyst. In this study, we analyzed 22 consecutive patients with Rathke's cleft cyst who underwent eTSS to determine if pituitary dysfunction recovered. The follow-up period ranged from 3 months to 19.25 years(mean, 4.75 years). Preoperative endocrinological evaluation showed impaired secretion of adrenocorticotropic hormone(ACTH)in 4 cases(18.2%), thyroid-stimulating hormone(TSH)in 2 cases(9.1%), hyperprolactinemia in 5 cases(22.7%), growth hormone(GH)in 9 cases(40.9%), and luteinizing hormone(LH)/follicle-stimulating hormone(FSH)in 11 cases(50%). In addition, preoperative DI was found in 2 cases(9.1%). We planned the site of fenestration for the cyst wall using preoperative sagittal magnetic resonance imaging. As a result, the recovery rate for ACTH, GH, and TSH secretion was 25%, 33.3%, and 50%, respectively. On the other hand, two patients with DI and other hormonal deficiencies did not recover pituitary function because of severe inflammation. Pituitary function might be preserved with minimally invasive surgery for Rathke's cleft cyst with mild inflammation.

Angioleiomyoma in the sellar region: a report of 2 cases and literature review

Objectives To report the cases of angioleiomyoma involving the sellar region and to review and summarize the characteristics of the disease combining with literature. Methods From June 2011 to June 2015, the clinical data of 2 patients with angioleiomyoma in the sellar region treated and confirmed by pathology in Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. Results Two patients were diagnosed as pituitary tumor by imaging before procedure. They had excessive bleeding during the operation and the total resection was difficult. The maximum tumor diameter was 3.0 cm in one of them. The tissue biopsy was conducted only with transsphenoidal microscopicsurgery. The patient received postoperative gamma knife therapy and was followed up for 4 years. The tumor had a tendency of sustained shrinkage. The maximum diameter of the tumor was 3.7 cm in 1 case. The tumor was resected partially with transsphenoidal microscopicsurgery. The patient was treated with gamma knife after procedure, and he was lost to follow up. After operation, HE staining showed that there were a lot of blood vessels, smooth muscles, and collagen tissues in the tumor tissues. Immunohistochemistry showed that the expressions of CD34, α-SMA, Ⅷ factor, CD31 and collagen Ⅰ- Ⅲ were positive. Conclusions The diagnosis of vascular leiomyomas is difficult before procedure, mainly based on pathology. The operation is difficult. Gamma knife therapy is helpful in controlling the tumors. Key words: Angioleiomyoma; Sella turcica; Disease attributes; Neurosurgical procedures; Radiosurgery