• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.355-359
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• 2009

Objective : The definition of empty sella syndrome is 'an anatomical entity in which the pituitary fossa is partially or completely filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa'. Reports of this entities relating to the brain tumors not situated in the pituitary fossa, have rarely been reported. Methods : In order to analyze the incidence and relationship of empty sella in patients having brain tumors, the authors reviewed preoperative magnetic resonance imaging (MRI) of 72 patients with brain tumor regardless of pathology except the pituitary tumors. The patients were operated in single institute by one surgeon. There were 25 males and 47 females and mean patient age was 53 years old (range from 5 years to 84 years). Tumor volume was ranged from 2 cc to 238 cc. Results : The overall incidence of empty sella was positive in 57/72 cases (79.2%). Sorted by the pathology, empty sella was highest in meningioma (88.9%, p=0.042). The empty sella was correlated with patient's increasing age (p=0.003) and increasing tumor volume (p=0.016). Conclusion : Careful review of brain MRI with periodic follow up is necessary for the detection of secondary empty sella in patients with brain tumors. In patients with confirmed empty sella, follow up is mandatory for the management of hypopituitarism, cerebrospinal fluid (CSF) rhinorrhea, visual disturbance and increased intracranial pressure.

• Journal of Korean Neurosurgical Society
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• v.45 no.2
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• pp.118-121
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• 2009

Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a pituitary adenoma or an adjacent pituitary gland. Pituitary apoplexy may be associated with a variety of neurological and endocrinological signs and symptoms. However, isolated third cranial nerve palsy with ptosis as the presenting sign of pituitary apoplexy is very rare. We describe two cases of pituitary apoplexy presenting as sudden-onset unilateral ptosis and diplopia. In one case, brain magnetic resonance imaging (MRI) revealed a mass in the pituitary fossa with signs of hemorrhage, upward displacement of the optic chiasm, erosion of the sellar floor and invasion of the right cavernous sinus. In the other case, MRI showed a large area of insufficient enhancement in the anterior pituitary consistent with pituitary infarction or Sheehan's syndrome. We performed neurosurgical decompression via a transsphenoidal approach. Both patients showed an uneventful recovery. Both cases of isolated third cranial nerve palsy with ptosis completely resolved during the early postoperative period. We suggest that pituitary apoplexy should be included in the differential diagnosis of patients presenting with isolated third cranial nerve palsy with ptosis and that prompt neurosurgical decompression should be considered for the preservation of third cranial nerve function.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1514-1518
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• 2000

Aspergillosis is an uncommon form of fungal infection of the central nervous system in immunocompetent patient, especially those involving the pituitary gland. Several cases of pituitary aspergillosis have been reported, but most of them are directly invaded from aspergillosis of sphenoid sinus. In the present case, a woman with primary pituitary aspergillosis had neither evidence of infection of the sphenoid sinus nor immunodeficiency. The patient underwent a transsphenoidal surgery for a presumed pituitary tumor. Histopathology demonstrated typical findings of aspergillosis. Postoperatively, amphotericin-B was administered and Gallium-67 scan was performed. We describe a case of primary pituitary aspergillosis mimicking pituitary tumor.

• Annals of Clinical Neurophysiology
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• v.15 no.1
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• pp.24-26
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• 2013

We encountered a case of pituitary apoplexy who presented with isolated headache and vomiting without visual disturbance or ophthalmoplegia. The cerebrospinal fluid examination was compatible with aseptic meningitis. A computed tomography revealed slightly high density in the pituitary fossa and suprasella area, but the signal change was very faint. Our case suggests that clinicians should take into account the possibility of pituitary apoplexy without visual disturbance or ophthalmoplegia, when aseptic meningitis is suspected.

• Investigative Magnetic Resonance Imaging
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• v.19 no.2
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• pp.117-121
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• 2015

Chordoid glioma is a rare, low-grade brain neoplasm typically located in the third ventricle. Herein, we report an unusual case of histologically confirmed chordoid glioma located in the pituitary fossa and suprasellar region, not attached to the third ventricle. A 57-year-old woman presented with a 2-month history of headache and visual disturbance. Magnetic resonance imaging revealed an ovoid mass in the pituitary fossa and suprasellar region, compressing the optic chiasm without involvement of the third ventricle. The tumor showed low signal intensity on T1-weighted images and iso- to high signal intensity on T2-weighted images, with strong and homogenous contrast enhancement. Subtotal resection was performed via the transcranial approach, and the patient subsequently received adjuvant gamma knife radiosurgery. However, the residual mass showed disease progression 5 months after the initial surgery.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.425-428
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• 2007

Hemangiopericytoma [HPC] is a rare tumor with uncommon location in the central nervous system. We report a rare case of sellar and suprasellar HPC mimicking pituitary adenoma in a patient initially seen with the symptoms of bitemporal hemianopsia, headache, and panhypopituitarism. Magnetic resonance imaging of the brain revealed a contrast-enhancing soft tissue mass arising from the pituitary fossa, with apparent compression of the chiasm and involving the cavernous sinus. Subtotal resection of the tumor was achieved via a pterional approach. Histopathological examination identified the tumor as a HPC. Nine years later, the tumor recurred. To our knowledge, this is the first reported case of sellar and suprasellar HPC in Korea.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1079-1085
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• 2001

Objective : We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. Methods : In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. Results : Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. Conclusion : Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.7 no.1
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• pp.43-48
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• 1977

The authors had observed a rare case of osteopetrosis from 8 years old male who had complained nasal obstruction at, Department of Dental Radiology, Kyung Hee University. In the serial roentgenograms the following results were revealed. 1. This osteopetrosis was considered to be malignant rather than benign. 2. In the skull, the greatest degree of radiopacity was found in the base. The pituitary fossa appeared to be small and posterior clinoid process revealed clubbing and thickening. 3. In the frontal and nasal bones were slightly enlarged with marked radiopacity and paranasal sinuses were obscured. 4. The maxilla was markedly affected and bony trabeculae were seen to be coarse and thickened but mandibular posterior segment slightly. 5. There were long retardation of the tooth eruption and physiologic resorption of the deciduous teeth, and tooth root revealed stunted and dwarfed appearance in the both jaws. 6. In this case, the thickened alveolar lamina dura was indistinguishable.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.325-335
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• 1998

Purpose : Since the mid cranial fossa is composed of various thickness of bone, the tissue inhomogeneity caused by bone would produce dose attenuation in cobalt-60 gamma knife irradiation. The correction factor for bone attenuation of cobalt-60 which is used for gamma knife source is -3.5$\%$. More importantly, nearly all the radiosurgery treatment planning systems assume a treatment volume of unit density: any perturbation due to tissue inhomogeneity is neglected, This study was performed to confirm the bone attenuation in mid cranial fossa using gamma knife. Materials and Methods : Computed tomography was performed after Leksell stereotactic frame had been liked to the Alderson Rando Phantom (human phantom) skull area. Kodak X-omat V film was inserted into two sites of pituitary adenoma point and acoustic neurinoma point, and irradiated by gamma knife with 14mm and 18mm collimator. An automatic scanning densitometer with a 1mm aperture is used to measure the dose profile along the x and y axis. Results : Isodose curve constriction in mid cranial fossa is observed with various ranges. Pituitary tumor point is greater than acoustic neurinoma point (0.2-3.0 mm vs 0.1-1.3 mm) and generally 14 mm collimator is greater than 18mm collimator (0.4-3.0 mm vs. 0.2-2.2 mm) Even though the isodose constriction is found, constriction of 50$\%$ isodose curve which is used for treatment reference line does not exceed 1 mm. This range is too small to influence the treatment planning and treatment results. Conclusion : Radiosurgery planning system of gamma knife does not show significant error to be corrected without consideration of bone attenuation.