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Sellar Tumor with Suprasellar Extension

Brain Tumor Sellar Tumor with Suprasellar Extension


Presentation

  • With ISG visual disturbances were present in 47% of cases at presentation. In front of SGPA, patient present most frequently acromegalic manifestations (67%), followed by visual manifestations in 29%.[atlasofscience.org]
  • In children, hypopituitarism commonly presents with delayed puberty or impairment of growth. Diabetes insipidus is rarely a presenting feature but may occur following surgery for a pituitary adenoma.[patient.info]
  • Hormonal imbalance due to overproduction tends to present earlier and tumors are thus usually small at presentation. This mode of presentation is discussed in the article on pituitary microadenomas.[radiopaedia.org]
  • Less commonly, Rathke's cyst may present with seizures or occur in association with a pituitary adenoma.[skullbaseinstitute.com]
  • Whilst contrast may not always be required, it is indicated in all those presenting with apparent macroadenoma, as our cases demonstrate.[endocrine-abstracts.org]
Asymptomatic
  • Treatment Because these cysts are often asymptomatic only patients with clear neurological and endocrinological indications require treatment.[skullbaseinstitute.com]
  • Visual field defects: these are common but often asymptomatic. Bitemporal hemianopia is the classic abnormality but any unilateral or bilateral visual field defect may occur. Ocular nerve palsies cause a squint.[patient.info]
  • […] compromise from tumor mass effect In children, hypothalamic and endocrine dysfunction may develop before visual defects are noticed Radiotherapy is indicated for treatment of residual tumor or recurrence Occasionally intralesional radiation to control cysts Asymptomatic[pathologyoutlines.com]
Fatigue
  • […] surgery or trauma Past Medical History: Hypothyroidism Medications: Levothyroxine Family History: Negative for cancer or ocular disease Social History: Machinist, longtime smoker Review of Systems: Negative, including no weight change, mood change, fatigue[webeye.ophth.uiowa.edu]
  • For example, insufficient adrenocorticotropic hormone means that the adrenal glands will not produce sufficient cortisol, resulting in slow recovery from illness, inflammation and chronic fatigue; insufficient growth hormone in children and adolescents[en.wikipedia.org]
Surgical Procedure
  • The surgical procedure may require more proximal control of the artery in the neck.[entokey.com]
  • Surgical procedures The surgical procedures via right single nostril-sphenoidal sinus approach, performed and recorded under camera-equipped surgical microscope, were completed by one single physician as follows.[bmcmedimaging.biomedcentral.com]
Anosmia
  • Cerebrospinal fluid rhinorrhea or anosmia can occasionally occur, especially if excessive retraction of the frontal lobe is indicated. 19 Schmidek and Sweet Operative Neurosurgical Techniques Indication[clinicalgate.com]
Diplopia
  • Visual symptoms and signs include vision loss, diplopia, and multiple cranial nerve palsies secondary to rapid expansion of the tumor into the adjacent cavernous sinuses, with cranial nerve III the most commonly affected.[webeye.ophth.uiowa.edu]
Psychiatric Manifestation
  • Psychiatric [ edit ] Various psychiatric manifestations have been associated with pituitary disorders including pituitary adenomas.[en.wikipedia.org]
Headache
  • They present with headaches, visual field defects and hypopituitarism (including growth failure, as often present in childhood and adolescence). Other causes of headache, visual field defects, visual disturbance and endocrine dysfunction.[patient.info]
  • Amongst the types of headaches experienced are both chronic and episodic migraine, and more uncommonly various unilateral headaches; primary stabbing headache, [6] short-lasting unilateral neuralgiform headache attacks with conjunctival injection and[en.wikipedia.org]
  • The common clinical presentation includes headache, visual impairment, and endocrine disorders. The most common endocrine disturbance is pituitary hypofunction, but other forms of endocrinopathies may also occur.[skullbaseinstitute.com]
  • Clinical features Insidious, with a delay of approximately 1 - 2 years between initial symptoms and diagnosis Visual disturbances Endocrine deficiencies GH LH / FSH ACTH TSH Growth failure and delayed puberty in children Diabetes insipidus ( adults) Headache[pathologyoutlines.com]
  • Other common signs and symptoms of functioning and nonfunctioning pituitary tumors include headache, vision change, difficulty in moving the eyes, seizures, clear and watery nasal drainage, hair loss, intolerance to cold, and weight change.[fortherecordmag.com]
Bitemporal Hemianopsia
  • The anatomy of this structure causes pressure on it to produce a defect in the temporal visual field on both sides, a condition called bitemporal hemianopsia.[en.wikipedia.org]
Apathy
  • "Apathy and pituitary disease: it has nothing to do with depression". The Journal of Neuropsychiatry and Clinical Neurosciences. 17 (2): 159–66. doi : 10.1176/appi.neuropsych.17.2.159. PMID 15939968. "Acromegaly and Gigantism". Merck.com.[en.wikipedia.org]
Tremor
  • Signs and symptoms of hyperthyroidism include accelerated metabolism, sudden weight loss, rapid/irregular heartbeat, sweating, nervousness, irritability, tremor, and insomnia.[fortherecordmag.com]

Workup

  • […] massive MRI: High signal intensity on T1 weighted images Heterogeneous enhancement Fluid levels consistent with cystic components CT: Better than MRI at showing calcifications Laboratory Same for both types of craniopharyngiomas Full pituitary endocrine workup[pathologyoutlines.com]
  • It is important to note that while a sellar mass may present with bitemporal hemianopia, the combination of findings described above describing a junctional scotoma also localizes to the sellar area, and additional workup is indicated.[webeye.ophth.uiowa.edu]

Treatment

  • Rapidly consult with trusted authorities thanks to new expert-opinion treatment strategies and recommendations. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.com]
  • Literature 433 A Review 439 TransnasoSphenoidal Approach to Skull Base Lesions 449 Transsylvian Pretemporal Approach to the Infundibular 462 The Microanatomical Basis for Cavernous Sinus Surgery 479 Vascular Lesions in the Sellar Region J I Ausman 490 Treatment[books.google.com]
  • Treatment Because these cysts are often asymptomatic only patients with clear neurological and endocrinological indications require treatment.[skullbaseinstitute.com]
  • Radiation therapy (92.2x) is another treatment option. It may be used in conjunction with surgery or as a stand-alone treatment.[fortherecordmag.com]
  • Advances in the treatment of prolactinomas. Endocr. Rev. 27, 485–534 (2006). 98. Oh, M. C. & Aghi, M. K. Dopamine agonist-resistant prolactinomas. J. Neurosurg. 114, 1369–1379 (2011). 99. Melmed, S. Acromegaly pathogenesis and treatment. J. Clin.[nature.com]

Prognosis

  • Prognosis Surgical good prognosis and the recurrence rate has been reported to be less than 5%. The postoperative outcome of most patients is resolution or improvement of their symptoms.[skullbaseinstitute.com]
  • For a general discussion, including epidemiology, treatment, and prognosis, please refer to the article on pituitary adenomas. Patients typically present with symptoms of local mass effect on adjacent structures (especially optic chiasm ).[radiopaedia.org]
  • Prognosis Remission can be obtained in up to 90% of patients with microadenomas and in about 50% to 60% of those with macroadenomas. [ 1 ][patient.info]
  • Pituitary apoplexy: evaluation, management, and prognosis. Curr Opin Ophthalmol, 20 (6):456-461. Nawa, R, et al. (2008). Pituitary tumor apoplexy: a review. J Intens Care Med, 23 (2):75-90. Mindermann, T, & Wilson, CB. (1994).[webeye.ophth.uiowa.edu]

Etiology

  • More common than papillary craniopharyngioma (even in adults) Higher frequency in Africans and Far East Asians Sites Suprasellar: frequently extend into neighboring structures Rarely intranasal, sphenoid sinus, cerebellopontine angle and pineal region Etiology[pathologyoutlines.com]

Epidemiology

  • Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Childs Nerv Syst. 2001; 17 (9): 503-11[ DOI ][ PubMed ] 2. Keene DL, Johnston DL. 2015; : 9-12[ DOI ] 3.[iranjradiol.com]
  • For a general discussion, including epidemiology, treatment, and prognosis, please refer to the article on pituitary adenomas. Patients typically present with symptoms of local mass effect on adjacent structures (especially optic chiasm ).[radiopaedia.org]
  • Always WHO Grade I Tumor with palisading epithelium, "wet" keratin and stellate reticulum associated with surrounding gliosis and Rosenthal fibers Terminology Epithelial neoplasm resembling ameloblastoma or keratinizing and calcifying odontogenic cyst Epidemiology[pathologyoutlines.com]
  • Epidemiology [ 1 ] Pituitary tumours account for 10% to 25% of all intracranial neoplasms. Adenomas account for the largest portion of pituitary neoplasms (estimated at approximately 17%). Only a minority of adenomas are symptomatic.[patient.info]
  • Figure 7 : Non-contrast head CT, axial view, showing layered hemorrhages within bilateral lateral ventricles Diagnosis Compressive optic neuropathy/junctional scotoma secondary to pituitary adenoma EPIDEMIOLOGY Age and gender predilection varies depending[webeye.ophth.uiowa.edu]
Sex distribution
Age distribution

Pathophysiology

  • Nelson syndrome: comprehensive review of pathophysiology, diagnosis, and management. Neurosurg. Focus 23, E13 (2007). 120. Wagenmakers, M. A. et al.[nature.com]

Prevention

  • -8055-8051-9 (Print) eISBN: 978-3-318-01300-9 (Online) Abstract The principles in the surgical management of sellar and suprasellar tumors are to relieve mass effect, normalize pituitary hypersecretion, preserve or restore normal pituitary function, prevent[karger.com]
  • If an extension of tumor hooks around the optic nerve or carotid artery, this extension prevents descent of the tumor, and the tumor extension above the carotid artery or chiasm is inaccessible. 19 The anterior extension is particularly troublesome for[clinicalgate.com]
  • A parasellar meningioma is a potential mimic of the pituitary adenoma, but has a comparatively harder texture, preventing it from compressing at the diaphragma sella, and therefore no “snowman” appearance.[webeye.ophth.uiowa.edu]

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