Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?
AIMS: Reported cure rates following trans-sphenoidal surgery for microprolactinoma are variable and recurrence rates in some series are high. We wished to examine the cure rate of trans-sphenoidal surgery for microprolactinoma, and to assess the long-term complications and recurrence rate. DESIGN: A retrospective review of the outcome of trans-sphenoidal surgery for microprolactinoma, performed by a single neurosurgeon at a tertiary referral centre between 1976 and 1997. PATIENTS: All thirty-two patients operated on for microprolactinoma were female, with a mean age of 31 years (range 16-49). Indications for surgery were intolerance of dopamine agonists in ten (31%), resistance in six (19%) and resistance and intolerance in four (12.5%). Two patients were from countries where dopamine agonists were unavailable. RESULTS: The mean pre-operative prolactin level was 2933 mU/l (range 1125-6000). All but 1 had amenorrhoea or oligomenorrhoea, with galactorrhoea in 15 (46.9%). Twenty-five (78%) were cured by trans-sphenoidal surgery, as judged by a post-operative serum prolactin in the normal range. During a mean follow-up of 70 months (range 2 months to 16 years) there was one recurrence at 12 years. Post-operatively, one patient became LH deficient, two patients became cortisol deficient and two became TSH deficient. Out of 21 patients tested for post-operative growth hormone deficiency, 6 (28.6%) were deficient. Five patients developed post-operative diabetes insipidus which persisted for greater than 6 months. There were no other complications of surgery. The estimated cost of uncomplicated trans-sphenoidal surgery, and follow-up over 10 years, was similar to that of dopamine agonist therapy. CONCLUSION: In patients with hyperprolactinaemia due to a pituitary microprolactinoma, transsphenoidal surgery by an experienced pituitary surgeon should be considered as a potentially curative procedure. The cost of treatment over a 10 year period is similar in uncomplicated cases to long-term dopamine agonist therapy. (+info)
Mucocele involving the anterior clinoid process: MR and CT findings.
We report two patients with surgically proved mucoceles involving the anterior clinoid process. One patient had a mucocele of an Onodi cell and the other had a mucocele isolated to the anterior clinoid process. The MR signal was increased on both T1- and T2-weighted images in the first patient but was isointense on both sequences in the second patient, a finding that resulted in misdiagnosis. The developmental and anatomic features, as well as the diagnostic pitfalls, are discussed. (+info)
On the homology of the alisphenoid.
The relationships of the elements of the cavum epiptericum in a hypothetical primitive mammalian precursor are reconstructed, and these are analysed in relation to the development of recent mammals, especially the fruit bat Nyctinomus johorensis. The alisphenoid in mammals is part cartilage bone, part membrane bone. The mammalian homologue of the primitive reptilian processus ascendens appears to be internal to the maxillary nerve. If so, then the 'lamina ascendens', that portion of the alisphenoid of mammals which lies between maxillary and mandibular nerves, cannot be a true processus ascendens but must be neomorphic. It is suggested that the mammalian lamina ascendens arose from an upgrowth of the root of the quadrate ramus of the epipterygoid in cynodonts, separating foramen rotundum from foramen ovale. In Ditremata the alisphenoid is completed by an element of membrane bone; this, it is suggested here, originated as the anterior lamina of the periotic in cynodonts, which is retained in monotremes. It is suggested that the alicochlear commissure of mammals originated as the later flange of the periotic in cynodonts. (+info)
Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography.
BACKGROUND AND PURPOSE: Radiologic evaluation of CSF leaks is a diagnostic challenge that often involves multiple imaging studies with the associated expense and patient discomfort. We evaluated the use of screening noncontrast high-resolution CT in identifying the presence and site of CSF rhinorrhea and otorrhea and compared it with contrast-enhanced CT cisternography and radionuclide cisternography. METHODS: We retrospectively reviewed the imaging studies and medical records of all patients who were evaluated for CSF leak during a 7-year period. Forty-two patients with rhinorrhea and/or otorrhea underwent high-resolution CT of the face or temporal bone and then had CT cisternography and radionuclide cisternography via lumbar puncture. The results of the three studies were compared and correlated with the surgical findings in 21 patients. RESULTS: High-resolution CT showed bone defects in 30 of 42 patients (71%) with CSF leak. High-resolution, radionuclide cisternography and CT cisternography did not show bone defects or CSF leak for 12 patients (29%) who had clinical evidence of CSF leak. Among the 30 patients with bone defects, 20 (66%) had positive results of their radionuclide cisternography and/or CT cisternography. For the 21 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defects revealed by high-resolution CT in all cases. High-resolution CT identified significantly more patients with CSF leak than did radionuclide cisternography and CT cisternography, with a moderate degree of agreement. CONCLUSION: Noncontrast high-resolution CT showed a defect in 70% of the patients with CSF leak. No radionuclide cisternography or CT cisternography study produced positive results without previous visualization of a defect on high-resolution CT. CT cisternography and radionuclide cisternography may be reserved for patients in whom initial high-resolution CT does not identify a bone defect or for patients with multiple fractures or postoperative defects. (+info)
Dysgenesis of the internal carotid artery associated with transsphenoidal encephalocele: a neural crest syndrome?
We describe two original cases of internal carotid artery dysgenesis associated with a malformative spectrum, which includes transsphenoidal encephalocele, optic nerve coloboma, hypopituitarism, and hypertelorism. Cephalic neural crest cells migrate to various regions in the head and neck where they contribute to the development of structures as diverse as the anterior skull base, the walls of the craniofacial arteries, the forebrain, and the face. Data suggest that the link between these rare malformations is abnormal neural crest development. (+info)
Evaluation of apical root resorption following extraction therapy in subjects with Class I and Class II malocclusions.
The purpose of this study was to determine the amount of root resorption during orthodontic treatment, and to examine the relationship between tooth movement and apical root resorption. Twenty-seven Class I and 27 Class II patients treated with edgewise mechanics following first premolar extractions were selected. The following measurements were made on the pre- and post-treatment cephalograms: upper central incisor to palatal plane distance, the inclination of upper central incisor to the FH and AP planes, the perpendicular distances from the incisor tip to the AP and PTV planes, and incisor apex to PTV. The amount of apical root resorption of the maxillary central incisors was determined for each patient by subtracting the post-treatment tooth length from the pre-treatment tooth length measured directly on cephalograms. Intra-group differences were evaluated by the Student's t-test and inter-group differences by the Mann-Whitney U-test. For correlations the Pearson correlation coefficient was used. The results show that there was a mean of approximately 1 mm (P < 0.01) of apical root shortening in Class I patients, but in Class II division I subjects the mean root resorption was more than 2 mm (P < 0.001). The inter-group differences were statistically significant. No significant correlations were found between the amount of apical root resorption and tooth inclination, or the duration of active treatment. (+info)
Age-related expansion and reduction in aeration of the sphenoid sinus: volume assessment by helical CT scanning.
BACKGROUND AND PURPOSE: Aeration of the sphenoid sinus expands with the development of the sphenoid bone, but scant detailed volumetric data regarding this process, as it evolves from childhood to old age, exist. Using helical CT scanning, we assessed age-related volumetric changes of the sphenoid sinus. METHODS: We used CT data obtained from 214 patients (age range, 1 to 80 years; 111 male and 103 female subjects) with middle or inner ear disease to assess the extent of sphenoid aeration. We also determined volumes of the sphenoid sinuses on 1.0- or 1.5-mm reformatted images by integrating the sinus air (< or = -900 HU) area. RESULTS: Sphenoid sinus aeration began as a doublet in the anterior boundary of the sphenoid bone by the age of 5 years, with patients more than 6 years old exhibiting varying degrees of aeration. The aeration on both sides continued to expand until the third decade of life. The maximum average volume was 8.2 +/- 0.5 cm3. Thereafter, the volume decreased gradually, with the average volume in the seventh decade of life being 71% of the maximum level. The aeration of the peripheral portions of the sphenoid bone, such as the pterygoid process, anterior clinoid process, and dorsum sella, occurred predominantly after closure of the spheno-occipital suture, and showed a tendency to recede during aging. CONCLUSION: Volumetric assessment of the sphenoid sinus by helical CT scanning revealed age-related expansion and reduction in aeration. (+info)
Sphenoid wing meningioma--an unusual cause of duro-optic calcification.
Sphenoid ridge is the third commonest site of intracranial meningiomas. Although sphenoid ridge meningiomas often involve the optic canal, calcification along the optic nerve has not been reported with these tumors. We describe CT features of a calcified optic nerve in a patient with a calcified sphenoid ridge meningioma. (+info)