No abstract

Background Pituitary stalk hemangioblastomas (PSHBLs) are rare vascular tumors and their surgical removal is challenging due to the proximity with several fundamental anatomic structures including the pituitary stalk, third ventricle, hypothalamus, and optic pathways. To date, only few descriptions of transcranial and transsphenoidal approaches for PSHBLs have been reported in the literature and none in video, with suboptimal outcomes in terms of pituitary function preservation. Here, we describe the use of orbitozygomatic (OZ) craniotomy with extradural anterior clinoidectomy (EAC) for the removal of a PSHBL with preservation of the pituitary stalk. Case Description A 60-year-old woman with a sporadic symptomatic HBL of the pituitary stalk, with the typical features of avid contrast enhancement on T1- and flow voids on T2-weighted magnetic resonance imaging (MRI) images, underwent a right OZ craniotomy with EAC. The choice of the approach was guided by the necessity of exposing the floor of the 3rd ventricle and infundibulum, where the origin of the pituitary stalk is better appreciated and preserved, without brain retraction. EAC was deemed important due to the necessity of widening the right carotico-oculomotor and opticocarotid triangles and gaining access to the ophthalmic segment of the internal carotid artery, origin of the superior hypophyseal artery, and the tumor supply. The postoperative MRI confirmed gross tumor removal with preservation of the pituitary stalk and no tumor recurrence after 2 years of follow-up. Conclusion OZ craniotomy coupled with EAC facilitates surgical removal of PSHBLs thus augmenting the chances of pituitary function preservation.The link to the video can be found at https://youtu.be/hH65W937RGY.

No abstract

No abstract

Introduction The importance of a correct preoperative radiological diagnosis in patients with cervical myelopathy has been widely demonstrated. Indeed, few studies still exist about the correlation between postoperative radiographic and clinical modifications. Materials and Methods The authors present a prospective study of 54 patients with cervical spondilogenetic myelopathy, who underwent surgery for corpectomy and anterior fusion with mesh in a period between January 2005 and August 2013. Images of cervical RMN were studied pre-and postoperatively and attention has been focused on alterations of intramedullary signal on T1- and T2-weighted sequences. Pre-and postoperative changes were correlated with clinical data (obtained by means of a Nurick scales and JOA classification—modified by Benzel). In relation to cervical RM-based studies, patients were divided into 3 groups: (A) no intramedullary signal alteration; (B) alterations in T2-weighted sequences; (C) alterations of the signal in both T1- and T2-weighted sequences. Results In all patients, decompression of the cervical spinal cord has been demonstrated by extension of the anteroposterior diameter of the spinal canal and by increase in the thickness of the subarachnoid space. In group A patients, no intramedullary signal changes were highlighted postoperatively. Patients in group B showed improvement on the base of hyperintensity disappearance on T2-weighted MRI, correlating with an improvement in the clinical quadro. Patients of group C have not been showing changes in the intramedullary MRI signal despite spinal cord decompression. Conclusions Signal alterations in T1 are an unfavorable prognostic index and proved to be irreversible. They correlate with a lack of clinical improvement of the patient. Patients in group B are those with the greatest clinical benefit after surgery and in whom clinical improvement correlates clearly with the radiological outcome.