No abstract

We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure.A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.KEywords: Chiasmatic cistern, Intraoperative MRI, Suprasellar tumor, Tuberculum sellae ÖZGenişletilmiş endoskopik endonazal yaklaşım kullanılarak güvenli bir şekilde çıkartılan bir supra-diyafragmatik ektopik hipofiz adenomu tanımlanmakta ve bu tür işlemde üç boyutlu (3B) endoskopi ve intraoperatif manyetik rezonans görüntülemenin (MRG) değeri tartışılmaktadır.Bitemporal hemianopsili, 61 yaşında bir erkek hasta hastanemize sevk edildi ve MRG'de optik kiazmayı sıkıştıran, kontrast tutan bir suprasellar tümör görüldü. Tümör, planum sfenoidale üzerine uzanmaktaydı ve sağ internal karotid arteri kısmen çevrelemişti. Endokrin değerlendirme normal pitüiter işlev gösterdi. İntraoperatif manyetik rezonans görüntüleme (MRG) odasında bir 3D endoskop kullanılarak genişletilmiş endoskopik endonazal yaklaşım gerçekleştirildi. Tümör diyafragma sella üzerinde bulunuyordu ve normal hipofiz bezinden ayrılmıştı. Patolojik bulgular işlev görmeyen bir hipofiz adenom düşündürüyordu ve tümöre bu şekilde bir supra-diyafragmatik ektopik hipofiz adenom tanısı konuldu. İntraoperatif MRG dural açıklığı minimuma indirmek için faydalı bilgiler sağladı ve supra-diyafragmatik ektopik hipofiz adenom intraoperatif MRG odasında 3B endoskopi kılavuzluğu altında genişletilmiş endoskopik endonazal yaklaşımla kompleks nörovasküler yapıdan çıkarıldı. Supra-diyafragmatik ektopik hipofiz adenomun güvenli ve etkin bir şekilde çıkarılması 3B endoskopi ve intraoperatif MRG tarafından sağlanan görsel bilgiler ve genişletilmiş endoskopik endonazal yaklaşım yoluyla gerçekleştirildi.

Background: Cervical aneurysms are rare, accounting for <1% of all arterial aneurysms, including dissecting, traumatic, mycotic, atherosclerotic, and dysplastic aneurysms. Symptoms are usually caused by cerebrovascular insufficiency; local compression or rupture is rare. We present the case of a 77-year-old man with a giant saccular aneurysm of the cervical internal carotid artery (ICA), which was treated with aneurysmectomy and side-to-end anastomosis of the ICA. Case Description: The patient had experienced cervical pulsation and shoulder stiffness for 3 months. The patient had no significant medical history. An otolaryngologist performed the vascular imaging and referred the patient to our hospital for definitive management. Neurological deficits were not observed. Digital subtraction angiography showed a giant cervical aneurysm with a diameter of 25 mm within the ICA, and there was no evidence of thrombosis within the aneurysm. Aneurysmectomy and side-to-end anastomosis of the cervical ICA were performed under general anesthesia. After the procedure, the patient experienced partial hypoglossal nerve palsy but fully recovered with speech therapy. Postoperative computed tomography angiography revealed the complete aneurysm removal and patency of the ICA. The patient was discharged on postoperative day 7. Conclusion: Despite several limitations, surgical aneurysmectomy and reconstruction are recommended to eliminate the mass effect and to avoid postoperative ischemic complications, even in the endovascular era.

The purpose of this study was to demonstrate the efficacy of a 14-coil (Target XL) for framing in coil embolization of small cerebral aneurysms. Methods: Between January 2017 and December 2018, 46 patients underwent coil embolization of a small cerebral aneurysm that was less than 5 mm in maximum diameter. They were categorized into 26 patients in whom only 10-coils were used and 20 in whom Target XL was used for framing. The volume embolization rate (VER) and recanalization rate were compared between the two groups. Results: Although there were two patients in whom Target XL was replaced with a 10-coil for framing, no adverse events associated with the use of Target XL were noted. The mean VER of the first framing coil was significantly higher in aneurysms that were framed with Target XL than in those framed with a 10-coil (Target XL 22.6 ± 4.5%, 10-coil 17.9 ± 8.4%; p = 0.03). Furthermore, the mean VER at the end of the procedure was significantly higher in aneurysms with Target XL used for framing than in those embolized using only 10-coils (14-coil: 36.8 ± 7.8%, 10-coil: 32.0 ± 6.5%; p = 0.03). No recanalization was observed in aneurysms for which Target XL was used for framing, whereas five aneurysms embolized using only 10-coils were recanalized. Conclusion: Target XL may be safe and feasible as a framing coil in coil embolization of small cerebral aneurysms, which may result in a high VER, low recanalization rate, and good outcome.