The World Health Organization (WHO) updated the classification of pituitary tumors in 2022. The new classification presents detailed histological subtyping of a pituitary neuroendocrine tumor (PitNET) based on the tumor cell lineage, cell type, and related characteristics. The immunohistochemistry for pituitary transcription factors (PIT1, TPIT, SF1, GATA3, and ERα) is routinely needed in this classifica-tion. The controversy regarding the change of behavior code of all PitNET/pituitary adenoma from “0” for benign tumors to “3” for primary malignant tumors is a topic of debate among experts, nowadays. Some authors represent that pituitary adenoma has a tendency for hemorrhage and necrosis and frequent invasion of the cavernous sinus. However, most small PitNET/pituitary adenoma do not need any treatment because of benign biologic behavior or less than 5% recurrence after gross total removal. Pituitary apoplexy is also benign nature but has a tendency of cranial nerve compression or panhypopituitarism. Most of cavernous invasion is compression of the cavernous sinus. Aggressive PitNET/ pituitary adenoma with malignant biological behavior is less than 1%.

In the paper by Lee et al., the name of the corresponding author was given incorrectly. The correct name should be Chan-Young Choi as given above.

A case report of an intracerebral parenchymal meningioma in a 28-year old male is presented. Meningiomas without dural attachment and malignant meningiomas are discussed and the pertinent literature is reviewed. The role of radiotherapy and radiosurgery for malignant meningiomas is also stressed.
Adult ; Humans ; Male ; Meningioma* ; Radiosurgery ; Radiotherapy

Intracranial aneurysms in the neonate are very rare and their clinicopathological findings remain unclear. We report a 26-day-old premature neonate who underwent microsurgical clipping on the ruptured middle cerebral artery bifurcation aneurysm successfully with a review of relevant literature.
Aneurysm ; Humans ; Infant, Newborn ; Intracranial Aneurysm ; Middle Cerebral Artery

Very few cases of arterial spasm after pituitary surgery have been reported to date. The author analysed 4 patients with vasospasm following transcranial subfrontal removal of pituitary adenoma, which were adimitted to our department and 4 cases were reviewed in the literature. In our 4 cases, the age of the patients varied between 23 to 59 years. There were 2 men and 2 women. Delayed deterioration of consciousness or neurologic deficit was observed in all cases. Two patients recovered completely and two were bed-ridden. Vasospasm was documented by angiogram or transcranial Doppler ultrasonography(TCD, EME, Co.). Possible mechanisms underlying this unusual complication are reviewed and discussed. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials are liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. These agents might then diffuse into the basal cisternal space and interact with blood vessel walls in such a way as to produce vascular spasm.
Blood Vessels ; Consciousness ; Female ; Humans ; Hypothalamus ; Male ; Necrosis ; Neurologic Manifestations ; Pituitary Gland ; Pituitary Neoplasms ; Spasm

OBJECTIVE: Endovascular treatment of cerebral aneurysms with detachable coils has proved to be a safe and effective. However, long term result was not satisfactory in less than 30% for regrowth or coil compaction. This paper highlighted the safety and technique of microsurgical clipping and coil removal in previously coiled aneurysms showing recurrence or remnant growth. METHODS: Sixty two patients from 2007 to 2010 were treated by endovascular coiling. Among them, six patients (9.6%) showed recurrence, who had near complete obliteration initially. We retrospectively analyzed the clinical data and radiographic images of these patients (male 2, female 4, mean age 46.6) who underwent microsurgical clipping with partial (4 cases) or complete (2 cases) coil removal. Computerized tomographic angiogram (CTA) was performed soon after microsurgical clipping for the evaluation. RESULTS: Four aneurysms were located at anterior circulation and two were at the posterior circulation. Four patients were detected by routine followed CTA or angiography and one had recurrent subarachnoid hemorrhage and another one had severe eyeball pain. Microsurgical treatment were performed about 12.9 months (range: 2~26) after coiling. Complete coil removal was done in two patients. Complete obliteration was performed in all, which were confirmed by postoperative CTA with less coil artifact. All patients attained the same neurological state presented prior to surgery (the Glasgow Outcome Scale (GOS) 4~5). CONCLUSION: Microsurgical clipping and coil removal following a previous endovascular coil embolization are not so common. However, these would be permanent treatment options without any morbidity in properly selected patients. These are challenging and risky procedure, but necessary to avoid postoperative coil artifact on the follow-up radiologic evaluation.
Aneurysm ; Angiography ; Artifacts ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Recurrence ; Retrospective Studies ; Subarachnoid Hemorrhage

The anterior choroidal artery has several kinds of variations. Among them, the transposition of anterior choroidal artery and posterior communicating artery origins has been extremely rare. We report a case with cerebral aneurysm arising from posterior communicating artery which origin was distal to the anterior choroidal artery and review the relevant literature.
Arteries ; Choroid ; Intracranial Aneurysm

OBJECTIVE: To evaluate the effectiveness and efficacy of delayed burr hole surgery in relation to the reduction of postoperative subdural hematoma (SDH) volume in patients with acute SDH. METHODS: We retrospectively analyzed patients with acute SDH who received delayed burr hole surgery at our institute. Age, sex, Glasgow coma scale, maximal SDH thickness, volume of SDH, midline shifts, hounsfield unit (HU), and medical history of anticoagulant agent usage were recorded. Outcome measures were delayed operation day, reduction of SDH volume after operation, and the Glasgow outcome scale (GOS) score at discharge. The patients were divided two groups according to the post-operative reduction of volume of SDH (≥50%, group A; <50%, group B). We also analyzed variables and differences between two groups. RESULTS: Eighteen patients were available for this analysis. The mean delayed of surgery was 13.9±7.5 days. Maximal thickness of SDH was changed from 10.0±3.5 mm to 12.2±3.7 mm. Volume of SDH was changed from 38.7±28.0 mL to 42.6±29.6 mL. Midline shifts were changed from 5.8±3.3 mm to 6.6±3.3 mm. HU were changed from 66.4±11.2 to 53.2±20.6. Post-operative reduction of SDH volume was 52.1±21.1%. Eleven patients (61%) had a discharge GOS score of 1 (good recovery). Ten patients (56%) were enrolled in group A. Midline shifting was greater in group A than in group B (7.4±3.3 vs. 3.0±2.4 mm; p<0.02). The delay of surgery was shorter for group A than group B (9.2±2.3 vs. 19.8±7.7 days; p<0.0008). CONCLUSION: Among well selected patients, delayed burr hole surgery in patients with acute SDH may be effective for reduction of SDH volume. Further studies will be necessary to establish the effectiveness and safety of delayed burr hole surgery in patients with acute SDH.
Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies

OBJECTIVE: Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. METHODS: Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. RESULTS: Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. CONCLUSION: Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.
Angiography* ; Arteries* ; Basilar Artery ; Carotid Artery, Internal ; Cerebral Angiography ; Female ; Hemorrhage ; Humans ; Incidence* ; Incidental Findings ; Ischemia ; Magnetic Resonance Angiography* ; Male ; Retrospective Studies ; Trigeminal Ganglion

Spontaneous dissection of the anterior cerebral artery is an unusual cause of subarachnoid hemorrhage. We present a case of a dissecting aneurysm of the anterior cerebral artery presenting with subarachnoid hemorrhage. A 51-year-old woman presented to our hospital with severe headache. Neurological examination demonstrated neck stiffness, decreased visual acuity of the left eye, and left ankle weakness. Computed tomographic scans showed subarachnoid hemorrhage. The initial cerebral angiogram demonstrated a slightly narrowed caliber and mild poststenotic dilation of the right A1 segment. A second cerebral angiogram 14 days later revealed no change in the focal narrowing of the proximal A1 segment but marked progression of the dilatation of the distal A1 segment. Right pterional craniotomy was performed. A sausage-like dilation of the right A1 segment was found with no definite mural hematoma. This abnormal right A1 segment was wrapped with a Sundt clip. A postoperative computed tomographic scan revealed infarction of the right head of the caudate nucleus and the anterior limb of the right internal capsule. If a dissecting aneurysm is suspected, serial angiographic studies should be performed because of the possibility of dynamic changes over a short period.
Aneurysm, Dissecting* ; Ankle ; Anterior Cerebral Artery* ; Caudate Nucleus ; Craniotomy ; Dilatation ; Extremities ; Female ; Head ; Headache ; Hematoma ; Humans ; Infarction ; Internal Capsule ; Middle Aged ; Neck ; Neurologic Examination ; Subarachnoid Hemorrhage ; Visual Acuity