Lymphocytic hypophysitis is a rare inflammatory disorder which is caused by autoimmune destruction of the pituitary gland. Almost all reported cases have been in women and the disease is often associated with pregnancy. We describe here the first male case of lymphocytic hypophysitis in Korea. The patient presented with headache, impotence, decreased libido, and deteriorated vision. Endocrinologic studies showed panhypopituitarism, and pituitary MRI imaging revealed a homogeneously enhanced pituitary mass with a thickened stalk. Treatment with prednisolone and thyroid hormone for five months was ineffective. Transsphenoidal resection of the pituitary mass was performed successfully with normalization of the visual field defect. Histologic examination revealed diffuse lymphocytic infiltration with dense collagenous fibrosis, consistent with lymphocytic hypophysitis. Lymphocytic hypophysitis should be considered in differential diagnosis even in men with hypopituitarism and an enlarged pituitary gland.
Adult ; Autoimmune Diseases/diagnosis* ; Autoimmune Diseases/pathology ; Autoimmune Diseases/surgery ; Eosinophilia ; Female ; Human ; Korea ; Lymphocytes/cytology ; Lymphocytes/immunology* ; Lymphocytes/metabolism ; Magnetic Resonance Imaging ; Male ; Pituitary Diseases/diagnosis* ; Pituitary Diseases/pathology ; Pituitary Diseases/surgery ; Pituitary Gland/pathology* ; Pituitary Gland/surgery ; Pituitary Hormones/metabolism ; Pregnancy

Adult ; Endoscopy ; Female ; Humans ; Mucocele ; surgery ; Paranasal Sinus Diseases ; complications ; surgery ; Pituitary Apoplexy ; complications ; surgery ; Sphenoid Sinus

OBJECTIVETo evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess.

METHODSEighteen pathologically diagnosed pituitary abscess were resected through transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011.Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache (13 cases), pituitary dysfunction (10 cases), Diabetes Insipidus (4 cases) visual interference (8 cases) and fever (4 cases). All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up results were recorded.

RESULTSAll patients were followed up from 6 months to 6 years. Postoperatively, headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach.

CONCLUSIONSTranssphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.

Abscess ; surgery ; Adolescent ; Adult ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Pituitary Diseases ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Young Adult

OBJECTIVETo analyze the clinical and imaging characteristics of patients with cystic lesions in sella region and to describe the experience of endoscopic transsphenoidal surgery.

METHODSFourty-six cases of cystic lesions in sella region confirmed by surgery and pathology between June 2003 and September 2013 were retrospectively analysed. The clinical features, imaging, surgical technique and postoperative recurrence in 46 cases were presented.

RESULTSAll lesions were resected through transsphenoidal endoscopic endonasal approach. Followed up lasted from 6 months to 6 years. Postoperatively, headache was recovered in 26 cases and wasn't recovered in 8 cases, visual was improved in 12 cases and wasn't improved in 2 cases, hypopituitarism was relieved in 18 cases and wasn't relieved in 15 cases, polyuria was disappeared in 8 cases and wasn't disappeared in 4 cases. Seven cases recurred, including 4 cases of craniopharyngioma, 2 cases of pituitary abscess, 1 case of cystic adenoma. There were no death and serious complication. The small age of onset, visual acuity and visual field symptoms, tumor in suprasellar, third ventricle compression was easy to occur in craniopharyngioma; cystic tumor, cavernous sinus invasion, the solid part homogeneous enhancement could be seen in cystic adenoma; Rathke cyst showed simple cystic, lighter clinical symptoms and a short course. Prone to diabetes insipidus, low multiple hormone level and the lesions of annular enhancement was more common in pituitary abscess.

CONCLUSIONSThe clinical features and imaging of cystic lesions in sella region feature overlap each other, but there are certain specificity. Transsphenoidal endoscopic endonasal approach for the surgery of cystic lesions in sella is effective and safe.

Abscess ; complications ; Adenoma ; complications ; Craniopharyngioma ; complications ; Cysts ; surgery ; Endoscopy ; methods ; Headache ; complications ; Humans ; Hypopituitarism ; complications ; Neoplasm Recurrence, Local ; Nose ; Pituitary Diseases ; surgery ; Pituitary Neoplasms ; complications ; Retrospective Studies ; Sella Turcica ; pathology

OBJECTIVETo summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases.

METHODSWe treated 1300 patients with different neurosurgical diseases by performing endoscopic neurosurgery (EN) and endoscopy-assisted microneurosurgery (EAM). Among 1300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunction with stereotactic guidance.

RESULTSTotally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with complicated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled pathologic septum fenestration, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic improvement was achieved in 341 of 362 patients (94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients (92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM (190 patients with epidermoid cyst), 8 patients with EN (all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients (87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma, and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9% (386/434) of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure.

CONCLUSIONSClinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery (ECM). It is also helpful to enhance surgical quality and, reduce the complications.

Adolescent ; Adult ; Aged, 80 and over ; Brain Diseases ; surgery ; Child ; Child, Preschool ; Epidermal Cyst ; surgery ; Female ; Humans ; Hydrocephalus ; surgery ; Infant ; Male ; Microsurgery ; methods ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neuroendoscopy ; Neurosurgical Procedures ; methods ; Pituitary Neoplasms ; surgery

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.
Adult ; Biopsy ; Female ; Giant Cells/pathology ; Granuloma/complications/*diagnosis/therapy ; Headache/etiology ; Hemianopsia/etiology ; Humans ; Hyperprolactinemia/etiology ; Hypopituitarism/etiology ; Inflammation/complications/*diagnosis/therapy ; Magnetic Resonance Imaging ; Optic Chiasm/pathology ; Pituitary Diseases/complications/*diagnosis/therapy ; Pituitary Function Tests ; Pituitary Gland/*pathology/surgery ; Predictive Value of Tests ; Severity of Illness Index ; Treatment Outcome

We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV+ within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.
Adult ; Carotid Artery Diseases/*diagnosis/etiology/therapy ; *Carotid Artery, Internal/pathology/surgery ; Diagnosis, Differential ; Embolization, Therapeutic ; Humans ; Magnetic Resonance Angiography ; Male ; Pituitary Apoplexy/complications/*diagnosis ; Tomography, X-Ray Computed