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Retinoblastoma is the most common ocular malignancy of childhood. It is present in childhood with leukocoria and strabismus. Most patients are diagnosed under 3 years of age. Funduscopic examination can reveal an intraocular mass, but imaging is essential for complete evaluation of the lesion. Although ultrasound is a non-invasive and relatively inexpensive screening tool, cross-sectional imaging is required to assess the involvement of optic nerve and intracranial spread. We report a case of retinoblastoma in a 5 year old male child who presented with headache diminution of vision in both eyes. Contrast enhanced magnetic resonance imaging (MRI) revealed an enhancing soft tissue mass in the right eye with involvement of optic nerve and optic chiasma and contiguous with a large suprasellar mass causing hydrocephalus. Non-contrast computed tomography (CT) showed extensive calcifications in the mass lesion.

Context The resection plan of pituitary adenoma (PA) needs preoperative observation of the sellar region. Radiomics prediction requires high-quality segmentations. Manual delineation is time-consuming and subject to rater variability. Objective This work aims to create an automated segmentation method for the sellar region, several tools to extract invasiveness-related features, and evaluate their clinical usefulness by predicting the tumor consistency. Methods Patients included were diagnosed with pituitary adenoma at Peking Union Medical College Hospital. A deep convolutional neural network, called gated-shaped U-net (GSU-Net), was created to automatically segment the sellar region into 8 classes. Five magnetic resonance imaging (MRI) features were extracted from the segmentation results, including tumor diameters, volume, optic chiasma height, Knosp grading system, and degree of internal carotid artery contact. The clinical usefulness of the proposed methods was evaluated by the diagnostic accuracy of the tumor consistency. Results A total of 163 patients with confirmed pituitary adenoma were included as the first group and were randomly divided into a training data set and test data set (131 and 32 patients, respectively). Fifty patients with confirmed acromegaly were included as the second group. The Dice coefficient of pituitary adenoma in important image slices was 0.940. The proposed methods achieved accuracies of more than 80% for the prediction of 5 invasive-related MRI features. Methods derived from the automatic segmentation showed better performance than original methods and achieved areas under the curve of 0.840 and 0.920 for clinical models and radiomics models, respectively. Conclusion The proposed methods could automatically segment the sellar region and extract features with high accuracy. The outstanding performance of the prediction of the tumor consistency indicates the methods’ clinical usefulness for supporting neurosurgeons in judging patients’ conditions, predicting prognosis, and other downstream tasks during the preoperative period.

Retinale Pathologien wirken sich auf Struktur und Funktion der postretinalen Sehbahn aus mit moglicherweise hochgradig negativen Auswirkungen auf den Erfolg innovativer retinaler Therapien, die auf eine Wiederherstellung des Sehvermogens abzielen. Aktuelle Entwicklungen im Feld des Neuroimagings und der assoziierten neurocomputationellen Analysen ermoglichen eine detaillierte Darstellung dieses Zusammenhanges und stellen somit eine Vorabeinschatzung des Therapieerfolges in Aussicht. Im vorliegenden Beitrag wird erlautert, wie Innovationen insbesondere der Magnetresonanztomographie-basierten anatomischen, funktionellen und Diffusionsbildgebung fur Sehbahnanalysen im Rahmen ophthalmologischer Fragestellungen angewendet werden konnen. Es werden konkrete Beispiele von Retina- und Sehbahnpathologien im Kontext einer detaillierten Sehbahnanalyse vorgestellt. Es wird ein Konzept entwickelt, das es ermoglicht, diese aussagekraftigen, aber technisch und computationell sehr anspruchsvollen Verfahren in klinische Fragestellungen einzubinden und effizient mit innovativen Therapieansatzen zu verbinden.

Introduction. Recurrent vomiting is a commonly overlooked debilitating symptom which causes significant impact on the quality of life. There are several causes for vomiting, ranging from commonly known causes to rare causes. Nonfunctioning pituitary macroadenomas generally present with visual disturbances, headache, and symptoms due to anterior pituitary hormone deficiencies. This case report is about an atypical presentation of a nonfunctioning pituitary macroadenoma in which the patient presented with cyclical vomiting with severe hyponatremia. Case Report. A 23-year-old girl presented with four to five episodes of vomiting per day for two days duration. She had a history of similar episodes of vomiting since 2016, with each episode generally lasting for 4-5 days and occurring in every four to six months. All episodes exhibited similar symptomatology and she was free of symptoms in-between. Generalized body weakness, postural dizziness, reduced appetite, and secondary amenorrhea were other symptoms she has had since 2016. Examination findings showed a low body mass index (BMI) (16 kg/m2) with normal system examination. Investigations showed severe hyponatremia (110 mmol/L) with hypokalemia (3.2 mmol/L) and hypochloremia (74 mmol/L). Her urinary excretion of potassium, sodium, and serum osmolality was low. Urine osmolality was mildly elevated compared to serum osmolality. Blood urea was normal. Severe hyponatremia with minimal hyponatremic symptoms was suggestive of chronic hyponatremia, which was accentuated by ongoing vomiting and possible reduced intake of salt. Further investigations showed evidence of secondary hypoadrenalism, central hypothyroidism, hypogonadotropic hypogonadism, and mild hyperprolactinemia. Magnetic resonance imaging (MRI) revealed a pituitary macroadenoma with mass effect on the optic chiasma. Hydrocortisone and levothyroxine were started, and she underwent transsphenoidal resection of the pituitary tumor. She recovered from cyclical vomiting. Conclusion. There can be multiple overlapping aetiologies for every observed symptom, sign, and abnormal investigation finding. Therefore, aetiological diagnosis is challenging, especially in the presence of an atypical clinical presentation. Cyclical vomiting and severe hyponatremia are atypical presentations of nonfunctioning pituitary macroadenomas.

Introduction: Xanthogranuloma of the sellar region is a rare benign lesion, and there are few cases reported in children. Its histogenesis is controversial, and it is difficult to strictly differentiate it from craniopharyngioma (CP), Rathke’s cleft cyst, or pituitary adenoma. Case Presentation: A 16-year-old boy presented with a rare xanthogranuloma of the sellar region after complaining of retardation of growth 5 years previously. The ophthalmologic evaluation revealed no visual field disturbance. Endocrinological examination revealed hypopituitarism. Magnetic resonance imaging showed an intrasellar mass extending into the suprasellar region and compressing the optic chiasma, which appeared mixed signals on T1-weighted images. Endonasal transsphenoidal resection of the tumor was performed. Histological analysis of the tumor sections demonstrated granulomatous tissue with cholesterol clefts, hemosiderin deposits, fibrous tissues, multinucleated giant cells, and lymphocyte. Thus, the tumor was pathologically diagnosed as xanthogranuloma of the sellar region, which is different from adamantinomatous CP. There was no epithelial tissue in any part of the tumor including tumor capsule but have focal necrosis and calcification. His endocrinological dysfunction did not recover, so a hormonal replacement was continuously required. Conclusion: Xanthogranuloma of the sellar region is a rare entity but must be considered in the differential diagnosis of lesions of the sellar region, even in pediatric population. We should think about this disease when dealing with children with stunted growth accompanied by a long medical history. Our case demonstrates the natural progression of the disease, suggesting that xanthogranuloma of the sellar region without epithelial components may be an independent disease.

Los craneofaringiomas (CF) son tumores raros de baja malignidad histológica, que surgen a lo largo del conducto craneofaríngeo. Los dos subtipos histológicos, craneofaringioma adamantinomatoso (CFA) y papilar (CFP), difieren en su origen y distribución por edad. Los CFA se diagnostican con un pico de incidencia bimodal (5–15 años y 45–60 años), mientras que los CFP se presentan exclusivamente en adultos, principalmente en la quinta y sexta décadas de la vida. Los CFA son generados por mutaciones somáticas en CTNNB1, codificador de β-catenina y son predominantemente de aspecto quístico. Los CFP albergan mutaciones somáticas en BRAF V600E y son típicamente tumores sólidos. Las manifestaciones clínicas de hipertensión endocraneana, compromiso visual o deficiencias endocrinas, sirven de alerta para solicitar imágenes. El tratamiento comprende generalmente neurocirugía y radioterapia (RT); la quimioterapia intraquística se usa en el CFA monoquístico. Aunque la supervivencia a largo plazo es alta, con frecuencia se ven afectadas la calidad de vida y la función neuropsicológica, debido a la proximidad anatómica al quiasma óptico, el hipotálamo y la glándula pituitaria. La afectación hipotalámica por el tumor y las lesiones secundarias al tratamiento, con frecuencia resultan en obesidad hipotalámica y déficits neuropsicosociales.

Background: We present a rare case of malignant transformation of a craniopharyngioma in a patient who received growth hormone replacement therapy. Case Description: A 43-year-old male came to our department with a headache and visual disturbance and was admitted. Brain magnetic resonance imaging (MRI) revealed a giant tumor in the intra- and suprasellar region compressing the optic chiasma. Using a transcranial pterional approach, the tumor was removed as much as possible, with the residual mass removed later with a trans-sphenoidal approach. The initial histopathological diagnosis was adamantinomatous craniopharyngioma. Decompression of the optic chiasma was achieved and visual function improved, though residual tumor tissue remained in the parasellar region, without regrowth seen for more than 24 years. At the age of 67 years, the patient received growth hormone replacement therapy because of a deficiency, then 2 years later the residual tumor began to grow gradually. Trans-sphenoidal surgery was again performed to remove the growing tumor and histopathology results revealed an adamantinomatous craniopharyngioma with malignant transformation. Stereotactic radiation therapy was performed for the residual mass with a total dose of 60 Gy. Presently, 1 year later the patient has a stable condition, and the tumor remains controlled, while follow-up examinations are continuing. Conclusion: A craniopharyngioma may undergo malignant transformation with continuous exposure to administered growth hormone. Close follow-up and imaging examinations are necessary to detect a change, including tumor growth in such cases.

Background Holoprosencephaly is a forebrain deformity that results from varying degrees of separation failure of cerebral hemispheres. The condition is classified based on the degree of non‐separation of the hemispheres which, in turn, determines its severity. Holoprosencephaly is usually accompanied by craniofacial defects whose severity tends to reflect the extent of brain deformities. In humans, holoprosencephaly is one of the commonest congenital brain anomalies but in animals, reported cases are scarce. The condition has multifactorial aetiology that involves interactions between several genetic and environmental factors. Case presentation A 4‐day‐old female Friesian calf with a deformed face was reported to the Faculty of veterinary medicine and surgery, Egerton University. The calf and the dam were sired by the same bull. On clinical and radiographic examination, the calf had a short snout that curved dorsally with bilateral cleft lip, right‐sided cleft jaw and a largely absent primary palate. Anatomopathological examination revealed brain deformities which included ventral fusion of frontal lobes of cerebral hemispheres, large merged lateral ventricles without septum pellucidum and fornix, hypoplastic corpus callosum, high degree of non‐separation between diencephalic structures, poorly developed hippocampal formation and hypoplastic olfactory lobe, optic chiasma, and nerve. Conclusion The case was confirmed as lobar holoprosencephaly based on characteristic anatomopathological findings. The aetiology of the defects in the present case could not be determined though they are thought to be either a result of recessive inheritance or exposure to teratogenic steroid alkaloids through materials fed to the dam during early pregnancy., HPE is a spectrum of brain deformities often accompanied by CFDs that results from varying degrees of non‐separation of cerebral hemispheres. A 4‐day old calf with OFCs was examined and then euthanized on animal welfare grounds followed by anatomopathological findings that revealed brain deformities characteristic of HPE such as ventral fusion of frontal lobes, merged lateral ventricles and hypoplastic corpus callosum among others. The aetiology of the deformity in the current case could not be determined but thought to have probably resulted from recessive inheritance or exposure of teratogenic steroid alkaloid from dam's feed material during early pregnancy.

Roughly quadrangular, the chiasma presents many morphological variations. The optical chiasm, odd and symmetrical structure of the optical pathways, is a required passage of the axons of neurons for the visual pathways. Any modification of its morphology evokes a pathological process, generally tumoral. The quality of MRI images rivals that of anatomical slices. So the MRI is essential for the study of the chiasma. The aim of this work was to study the morphometry of the optic chiasm in patients addressed for cerebral MRI to the imaging department of the university hospital of the POINT-G, during the period from July 29, to November 30, 2016. All patients who had a normal examination of the optic chiasma, numbering 15, were included in this study. In 86.66% of cases the chiasma had a quadrilateral form. Its average length was 8.73 mm and its average width was 13 mm. The average thickness was 4.13 mm.

The purpose of this study is to investigate methods to visualize and measure the fetal optic chiasma (OC) using transabdominal and/or transvaginal two-dimensional (2D) ultrasound in the coronal plane. The role of analyzing optic chiasma cannot be down scaled in prognosticating septo-optic dysplasia (SOD) and agenesis of septum pellucidum. This is a retrospective study of 117 random cases referred for various indications. The gestational age of the fetuses included in the study was between 19 and 37 weeks. The OC was visualized and measured in the 2D coronal plane with color Doppler by transabdominal and/or transvaginal routes. There were 97 normal low risk cases and 19 abnormal cases in the study. We conclude that it is possible to locate and measure OC width by transabdominal and transvaginal scans from 19 week onwards. It is possible to get equally good views by both, transabdominal and transvaginal routes.

The death of retinal ganglion cells (RGCs) is a key factor in the pathophysiology of all types of glaucoma, but the mechanism of pathogenesis of glaucoma remains unclear. RGCs are a group of central nervous system (CNS) neurons whose soma are in the inner retina. The axons of RGCs form the optic nerve and converge at the optic chiasma; from there, they project to the visual cortex via the lateral geniculate nucleus (LGN). In recent years, there has been increasing interest in the dysfunction and death of CNS and retinal neurons caused by transneuronal degeneration of RGCs, and the view that glaucoma is a widespread neurodegenerative disease involving CNS damage appears more and more frequently in the literature. In this review, we summarize the current knowledge of LGN and visual cortex neuron damage in glaucoma and possible mechanisms behind the damage. This review presents an updated and expanded view of neuronal damage in glaucoma, and reveals new and potential targets for neuroprotection and treatment.

Traumatic chiasmal syndrome is one of the rare etiologies of chiasmal syndrome, characterized by optic chiasm injury following head trauma. The main visual defect associated is bitemporal hemianopia with macular splitting; however, it can present with a variety of other visual defects and neurologic signs. The authors report a case of complete bitemporal hemianopia after head trauma, with multiple frontal and skull base fractures and no other neurologic deficits, or hypothalamic-pituitary abnormality. Most cases of traumatic chiasmal syndrome are caused by mechanical stretch or compression of the chiasma. Nevertheless, in this case, the radiologic findings excluded macroscopic disruption or external compression of the chiasma, raising the possibility of a contusion necrosis associated with functional impairment of the optic chiasma. Traumatic chiasmal syndrome must be considered in the differential diagnosis of patients presenting with complete bitemporal hemianopia after head injury caused by frontal and skull base fracture.

It is arguable that whether the single camera captured (monocular) image datasets are sufficient enough to train and test convolutional neural networks (CNNs) for imitating the biological neural network structures of the human brain. As human visual system works in binocular, the collaboration of the eyes with the two brain lobes needs more investigation for improvements in such CNN-based visual imagery analysis applications. It is indeed questionable that if respective visual fields of each eye and the associated brain lobes are responsible for different learning abilities of the same scene. There are such open questions in this field of research which need rigorous investigation in order to further understand the nature of the human visual system, hence improve the currently available deep learning applications. This paper analyses a binocular CNNs architecture that is more analogous to the biological structure of the human visual system than the conventional deep learning techniques. While taking a structure called optic chiasma into account, this architecture consists of basically two parallel CNN structures associated with each visual field and the brain lobe, fully connected later possibly as in the primary visual cortex. Experimental results demonstrate that binocular learning of two different visual fields leads to better classification rates on average, when compared to classical CNN architectures.

Neurohypophysis granular cell tumor (NGCT) is a rare entity and is classified under thyroid transcription factor 1 (TTF-1) expressing tumors of pituitary. It is considered as an uncommon differential during sellar and suprasellar mass evaluation. Its intraoperative squash cytology is distinct and has rarely been reported in literature. A 65-year-old female presented with reduced vision of right eye and history of seizures. Radiological findings revealed a sellar/suprasellar mass with mass effect on optic chiasma. Intraoperative squash neurocytology examination showed a spindle cell lesion with abundant granular cytoplasm in tumor cells. Subsequent histopathology and immunohistochemistry confirmed the diagnosis of granular cell tumor. Granular cell tumor remains one of the sellar/suprasellar surprises. Its intraoperative neurocytology is unique and should be considered while evaluating a sellar/suprasellar mass. A case of sellar granular cell tumor with its intraoperative squash cytology, histopathology along with a review of literature is being presented with special emphasis on cytological differential diagnosis in pituitary region.

Background In this study, we evaluated the changes in resting-state networks (RSNs) under anesthesia in neurosurgical patients. Methods RSNs were analyzed in 12 patients with pituitary adenoma presented by chiasma compression operated via standard transsphenoidal approach under propofol anesthesia before and after tumor resection. All the patients had suprasellar tumor extension with compression of the optic chiasma. We investigated second-level effects by contrasting dummy-encoded covariates representing the effects of the sessions (first vs. second) on RSNs. We corrected for multiple comparisons using a false discovery rate of 0.05 (2-sided). Results Connectivity between the right and left precentral gyri (motor network) decreased significantly from the first to the second session (P = 0.0002), as did the connectivity between the postcentral gyri (P = 0.009). The same was valid for connectivity between the visual cortices (P = 0.0002). The salience network showed a significant decrease in the connectivity of the anterior part of the cingulate gyrus and insular cortex (P = 0.0001). The default mode network showed a decrease in the connectivity between the posterior part of the cingulate gyrus, parietal, and frontal cortices (P = 0.0002). There was no significant correlation between the reduction in connectivity and dose or duration of anesthesia. Conclusions Different RSNs could be identified under anesthesia and used for intraoperative brain mapping and remapping during tumor resection. However, RSNs showed a significant decrease in connectivity with the continuation of anesthesia.

Ethambutol is an integral part of Antitubercular therapy (ATT) and is often associated with optic neuropathy, However, neuroimaging of ethambutol induced optic neuropathy has been sparsely reported in the literature. We describe the case of a 45-year male patient, diagnosed as Tuberculous spondylodiscitis and was on ATT. Four months after ATT initiation, he presented with visual blurring in both the eyes with bitemporal hemianopia and central scotomas. Visual evoked potential (VEP) revealed prolonged latencies in N75 and P100 waveforms bilaterally. Magnetic Resonance Imaging (MRI) showed optic chiasma and bilateral optic tract hyperintensities on 3D Fluid Attenuated Inversion Recovery (FLAIR) and 3D Double Inversion Recovery (DIR) sequences. Ethambutol was discontinued immediately. On follow-up after 8 weeks, visual acuity reversed back to normal in both eyes.

We hereby report a case of metastatic Ewing’s sarcoma presenting with rapid-onset total ophthalmoplegia, optic atrophy, and right temporal hemianopia. Comprehensive ophthalmic and neurological evaluation with targeted radioimaging revealed a tumor mass centered over the sella, compressing optic chiasma, extending to involve the left cavernous sinus and the left orbital apex. Whole-body imaging revealed the evidence of multifocal lung and mediastinal metastasis with focal lytic defect in the left femoral head. Histopathological evaluation of transnasal punch biopsy from the nasopharyngeal extension of the tumor revealed small round-cell tumor with strong CD99 positivity, supporting the diagnosis of Ewing’s sarcoma. Rapid, aggressive extensions of the metastatic tumor into vital structures despite the initiation of chemoradiation of the extensive intracranial tumor led to unexpected demise of the patient. Our case is an unusual case of Ewing’s sarcoma metastasis manifesting as a sellar mass and mimicking a pituitary adenoma radiologically, with a rapid progression within 2 weeks to cause massive extension of tumor into suprasellar, infrasellar, and left parasellar area, indicative of highly malignant nature of the tumor.

Introduction: Radiotherapy still the most facilitated modality for treatment malignant brain tumors with or without chemotherapy and after surgery or when surgery is impossible. Purpose: Comparison between the effects of three planning techniques with similar, opposed and non-wedges in brain tumor cases. Methods: Twenty patients with brain tumors (Glioblastoma Multiform) of both sexes were enrolled in the study. A LINAC with 6MV photon beam was used to deliver the prescribed dose. The whole brain technique was applied to each patient and the planning was constructed with non-wedges, similar wedges and opposed wedges within 95% to 107% of the prescribed dose as recommended by the RTOG. The considered organs at risk were; Right and Left (eyes, lenses, and optic nerves), optic chiasma and the brain- stem. Results: The results showed significant difference (at the level P

Cavernous malformations (CM) affect approximately 0.5% of the population, with only a limited portion being located in the optic nerve and chiasma. The clinical presentation is determined by their locations. In the optochiasmatic CM, the acute visual disturbance is the most common presentation. Chronically, many show a progressive visual loss, chronic headache, and pituitary disturbances. The differential diagnosis includes optic glioma, arteriovenous malformations, aneurysm, craniopharyngioma, pituitary apoplexy, and inflammatory conditions. In Video 1 , we present the case of a 39-year-old woman with a history of a hemorrhagic optochiasmatic cavernoma in 2016, who started using propranolol to reduce the lesion and symptoms of visual loss. Moreover, the first microsurgical resection of the cavernoma and evacuation of the hematoma were performed in the same year. Owing to evolvement from a partial to a total vision loss in the left eye and presentation of new symptoms in the right eye, the patient underwent microsurgical resection. The surgery was performed sequentially. An awake craniotomy was performed to monitor the chiasma and right optic nerve. The postoperative magnetic resonance imaging showed complete resection of the CM, and the patient fully recovered. The patient signed the institutional consent form, stating that he or she accepts the procedure and allows the use of his or her images and videos for any type of medical publications in conferences and/or scientific articles.

Background Diverse methods have been developed for intraoperative monitoring of the integrity of the visual pathways. We performed a review of the literature to determine the methodology of each technique as well as their recent development. The predictive power of each eligible technique was determined based on a meta-analysis. Methods A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Techniques adopted for intraoperative monitoring of the integrity of the visual pathways were extracted and described. The power of each eligible technique to predict the visual outcome was tested. Results Visual evoked potentials showed marked methodologic improvement in recent studies. Predictive power for visual deterioration after surgery was approximately 60% and reached 100% when coupled with simultaneous monitoring of electroretinography. The sensitivity of visual evoked potentials for detection of deterioration was 47.2%. The decrease of fractional anisotropy of the optic chiasma showed significant correlation with improvement of vision after chiasma compression and showed 100% predictive power for improvement. Conclusion Each technique had limitations. Visual evoked potentials had a high predictive power for detection of deterioration but with low sensitivity. Fractional anisotropy of the optic chiasma had high predictive power for improvement of vision with low predictive power for deterioration.

Vision loss is a disabling complication of tuberculous meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in tuberculous meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of tuberculous meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of tuberculous meningitis is the only way forward to tackle this problem.

Segmentation of the anterior visual pathway (AVP, including optic nerve, optic chiasma, and optic tract) and the medial rectus muscle (MRM) in computed tomography (CT) images is indispensable in the treatment planning of skull base tumors. However, the optic tract and the optic chiasma are difficult to visualize because of weak CT imaging on soft tissue. In this paper, we propose a multi-modal image fusion-based segmentation approach for low-contrast AVP and MRM in CT images. First, a statistical shape model is constructed from the magnetic resonance (MR) images in which the optic tract and the optic chiasma are imaged clearly. Second, a deformation field is calculated by fusing the target CT image and the reference MR image and applied to the statistical shape as the initial segmentation result. Third, a multi-feature constrained surface of the AVP and the MRM is generated from the CT image. After fitting the initial segmentation result to the surface, the structures, including the optic tract and the optic chiasma that are invisible in CT images, can also be segmented. The proposed method is demonstrated on the clinical data of human head with respect to the Dice value and mean distance. The mean Dice and the mean distance between the segmentation results and the ground truth are 0.66 and 0.58, respectively.

The study provides an up-to-date overview of pathogenesis, functional and structural changes in normal tension glaucoma (NTG) and its differences from high tension glaucomas (HTG). The authors point to less known facts which make both diagnostic groups different. First of all, there are electrophysiological findings that verify pathology in the complete visual pathway in HTG in contrast to NTG where the retinal ganglion cell response is relatively normal but the abnormalities are in the visual pathway. This corresponds to the findings of functional magnetic resonance imaging of the brain with a significant decrease in activity in HTG compared to NTG. We found a higher decrease in activity in HTG following application of the colour paradigm compared to NTG where we did not see a similar difference. We also investigated the central corneal thickness (CCT) in both diagnostic groups. We did not find a statistically significant difference. However, we found the effect of CCT on progression of the changes in visual fields in HTG. In relation to suspicion of abnormally low cerebrospinal pressure and a possible cerebrovascular fluid flow disturbance in NTG, we examined the optic nerve thickness (OND) and optic nerve sheath diameter (OSD) at a distance of 4, 8, 16 and 20mm from the posterior pole of the eye. In the comparison with the healthy population, we did not find any abnormalities except for the width of the optic chiasma that was markedly lower in NTG. In relation to a possible impairment of cerebral perfusion we determined the degrees of cerebral atrophy using magnetic resonance imaging by measuring the bicaudate ratio (BCR) and white matter lesions using the Fazekas scale. We did not find a difference between HTG and NTG in BCR. We found statistically significant changes in BCR which correlated with the changes in visual fields. The higher values of the pattern defect were associated with increased brain atrophy (BCR). We did not detect similar relations in the Fazekas scale. We found a significant difference in this parameter among NTG, HTG and a control group. We found the most advanced changes in the patients with HTG. Conclusion: In HTG, impairment of retinal ganglion cells and subsequently also their axons, including visual cortex occurs because of a high intraocular pressure. In NTG, the retinal ganglion cells are relatively normal like the visual cortex, but alteration occurs in their axons. The cause is not a high intraocular pressure but most probably ischemia.

The case concerns a 26-year-old patient with bilateral recurrent optic neuritis episodes in the context of suspected neuromyelitis optica. In the first outbreak, she had greatly impaired visual acuity of the left eye, as well as seeing ganglion cell layer damage in both eyes in the optic coherence tomography, with evidence of a possible extensive lesion in the optic chiasma. Likewise, MRI with contrast showed a great involvement of the left optic nerve that compromises the chiasma increasing the suspicion of a neuromyelitis origin. Althogh the anti-myelin oligodendrocyte glycoprotein (MOG) and anti-AQP4 (aquaporin-4) antibodies were negative at first, bilateral involvement of the ganglion cells suggested an extensive lesion that is more characteristic of seropositive anti-MOG neuromyelitis.

Objective Understanding the relationship between the carotid artery, optic nerve and the anterior clinoid process is the basis of surgical approaches performed in the subchiasmal region. The location of the optic chiasm, the length of the optic nerves, and the distance and angle between the optic nerves determine the route of surgical approaches. We have determined the types of optic chiasm to study the relationship between vascular and neural structures in this region. Materials and methods Thirty autopsy specimens were investigated at the Bursa Forensic Medicine Institute for optic chiasm types and the relationship between the neural and vascular anatomical structures of the sellar–parasellar and subchiasmal region was examined between June 2016 and November 2016. Results In this study, 4 prefix types (13%), 6 postfix types (20%), and 20 central types (67%) of chiasm were defined. Furthermore, we measured this angle between two optic nerves, which indirectly shows the location of chiasm according to the diaphragma sellae, and then detected the mean value of this angle as 87.1 ± 11.6°. The “limit” value to designate a chiasm as prefix was measured in the current study as ≥101.1°. The angle between optic nerves ranged from a mean value of 69.9 ± 3.7° in 6 cases with postfix chiasm, to a mean value of 104.0 ± 2.1° in 4 cases with prefix chiasm and a mean value of 88.8 ± 6.7° in 20 cases with central chiasm. Conclusion In this study, we showed that the relationship among optic chiasma types, optic nerves and bony and vascular structures around the sellar area was effective at determining the surgical approach to this region.

Background: The suprachiasmatic nucleus (SCN) is one of the nuclei in the anterior hypothalamus superior to the optic chiasma. It is well known that vasopressin and oxytocin neurons are located in the hypothalamic para-ventricular and the supraoptic nuclei. Extensive vasopressin neurons were observed in the rostral and middle regions of the suprachiasmatic nucleus.Aim of the work: Although the presence of oxytocin immunoreactive neurons within the SCN is unusual, this study was designed to clarify immunohistochemical localization of oxytocin neurons in the suprachiasmatic nucleus in the male and pregnant female adult albino rat and to investigate morphometrical differences in those neurons in relation to the gender.Material and Methods: Twenty adult rats (10male and 10 non pregnant female) were involved in this study. Rats were anaesthetized with ketamine, sacrificed and their brains were carefully dissected. The anterior portion of the hypothalmus containing the suprachiasmatic nucleus was taken. Coronal sections of the brain were prepared for histological stains (Hematoxylin and Eosin) and immunohistochemical stain (Oxytocin immunostaining). The diameters and number of oxytocin labelled neurons in the suprachiasmatic nucleus in each group were measured in a fixed field. The data will be used for morphometrical study.Results: The SCN in rat was formed mainly of 2 regions according to the change in the shape, rostral SCN (rSCN) and caudal SCN (cSCN).The rSCN appeared as a collection of neurons basal to the third ventricle and superior to the optic chiasma. It showed mixture of bipolar and multipolar cells. The cSCN was formed of mixture of large rounded and small bipolar neurons. The rostral part of the nucleus showed positive OT immune-reactive neurons throughout its structure in both male and female rats, the caudal part of the nucleus exhibited OT immune-reactive neurons in the lateral part only on both sides of the third ventricle, while its medial potion showed negative reaction for OT in both groups.Conclusion: The present findings proved immunehistochemical identification of OT neurons in the adult male and nonpregnant female rat SCN, and indicate clear sex differences in OT neurons morphometrical measurements which may be parallel to differences in the neuroendocrine and behavioral function in both sexes.

Background Oculocutaneous albinism (OCA) is a genetically heterogeneous group of disorders affecting melanin biosynthesis. It is always an autosomal recessive inheritance and is characterized by decreased or absent pigmentation of hair, skin, iris and retina. Clinical presentation is typically of an infant who does not appear to see at the expected 6–8 week corrected age, often with nystagmus and pale pigmentation. Clinical findings demonstrate grossly obvious iris attenuation and iris transillumination, refractory errors and photophobia. Investigations include genetic testing, Optical Coherence Tomography (OCT) to identify foveal hypoplasia and electrophysiology to establish any excessive crossing of optic nerve fibres at the optic chiasma. Method A Caucasian female, born to non-consanguineous parents was referred to Paediatric services at one week of age with concerns regarding her pale hair, eyelashes and diffuse pink reflex from both eyes. On examination she had marked iris transillumination without nystagmus and significant hypermetropic astigmatism for which glasses were prescribed. Her father had iris transillumination and nystagmus but met the visual standards to drive. By eight weeks, the infant had developed nystagmus and was showing some visual awareness. Developmental examination was age appropriate. Results At initial presentation the expectation of delayed visual maturation was explained to the parents with reassurance that once vision has matured, OCA is a stable condition. Advice was given regarding protection from solar damage as well as the importance of regular skins checks in view of the possible increased risk of skin cancers. The family history and the phenotypical variability between OCA subtypes prompted gene testing to arrive at a molecular diagnosis. Conclusion The case highlights the importance of early identification so families are aware of the natural history of OCA as well as the need to protect skin from UV damage. Carrier detection and personalised genetic counselling are possible once the disease causing mutations in the family are identified.

Morphological study was conducted on the brain of nine fowl aged from 2 to 6 months. The pear-shaped brain lodged in the cranial cavity was 3.34 ± 0.08 g in weight, with a length of 26.69±0.40 mm and width of 20.60 ± 0.17 mm. It consisted of cerebral hemispheres, pineal body, optic lobes, and cerebellum when viewed from the dorsal surface. On ventral surface, from cranial to caudal end it had olfactory bulbs, orbital faces of the cerebral hemispheres, optic chiasma, optic tract, optic lobes, hypophysis cerebri, midbrain (cerebral peduncles), pons and medulla oblongata, which was continued into the spinal cord. Olfactory bulbs present on the tapered cranial end of cerebral hemisphere were so closely attached with each other that were giving the appearance as a single structure. The cerebral hemispheres were obtuse triangular and devoid of gyrus and sulci. The cerebellum was located behind the transverse sulcus and had gyri and sulci. It was round structure resembling a curled worm and was 11.80±0.25 mm in length and 8.53±0.21 mm in width.

Background Solitary metastasis of tumors to the third ventricle is very rare and difficult to treat. Diagnostic and secondary treatment considerations are therefore important to improve outcomes. Case Description A 51-year-old healthy male with disorientation, drowsiness, and incontinence was found to have a third ventricular tumor with intratumoral hemorrhage triggering the hypothalamic disorder. The patient also had bullae in the bilateral lung attributed to prolonged smoking. An endoscopic biopsy of the third ventricle tumor was performed. The pathological diagnosis was uncertain because of sampling error. Three weeks later, an emergency craniotomy was performed due to rapid tumor growth. The tumor was reddish, elastic, hard, and strongly adhered to the ventricular wall. It was removed with the third ventricle bottom. The optic recess and optic chiasma were found to be intact. The tumor was considered to originate from the hypothalamus. Hematoxylin and eosin staining revealed atypical growth in the sheet form. Immunohistochemical analysis for cytokeratin7, cytokeratin20, and vimentin confirmed the diagnosis of a metastatic tumor, with strong positive results for programmed cell death 1- ligand 1. Fluorodeoxyglucose positron emission tomography showed high accumulation consistent with a bulla-like lesion. The patient could not receive treatment with immune checkpoint inhibitors due to poor general condition and died three months following surgery due to tumor recurrence. Conclusions We report a case of primary lung carcinoma solitarily metastasizing to the third ventricle in a 51-year-old individual. Death outcome could be attributed to difficulties in total excision and the poor general condition caused by the hypothalamic disorder and warrants consideration for control of hydrocephalus and hypothalamic functions.

Intrasellar arachnoid cysts are rare entities. High index of suspicion and precise radiological evaluation are the cornerstone for appropriate diagnosis and treatment. We present a symptomatic case of a sellar cystic lesion in a 52-year-old lady, who had complaints of decreased vision associated with diplopia of three months duration. Clinical evaluation showed bitemporal hemianopia. Magnetic Resonance Imaging (MRI) of brain revealed features of sellar arachnoid cyst with the intracystic component similar to cerebrospinal fluid (CSF). She underwent endoscopic transnasal transsphenoidal excision of lesion. Her visual symptoms improved well on subsequent follow up.However infrequent, sellar arachnoid cyst should be borne in mind as differential diagnosis for any cystic sellar lesions, as they can mimic pituitary adenomas, either by impairment of pituitary hormonal function or by exerting pressure effects on optic chiasma. Evaluation modalities, therapeutic challenges and literature review are presented in this case report.

OBJECTIVE The study aimed to characterize magnetic resonance imaging (MRI) findings of solitary hypothalamitis and evaluate their clinical value in diagnosis. METHODS Magnetic resonance imaging scans, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and contrast-enhanced T1-weighted sequences, of 8 biopsy-proven hypothalamitis lesions were retrospectively analyzed along with MRI features including size, shape, signal intensity, enhancement pattern, correlation with adjacent tissues, and changes in infundibular stalk and sella turcica. RESULTS Of 8 patients, 5 were diagnosed with lymphoplasmacytic proliferative inflammation, 2 with Langerhans cell histocytosis, and 1 with Rosai-Dorfman disease. Solitary hypothalamitis predominantly demonstrated mild hypointensity/isointensity in T1WI and mild hyperintensity in T2-weighted imaging. In contrast-enhanced T1WI, all lesions showed heterogeneous but primarily peripheral enhancement patterns. Seven cases showed the polygon sign. In T1WI, the normal high signal intensity of neurohypophysis was absent from all patients, with no infundibular stalk thickening. Seven patients presented with optic chiasma edema, and 5 with edema-like changes along the optic tract (OTE), but most showed no visual impairment (n = 7). CONCLUSIONS Magnetic resonance imaging, particularly postcontrast MRI, is the optimal modality for assessment of hypothalamic lesions. Peripheral enhancement with polygon sign and optic tract or chiasm edema without visual impairment are highly suggestive of hypothalamitis.

Background Oligodendrocytes are critical to the function of the brain. They generate the myelin sheath which ensures saltatory conduction, which is a more energy saving and efficient means of axonal impulse transmission. Ventriculomegaly results in neuronal degeneration and astrogliosis. Purpose The effect of the degree of ventriculomegaly on oligodendrocyte in kaolin-induced hydrocephalus and the timeline have not been extensively documented, hence this study. Methods A total of 81 rats that were 3 weeks old were divided into 4 groups each consisting of control and experimental subgroups. Kaolin suspension was intracisternally injected to induce hydrocephalus and the animal sacrificed post-induction at 1, 2, 3, and 4 weeks. Two 1-mm-thick coronal slices at optic chiasma level were fixed in 10% buffered formal-saline and Karnovsky's fixative for light and transmission electron microscopy (TEM), respectively. The former slices were processed and stained with hematoxylin and eosin for glial density, cortical thickness, and oligodendrocyte evaluations. Subcortical white matter region of the latter were processed by conventional techniques for TEM. Results Compared with their corresponding control rats, thickness of the dorsolateral cortex was significantly reduced across the 2-4 week post-induction (WPI), glial density was significantly increased in the mild and moderate ventriculomegaly subgroups 1 WPI but only in mild ventriculomegaly subset 2 WPI. In the 4 WPI group, there was significant increase in glial density across the 3 ventriculomegaly subsets. Early hydropic changes of oligodendrocytes were noted in the inner pyramidal layer mostly in the 4 WPI experimental rats. Dilation of the endoplasmic reticulum precedes that of mitochondria, while mitochondrial crista disruption was noted in the 3 and 4 WPI rats. The nuclear membrane of the oligodendrocytes was progressively deformed from the 2nd to 4th WPI. Conclusion This study reported degenerative changes of oligodendrocytes and its organelles in kaolin-induced hydrocephalus. Degeneration was worse with duration and in the deep cortical layers.

The annual migration of a bird can involve thousands of kilometres of nonstop flight, requiring accurately timed seasonal changes in physiology and behaviour. Understanding the molecular mechanisms controlling this endogenous programme can provide functional and evolutionary insights into the circannual biological clock and the potential of migratory species to adapt to changing environments. Under naturally timed photoperiod conditions, we maintained captive Swainson's thrushes (Catharus ustulatus) and performed RNA sequencing (RNA-Seq) of the ventral hypothalamus and optic chiasma to evaluate transcriptome-wide gene expression changes of individuals in migratory condition. We found that 188 genes were differentially expressed in relation to migratory state, 86% of which have not been previously linked to avian migration. Focal hub genes were identified that are candidate variables responsible for the occurrence of migration (e.g. CRABP1). Numerous genes involved in cell adhesion, proliferation and motility were differentially expressed (including RHOJ, PAK1 and TLN1), suggesting that migration-related changes are regulated by seasonal neural plasticity.

A 47-year-old woman presented with history of recurrent episodes of transient quadriparesis associated with documented hypokalemia for the last 12 years (serum K+ levels documented during those episodes were 1.7–3.2). She was diagnosed with HP at another center and was on supplemental potassium for the last 6 years. She also complained of transient, postprandial, binocular blurring of vision, progressing to persistent progressive painless vision loss bilaterally for the last 2 months. There was a history of dry mouth and eyes. There were no other systemic or neurologic complaints. General examination results were normal. Visual acuity was reduced to perception of light in the left eye and 6/60 in the right eye. There was bilateral optic atrophy and left-sided relative afferent pupillary defect. The rest of the neurologic and general physical examination was normal. MRI revealed hyperintense signal changes in bilateral optic nerves, optic chiasma, and optic tracts with mild contrast enhancement. Serum anti-aquaporin 4 antibodies were negative. CSF analysis was normal (no cells, normal glucose [86 mg/dL], and normal protein [42 mg/dL]). Investigations revealed metabolic acidosis (arterial pH 7.24), persistent hypokalemia (serum potassium 2.9 mEq/L [normal range 3.5–5.5]), hyperchloremia (serum chloride 122 mEq/L vs normal upper limit of 108 mEq/L), low serum bicarbonate (9 mEq/L [normal range 23–26 mEq/L]), and high urinary pH (6) without aminoaciduria or glycosuria (table). Renal, thyroid, and liver function tests and serum calcium, magnesium, and phosphorus were normal. The overall picture was that of hyperchloremic metabolic acidosis with normal anion gap, suggestive of distal renal tubular acidosis (RTA). Antinuclear antibody (ANA) was strongly positive; anti-Ro and anti-La titers were highly raised (24,952 U/mL and 12,713 U/mL, respectively, vs normal upper limits of 10 U/mL). Schirmer test revealed markedly reduced lacrimation (0 mm bilaterally). Ninety-nine meter TcO4 scintigraphy revealed negligible tracer uptake in both parotid and submandibular glands. Nerve conduction studies revealed autonomic neuropathy (absent sympathetic skin response) and ultrasonography of kidneys revealed simple cortical cysts. Final diagnosis of SS with distal RTA and hypokalemic paralysis, optic nerve involvement, and autonomic neuropathy was made and the patient was started on 60 mg prednisolone daily with oral potassium supplements. She improved initially in visual acuity, but developed acute right ophthalmoplegia with nasal obstruction (onset to peak 2 days) after 3 weeks of treatment. Repeat MRI of brain revealed findings suggestive of invasive rhino-orbitocerebral fungal infection. Nasal biopsy revealed invasive mucormycosis. She received IV amphotericin B but died of her illness after 2 weeks. A whole-body autopsy was done that confirmed invasive rhinocerebral mucormycosis along with pulmonary and hepatic dissemination along with evidence of SS in the form of tracheobronchial submucosal layer lymphocytic infiltration (figure, A) and medullary and papillary nephrocalcinosis (figure, B and C).

Neuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving the optic nerve and spinal cord, and imaging techniques and their effects have been the focus of investigations. The aim of the present study was to examine the value of three-dimensional double inversion recovery (3D-DIR) in the early differential diagnostic and prognostic evaluation of NMO. Forty-eight patients with suspicious NMO were included into the study and underwent a combination of serum NMO-IgG quantitative detection and 3D-DIR examination. Forty cases (83.3%) of the suspicious cases were confirmed with NMO. The average time from onset to definite diagnosis was 3.5±0.6 days. The brain showed high T2W and fluid-attenuated inversion recovery (FLAIR) signals, involving 5.8±1.2 sites on average, distributed in the peripheral lateral ventricle, medulla, cerebral white matter, the third ventricle, peripheral aqueduct of sylvius, pons and diencephalon. The average T2W signal strength was 2.73±0.12. The signal intensity of DIR was significantly higher than that of T2W and FLAIR, and the difference was statistically significant. The optic nerve and chiasma showed a high FLAIR signal, with an average signal intensity of 2.13±0.14. The spinal cord showed swelling, necrosis and cavity lesion, involving the gray and white matter of the central site, transversely, with an average lesion length of 4.7±0.6 centrum. The relative signal intensity of DIR was significantly higher than that of T2W and FLAIR. Following treatment, the signal intensity of the brain, optic nerve, optic chiasma and spinal cord decreased significantly (P

Pituitary adenomas are associated with intracranial aneurysms. Giant non-functioning pituitary adenomas with aneurysms in their vicinity pose technical surgical challengesas aneurysm rupture can be catastrophic during surgery. We present the case of a middle aged women who presented with progressive visual loss in both eyes caused by a giant pituitary adenoma compressing the optic chiasma. She also had associated mirror image carotid aneurysms embedded in the tumour. They were successfully coiled preoperatively and the tumour was removed safely with improvement of her symptoms.

Objectives To discuss the use of the posterior petrosal approach for the resection of a retrochiasmatic craniopharyngioma. Design Operative video. Results In this case video, the authors discuss the surgical management of a large craniopharyngioma, presenting with mass effect on the third ventricle and optic apparatus. A first surgical stage, through an endoscopic endonasal transtubercular approach, allowed satisfactory decompression of the optic chiasma and nerves in preparation for adjuvant therapy. However, accelerated growth of the tumor, with renewed visual deficits and mass effect on the hypothalamus and third ventricle, warranted a supplementary resection. A posterior transpetrosal1 2 (also called “retrolabyrinthine transtentorial”) was performed to obtain a better exposure of the tumor and the surrounding anatomy (floor and walls of the third ventricle, perforating vessels, optic nerves, etc.)3. Nuances of technique and surgical pearls related to the posterior transpetrosal are discussed and illustrated in this operative video, including the posterior mobilization of the transverse–sigmoid sinuses junction, preservation of the venous anatomy during the tentorial incision, identification and preservation of the floor of the third ventricle during tumor resection, and a careful multilayer closure. Conclusion Retrochiasmatic craniopharyngiomas are difficult to reach tumors that often require skull base approaches, either endoscopic endonasal or transcranial. The posterior transpetrosal approach is an important part of the surgical armamentarium to safely resect these complex tumors.The link to the video can be found at: https://youtu.be/2MyGLJ_v1kI.

Background:Gangliogliomas are neoplasms containing both astrocytic and neuronal components. We present a case of gangliogliomas of the optic chiasm, which are extremely rare pathologies.Case Description:A 16-year-old female patient referred to our clinic with gradual deterioration of vision for the age of 1 year mostly in the right eye. Ophthalmic examination confirmed reduced visual acuity with only perception of light in the left eye. Brain magnetic resonance imaging showed a solid mass lesion involving the hypothalamus and the optic chiasm, which was hypointense on T1-weighted images, hyperintense on T2-WI, and marked homogenous contrast enhancement. The patient was operated and bulging of the optic chiasm and the site of lamina terminalis was seen. Subtotal resection of the tumor was achieved. Histopathological examination revealed ganglioglioma (WHO Grade I). Follow-up of the patient was for 3 years and 8 months with stable neurologic and radiologic findings.Conclusion:To the best of our knowledge, 20 cases, including ours, have been reported in the literature and a presurgical diagnosis of ganglioglioma is very infrequent with confused radiologically with low-grade pilocytic astrocytomas.

Pituitary adenomas are the most common tumours of the sellar region. Functional pituitary adenomas are related with immense assorted variety in their endocrine manifestations secondary to hypo or hyperfunction of the pituitary gland and mass impact. They can have a slow but severe impact on vision due to compression of the optic nerves, optic chiasm and cavernous sinus. Hereby, we discuss a case of a 29-year-old female patient who presented to the emergency with an alleged history of chest pain after ingestion of rat poison (zinc phosphide) in an attempt to commit suicide. Autopsy finding revealed a large mass that was present in the pituitary fossa impinging onto the optic chiasma. On further inquiry of the law enforcing agencies, it was found that the patient was undergoing treatment for psychiatric illness, and she had also complained of vision loss for the past few months. The parents of the deceased lodged a case of homicide by the husband. This case demonstrates the psycho-social and forensic implications of a pituitary tumour. The role of collaborative efforts of the autopsy team and the law enforcing agencies are emphasised.

The objective of the present study was to perform histological and stereological examination of alcohol-induced changes in the optic nerve, considered an extension of white matter of the brain, in rats. This study included 20 male Wistar albino rats aged 60 days and weighing 190–220 g. The rats were divided into three groups: ethanol ( n = 7), maltodextrin ( n = 7), and control ( n = 6) groups. The ethanol group was administered ethanol at a dose of 6.4% (v/v) instead of water for 18 days; the maltodextrin group received maltodextrin for the same time period, and the control group was the sham group. At the end of the experiment, a 0.5-mm long section of the optic nerve starting from the optic chiasma was dissected and examined with routine microscopic histological examination methods. The modified Cavalieri method was used for stereological measurement. Total tissue area ratios were calculated with a point grid provided by the Shtereom 1.5 software package. The statistical comparison of the groups revealed that the ethanol group had a significant reduction in the number of axons and sheath area of the optic nerve compared to the control and maltodextrin groups ( p < 0.017, p < 0.022, respectively). These results indicate the toxic effects of ethanol on the optic nerve.

Background The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs. Methods A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n = 14), solid tumor ≥2 cm in size (group B, n = 7), and tumor growth on follow-up MRI (group C, n = 12). The clinical outcomes were analyzed accordingly. Results Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life. Conclusions Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.

Background Brain metastases are one of the main causes of morbidity and mortality of patients with oncological disease. In non-small cell lung carcinoma (NSCLC), the risk of CNS secondary development is 30-50%. An unusual diagnostic and therapeutic problem is the finding of suspicious pituitary lesions. Obtaining a differential diagnosis relies on evaluating the clinical course of the disease (visual disturbances, diabetes insipidus (DI), weakness etc.), and performing endocrinological examinations and imaging analyses (CT, but mainly MRI). Sometimes, however, definitive resolution of the problem requires histological assessment of the tumor. Case report A 65-year-old patient with a newly diagnosed metastatic lung adenocarcinoma was admitted to our department for a first cycle of chemotherapy consisting of cisplatin and navelbine. However, at the beginning of hospitalization, the patient developed qualitative disturbances in consciousness and disorientation. Emergency CT of the CNS revealed a tumor of the pituitary gland, and a subsequent MRI showed intraseller and suprasellar masses making contact with the optic chiasma. An endocrinological examination revealed panhypopituitarism. Pituitary metastasis of NSCLC was confirmed by tumor histology using the trans-sphenoid approach. Conclusion Lung and breast carcinomas are among the most common cancers to metastasize to the pituitary gland. The incidence of pituitary metastases is reported to be 0.4-28.1%. Clinically, they are mostly silent, but may manifest as endocrine disorders, such as DI, hypothyroidism, and hypocorticism, or as visual disturbances due to compression of the optic nerve. Management depends on the establishment of a correct diagnosis. Key words: hypopituitarism - magnetic resonance imaging - pituitary neoplasm - radiosurgery - targeted therapy The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 26. 4. 2018 Accepted: 27. 6. 2018.

Rapidly progressive dementia (RPD) is generally obvious to family member but often difficult for physicians to pinpoint the underlying pathology. Some common causes, such as prion's disease, Alzheimer's disease, central nervous system vasculitis, or infection, might present with disease-specific signs or symptoms where many etiologies do not produce such warning signs. Here, we are presenting a case who attended the psychiatric clinic for decreased motivation to do work, easy fatigability, infrequent falls, recent memory impairment, increased appetite, polydipsia and polyuria, and provisionally diagnosed with RPD. Magnetic resonance imaging revealed solid cystic lesion in suprasellar location involving hypothalamus, optic chiasma, and optic tracts, compressing the floor of the third ventricle suggestive of craniopharyngioma which is one of the very few reports in literature.

Background Pituitary adenomas are one of the most common tumors of adulthood; however, subtypes such as Crooke cell adenoma are relatively rare. Case Description We present the case of a 55-year-old woman who presented with new-onset intermittent headache and dizziness. Clinical and laboratory investigations were not suggestive of corticotroph tumor. However, subsequent computed tomography and magnetic resonance imaging scans revealed the presence of a suprasellar pituitary adenoma displacing the optic chiasma superiorly, with hemorrhage and sellar expansion. The lesion was removed by transsphenoidal surgery and the biopsy confirmed the lesion to be a nonfunctioning pituitary macroadenoma. Further investigation revealed that the specimen demonstrated Crooke hyaline changes, with strong immunoreactivity for adrenocorticotropic hormone. However, initial workup and postoperative testing lacked evidence of Cushing disease. There was no sign of recurrence after 1-year follow-up. Conclusions Clinically silent Crooke cell adenomas are rare occurrences, and as such we report this case with investigation of past cases.

The pituitary or infundibular stalk is an anatomically important structure identified routinely in radiologic imaging for the evaluation of pituitary and suprasellar lesions. The morphometry of the pituitary stalk with 1.5 T MR images was useful in diagnosing the infundibular lesion and to assess the efficacy of treatment given by chemotherapy for many pathological conditions. The normative data for the length, the thickness of the stalk, and the infundibular recess are inadequate in the literature. There are no data regarding the morphometry of the pituitary stalk in the adult population. One hundred and fifty normal brain MR images (75 males and 75 females) were analyzed for the evaluation of stalk and other parameters. Mean and the standard deviation were calculated. The unpaired t test was used to assess any significant difference between age-groups and gender. The intraclass coefficient correlation was used to analyze the inter-observer variability. The mean length of the stalk was 0.55 ± 0.16 mm. There was a significant difference (p

The present investigation aims to give a detailed histomorphological feature of the anterior group of hypothalamus of adult New Zealand rabbits in both sexes. Specimens were prepared to be examined microscopically by using light and transmission electron microscope. The obtained results revealed that, the anterior group of the hypothalamus composed of paraventricular (PVN) and supraoptic nuclei (SON). The paraventricular nucleus was located on either sides of the 3rd ventricle. It consisted of different-shaped neurons which appeared in the form of clusters and irregular groups intermingled with nerve fibers associated with neuroglia cells and permeated by blood capillaries. Ultrastructurally, the neurons appeared polyhedral in shape contained large eccentric euchromatic nucleus and electron lucent cytoplasm contained many mitochondria, rER, Golgi apparatus, numerous ribosomes and some secretory granules. On the other hand, the supraoptic nucleus was located dorsolateral to the optic chiasma and consisted of two portions; thin medial and thick lateral one. The neurons of the thin medial part appeared pyramidal in shape with vesicular oval eccentric nuclei and lightly stained cytoplasm, while that of the thick lateral one showed irregular groups or rows of oval and pyriform shaped cells contained vesicular rounded eccentric nuclei. Ultrastructurally, the neurons of the thick lateral part of SON appeared pyriform in shape with spherical eccentric euchromatic nucleus in electron lucent cytoplasm showed intensive network of rER, many mitochondria, Golgi apparatus, numerous free ribosomes and few secretory granules. The cytoplasmic granules of the PVN and SON neurons gave positive reaction with all nonspecific and specific stains used. Also, they gave positive immunoreactions when subjected to Anti-CGA and Anti-NSE antibodies. There were no microscopic structural differences correlated to neither sex nor age of studied animals.

Ionic regulation is essential for the metabolism and cellular function. For many physiological processes, ionic calcium (Ca(+2)) is important for example muscle contractions, nerve signaling, membrane permeability, cell division and hormone release. In nerve cells, the excess intracellular concentration of Ca(+2) causes cell death. It has been shown that certain calcium binding proteins (CaBPs) are essential for Ca(+2) homeostasis and protect neurons from excess Ca(+2) influx. We are for the first time showing an unusual calretinin (CR) expression and significant differences in its occurrence in the forebrain of the cichlid fish (Cynotilapia sp.) compared to other teleosts. CR labeled neurons were seen in the dorsal and lateral part of the dorsal telencephalic area, entopeduncular nucleus (EN), nucleus preopticus (NPO), diffuse nucleus of lateral torus (NDTL), ventral hypothalamic nucleus (VH), preglomerular nucleus (NPG) and optic tectum. Surprisingly, large numbers of CR immunoreactive perikarya were noted in the optic chiasma (Oc). These neurons were oval with elongated processes and forming a huge fiber network in the Oc. Enormously CR stained fibers were seen in the lateral and medial olfactory tract. Widespread distributions of strongly CR labeled fibers were observed around the EN projecting dorsally into the telencephalon, Oc and optic nerve. Presence of CR in the NPO suggests that it may be involved in the hormonal regulation by the pituitary. As in vertebrates EN plays an important role in sensory functions, massive localization CR in the EN may suggests role of CR in sensory functions of the cichlid fish.

Address for Correspondence: Dr. Ashraf M. E.A. Sakran, Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, P.O. Box: 7607, Makkah, Saudi Arabia. Phone: 00966568841873 or 00249912254379 E-Mail: ashrafsakran@hotmail.com 1,2,3,5,6 Department of Human Anatomy, Faculty of Medicine, Umm al Qura University, Makkah, Saudi Arabia. 4 Department of Public Health, Health Sciences College at Al.leith, Umm al Qura University, Saudi Arabia. 7,8,9,10 Medical students, Faculty of Medicine, Umm al Qura University, Makkah, Saudi Arabia. Background and objective: Precise anatomical knowledge of the sella turcica is important for neurologists and surgeons operating in the region of cavernous sinus or the surrounding structures. The current study was undertaken to record normal morphometric parameters for future reference and to determine if there is any significance difference in the sella turcica morphometry regarding the gender. Methodology: A Morphometric analysis of the Sella Turcica and structures in vicinity were done in thirty six adults’ formalin fixed cadaver’s skulls (22 male and 14 female). Results: The pituitary stalk positions were middle in majority of male cases (72.7%), the remaining 27.3% were posterior. Among female; 57.1% were middle and the remaining 42.9% were posterior, no anterior position was detected among both genders with no different between male and female (p = 0.494) Normal Optic chiasma position was detected in all female cases and in 63.6% of male cases with no significant differences regarding gender (p= 0.070). No significant different in diaphragma sella shape and opening regarding gender (p.value = 0.170 and 0.914 respectively) No significant difference between males and females concerning linear dimensions of sella turcica (length, depth and Anteroposterior diameters). Concerning diaphragma sella opening; no significant different regarding gender in transverse diameter (p.value= 0.316) while significant different was detected in anteroposterior diameter (p.value= 0.046) For interclinoid (anterior, posterior) diameters, which represented statistically significant different regarding gender in both right and left sides (p.value = 0.004 and 0.001 respectively). Conclusion: Present study will providing the normal morphometric data for future reference and further studies.