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Background: Pituitary adenomas and nonadenomatous lesions in the sellar region may be difficult to distinguish by imaging yet that distinction is critical in guiding management. The nature of the diagnostic errors in this setting has not been well documented., Methods: Two neurosurgeons and 2 neuroradiologists of differing experience levels viewed deidentified MRIs of 18 nonadenomatous sellar lesions and 21 adenomas. They recorded their diagnoses, the imaging features they used to make those diagnoses, and their confidence in making those diagnoses., Results: Among the 18 nonadenoma cases, 11 (61%) were incorrectly diagnosed as adenoma by at least 1 reader, including Rathke cleft cyst, plasmacytoma, aneurysm, craniopharyngioma, chordoma, Langerhans cell histiocytosis, metastasis, and undifferentiated sinonasal carcinoma. Among the 21 adenoma cases, 8 (38%) were incorrectly diagnosed by at least 1 reader as craniopharyngioma, Rathke cleft cyst, sinonasal carcinoma, hemangioblastoma, and pituitary hyperplasia. Incorrect imaging diagnoses were made with high confidence in 13% of readings. Avoidable errors among the nonadenomatous cases occurred when readers failed to appreciate that the lesion was separate from the pituitary gland. Unavoidable errors in those cases occurred when the lesions were so large that the pituitary gland had been obliterated or the imaging features of a nonadenomatous lesion resembled those of a cystic pituitary adenoma. Avoidable errors in misdiagnosis of adenomas as nonadenomas occurred when readers failed to appreciate features highly characteristic of adenomas. An unavoidable error occurred because a cystic adenoma had features correctly associated with craniopharyngioma., Conclusions: Errors in imaging differentiation of pituitary adenoma from nonadenomatous lesions occurred often and sometimes with high confidence among a small sample of neurosurgeons and neuroradiologists. In the misdiagnosis of nonadenomatous lesions as adenomas, errors occurred largely from failure to appreciate a separate pituitary gland, but unavoidable errors occurred when large lesions had obliterated this distinguishing feature. In the misdiagnosis of adenomas as nonadenomatous lesions, avoidable errors occurred because readers failed to recognize imaging features more characteristic of adenomas and because cystic adenomas share features with craniopharyngiomas and Rathke cleft cysts. Awareness of these errors should lead to improved management of sellar lesions., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by North American Neuro-Ophthalmology Society.)

Study Design: Technical case report., Objective: To report an alternative to suture for dual closure in minimally invasive spinal surgery., Summary of Background Data: Dural closure in minimally invasive spinal intradural tumor resection can be technically challenging. The U-clip is a novel self-closing device that was originally designed to facilitate coronary arterial anastomosis by obviating the need for suture management and knot tying. Given its ability to achieve tissue approximation without knot tying, the U-clip is ideal for dural closure in the narrow surgical corridors provided by the retractors used in minimally invasive procedures., Methods: We report the results of 2 cases in which the U-clip device was used for dural closure after minimally invasive spinal resection of an intradural mass., Results: Two patients presented with spinal intradural tumors. Patient 1 presented with severe upper back pain and was found to have an intradural extramedullary mass at T2 causing severe spinal cord compression. Patient 2 was incidentally found to have an intradural mass causing significant compression of the cauda equina at L2-3. Both patients underwent minimally invasive tumor resection using an expandable tubular retraction system. Dural closure was accomplished using the U-clip device in conjunction with Tisseal. Postoperatively, both patients were mobilized early and neither developed symptoms related to cerebrospinal fluid leakage., Conclusions: Successful dural closure can be achieved using the U-clip device, thereby eliminating the difficulty associated with suture management and knot tying during minimally invasive spinal procedures.