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Apart from the radiologic features regarding size and invasiveness, we had noticed some differences in morphology among types of pituitary adenomas. We conducted this study to verify the differences in radiologic morphology between growth hormone producing pituitary adenomas (GHoma) and nonfunctioning pituitary adenomas (NFoma). Pre-surgical magnetic resonance images (MRIs) were assessed in 50 cases of GHoma and 50 cases of NFoma. Geometric parameters on MRI were set in accordance with sellar anatomy. Intensity of T1-weighted image was not different between the two groups, but hypo-intensity of T2-weighted image was more frequently seen in GHoma. Predominant inferior extension of tumor was seen mostly in GHoma (88 vs. 38 %). Extension of the tumor to the superior compartment of cavernous sinus was more frequent in NFoma. Pituitary gland was generally located superior to GHoma and postero-superior to NFoma. Growth characteristics of pituitary adenoma were confirmed to differ between GHoma and NFoma. [ABSTRACT FROM AUTHOR]

Conclusions: The endoscopic endonasal transsphenoidal approach can be a choice for sellar tumors beyond the sellar turcica, but it is necessary to make the choice carefully because of the severe surgical risks. Objectives: To summarize our experience of removal of sellar tumors beyond the sellar turcica via the endoscopic endonasal transsphenoidal approach and to evaluate the surgical efficacy and complications. Methods: Between January 2007 and January 2012, 30 patients with sellar tumors beyond the sellar turcica underwent surgery using the endoscopic endonasal transsphenoidal approach. Results: Postoperative pathological examination demonstrated that pituitary adenoma occurred in 22 patients, craniopharyngioma in 5, and meningioma in 3. Total removal was achieved in 21 patients (70.0%) and subtotal removal was achieved in 8 patients (26.7%). After the surgery, cerebrospinal fluid leakage occurred in 3 patients, temporary diabetes insipidus occurred in 25 patients and persistent diabetes insipidus in 4 patients, intracranial infection occurred in 1 patient, frontal subdural effusion occurred in 1 patient, sinusitis occurred in 2 patients, epistaxis occurred in 3 patients, and 1 patient with a huge pituitary adenoma died of hypothalamic failure related to the operation. [ABSTRACT FROM AUTHOR]

Objectives: Pituitary adenoma represents the most frequent tumour encountered in the sellar region. We have proposed to review the principles of diagnosis and treatments and to analyze their standard protocol of approaching pituitary lesions. Material and method: We have retrospectively analyzed the cases of pituitary adenoma between Jan 2006 and Dec 2010, we studied presenting symptoms, hormonal status, local extension, surgical approach, tumor histology, type of resection, tumor volume, cavernous sinus invasion, surgical corridors, recurrence rate, intra operative and postoperative complications Results: 72 patients were included in the study, with no significant difference between sexes, the pathology was dominated by pituitary macro adenomas in 47 cases, regarding the hormonal status 51.3% were non secreting pituitary adenomas, the rate of operability in our series was 65.2%, the surgical indication has been given mainly by the hormonal status and involvement of the optic apparatus which in our series was 51%, the invasion of the cavernous sinus has been appreciated according the Knosp criteria (7) and grade 3 and 4 was present in 44% of the cases. The most used surgical approach was the pterional approach in 83% and the remaining 17% by the transsphenoidal approach. The most frequent surgical corridor was represented by the prechiasmatic route in 54%, gross total resection was achieved in 51%. The most frequent postoperative complication encountered in our series was represented from systemic complication the meningitis 13%, as for endocrine complication it was represented by transitory diabetes insipidus in 23.4% and SIADH in 4.2% (2 cases). The follow up at 3 months showed no cases of early recurrence, from the group of patient with STR 6 were sent to radiotherapy. The follow up at 1 year has comprised 3 deaths, 3 cases of hydrocephalus treated with ventriculoperitoneal derivation, 19 cases were with no imagistic or clinical symptoms of tumour and 22 presented with imagistic evidence of stable residual tumour with no clinical symptoms. Conclusions: The main surgical indication in pituitary adenomas is represented by the secreting hormonal status of the patient (excepting prolactin secreting tumours) and the impairment of the vision. The most frequent surgical approach was represented by the transcranial (pterional) approach due to the large dimensions and invasiveness of the tumours presented in our series but also the surgical team preference (in the absence of intracranial endoscopy at those times).

Extraventricular neurocytoma (EVN) is a rare tumor that mainly occurs in the cerebral hemispheres and spinal cord. Sellar neurocytoma is extremely rare, with only two previously reported cases. We report a sellar EVN in a 48-year-old man presenting with visual impairment. This tumor was partially resected. The residual tumor disappeared on MRI with adjuvant radiotherapy. However, 2 years later the tumor recurred with craniospinal dissemination, which is also very rare, with only four previously reported cases. The recurrent tumor showed atypical features with an MIB-1 LI score of 3 %. It is suggested that postoperative adjuvant radiation therapy with long-term follow-up is required for incompletely resected EVN. [ABSTRACT FROM AUTHOR]

Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region. [ABSTRACT FROM AUTHOR]

Objectives: The endoscopic endonasal approach (EEA) is widely used in the treatment of cranial base tumors. Skull base reconstruction is a crucial part of EEA, which has a great impact on patients' prognosis. In this study, we report our experience with sellar dural suturing in cranial base reconstruction and retrospectively analyze its effect., Methods: The clinical data of 134 patients who suffered intraoperative CSF leakage and underwent EEA surgery in the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University from October 2018 to November 2020 were retrospectively collected and analyzed. According to whether sellar dural suturing was performed during the operation, they were divided into a suture group (55 cases) and a control group (79 cases)., Results: The results showed that dural suturing of the sellar floor effectively reduced the postoperative hospitalization duration ( p  = 0.026) and the use rates of lumbar drainage ( p  = 0.047), autologous fat transplantation ( p  = 0.038), and pedicled nasoseptal flaps ( p  = 0.026)., Conclusion: Sellar dural suturing under endoscopy is a promising and effective method for cranial base reconstruction in EEA surgery and is worthy of clinical application., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Liu, Zhao, Wang, Dai, Lu and Zhao.)

Abstract: Repeat trans-sphenoidal surgery for pituitary adenomas is fraught with the risk of injury to the internal carotid artery that can occur either while incising scar tissue in the sphenoid sinus/sella or during tumour decompression. The ensuing complications can be devastating and difficult to manage within the limited confines of the bony sella and sphenoid sinus, and more so when the local anatomy is distorted by previous surgery. This article highlights complications involved in repeat trans-sphenoidal pituitary surgery and outlines the role of image-guided surgery in avoiding them. With the use of modalities like Doppler sonography and neuronavigation, the position of the ICA can be determined accurately in all cases. [Copyright &y& Elsevier]

Objective: The computerized freezing milling technique is derived from the virtual human project. It has been widely used in three-dimensional (3D) reconstruction of the human body and organs. With this technique, the study was undertaken to explore the 3D features and adjacent anatomic relationships of the sellar region for skull base surgery. Methods: Continuous thin sections on the coronary plane were performed with the computerized freezing milling technique using a human head specimen. The related structures were described in six sections. After segmenting, labeling, and extracting in serial sections, the 3D reconstruction of the sellar region was finished with Amira 4.1 software. Results: A total of 390 thin coronary sections were obtained. In six sections, the anatomic relationships of the pituitary gland, carotid artery, sphenoid sinus, and nerves are displayed. Three-dimensional images of the sellar region are video films that continuously and dynamically display anatomic structures in 3D space at different velocities. It can show that the cavernous segment of the internal carotid artery is located anterolateral to the sphenoid sinus and lateral to the pituitary gland. The optic nerve protrudes into the superolateral portion of the sphenoid sinus. Conclusions: The combination of coronary sectional anatomy and 3D reconstruction can display the anatomic characteristics of the sellar region. The 3D models are video films that continuously and dynamically display anatomic structures in 3D space at different velocities. [Copyright &y& Elsevier]

Background: Various approaches to lesions in the anterior cranial fossa and sellar region have been described by different authors under various names which describe the extent of craniotomies. The aims of this study were to describe and retrospectively analyze and evaluate the anterolateral mini fronto-orbito-zygomatic (MFOZ) approach via an eyebrow incision in treating pediatric pathologies, especially those related to the sellar region. Method: Between January 2003 and December 2008, 18 patients with lesions in the sellar region or the anterior corridor leading to it were operated upon via the same approach. There were 10 males and 8 females. The age ranged between 11 months and 15 years (mean 7.9 years). The pathologies were craniopharyngiomas in 6 cases, hypothalamic and chiasmal pilocytic astrocytoma in 7 and 5 miscellaneous cases including 2 pituitary adenomas, 1 extradural hematoma, hypothalamic hamartoma and 1 arachnoid cyst in the retrosellar and prepontine area. Surgery was performed from the right side in 15 cases and from the left in 3 cases. Results: Total resection was achieved in 9 cases (50%), subtotal resection in 4 cases (22%), and partial resection in 5 cases (28%). Complications related to the approach like CSF rhinorrhea, supraorbital hypoesthesia and loss of upward elevation of the eyebrow were temporary. There was no mortality in this study and no significant added morbidities related to the approach. The approach has the advantages of the small cosmetic eyebrow incision and the skull base trajectory, thus reducing brain retraction and achieving the desired exposure with good outcome. Conclusion: The MFOZ craniotomy using an eyebrow incision in pediatric patients is safe, effective, and both suitable and convenient for treating lesions especially at the sellar region. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: In the past, sporadic demonstrations of the existence of a subarachnoid subdiaphragmatic cistern have been published. The aim of this study was to evaluate the anatomical characteristics of the subdiaphragmatic cistern of the pituitary gland. Methods: After a complete review of the literature published on the topic, we report anatomical observations of the subdiaphragmatic cistern and its relationship to the pituitary gland and to the chiasmatic cistern. Ten cadaveric heads were studied using different techniques and surgical methods (plastination, plastic casts of the subarachnoid spaces, microscopic and transsphenoidal endoscopic approaches). Moreover, 3-T magnetic resonance images of ten healthy volunteers were analyzed to investigate the presence and anatomical variability of the subdiaphragmatic cistern. Results: By means of our qualitative radioanatomic study, we found that the roof of the subdiaphragmatic cistern is formed by the diaphragma sellae, the floor by the superior face of the pituitary gland, the lateral walls by the arachnoidea extending laterally through the medial walls of the cavernous sinus, and the medial walls by the infundibular stem. The subdiaphragmatic cistern communicates by means of the ostium of the diaphragm with the chiasmatic cistern. Conclusion: We confirmed the existence of the subdiaphragmatic cistern. The overused term 'suprasellar cistern' refers more to a complex of cisterns, formed by the subdiaphragmatic cistern, below the diaphragma sella, and by the chiasmatic cistern, above it, in direct communication with the lamina terminalis and carotid cisterns. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary pituitary lymphoma in immunocompetent patients is an exceedingly rare clinical entity. We report the case of a 41-year-old woman with initial polydipsia and polyuria. When laboratory evaluation revealed panhypopituitarism, a pituitary enhanced MRI was performed and was suggestive of a pituitary adenoma. Obstructive hydrocephalus provoked by enlarged sellar mass was also demonstrated during observation, and a shunt procedure following lesion resection was carried out. Histopathological examination and immunophenotyping verified diffuse large B-cell non-Hodgkin's lymphoma. No systemic disease was found on staging of the patient. We will also review the clinical, radiological features and outcomes of 28 cases that have been reported since 1993. [ABSTRACT FROM AUTHOR]

The endoscopic expanded endonasal approach (EEA) has been reported in literature as a useful tool to treat sellar, parasellar, suprasellar, and clival lesions. The endoscope permits a panoramic view rather than a narrow microscopic view, and this approach can reach the lesion without brain retraction and with minimal neurovascular manipulation. However, because of the narrow corridor, the preoperative evaluation of the lesions should be of high priority. 3D fast-imaging employing steady-state acquisition (3D-FIESTA) or constructive interference in steady state (CISS) MR imaging provides high spatial resolution in the small structures within the cisterns. Therefore, this technique may be useful for better preoperative planning in detecting optic nerve, oculomotor nerve, chiasma, infundibulum, pituitary stalk, and small vessels in sellar region. Here we used the 3D-FIESTA MR images to evaluate EEA for seven midline skull-base lesions. Our report showed that, when EEA was used to treat midline skull-base lesions, 3D-FIESTA MR images were valuable in the assessment of vital structures in and around the tumor-involved midline skull-base region. 3D-FIESTA MR images can help in making a better preoperative planning, locating the intraoperative structures, and reducing the surgical risks. Otherwise, this approach is helpful for the craniopharyngioma classification based on EEA. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Endoscopic endonasal transsphenoidal surgery (EETS) is still rarely used in pediatric subjects compared with adults. Reports on EETS in children appeared only recently in the literature, usually regarding small series. The aim of the study is to assess the actual role and the limits of EETS in children with sellar tumors by reporting a two-centers experience. Methods: Twenty-seven children (mean age: 12.2 years) were operated on during the last decade. Seventeen patients harbored a sellar mass, 7 a suprasellar tumor, and 3 a clival mass. Laboratory investigations revealed hypopituitarism in 6 children and hormone hypersecretion in 9. All the operations were carried out by a team including both ENT surgeon and neurosurgeon using a dedicated 18-cm long rigid endoscope (2.7mm and 4mm diameter) through the direct paraseptal or the transethmoidal or the transpterygoid route. Results: Overall, 29 operations were performed. Gross total tumor resection was obtained in 22 children (81.5%) while a subtotal and a partial removal in 2 (7.5%) and 3 cases (11%), respectively. Pituitary adenoma was the most common histotype (12 cases), followed by craniopharyngioma (5) and Rathke''s cleft cyst (4). No surgical mortality or neurological morbidity or late nasal complications were observed. Postoperative CSF fistula occurred in 3 patients. All children are alive at current follow-up (average: 8.6 years). Preoperative hypopituitarism disappeared or improved in 4 cases and was stable in the remaining 2 (no new hormone deficits appeared). Conclusion: EETS is a safe and effective surgical option also in children. As for adults, it allows to manage most of the tumor lesions of the sellar region with stable long-term results. [Copyright &y& Elsevier]

The purpose of this study was to explore the anatomical complexity and adjacent relationships of the sellar region in thin continuous sections so as to provide intimate morphological data for imaging diagnosis and surgical operations of the diseases in this region. After CT and MR examination verifying no brain lesions, one normal cadaver head was selected for this study from four Chinese adult male cadavers. After being embedded and frozen, the head was sliced into serial sections at 0.1 mm intervals in the transverse plane with SKC 500 computerized freezing milling machine. Then the serial transverse sections were photographed by a high-resolution digital camera and saved in the computer. Subsequently, the anatomic structures of the sellar region on the thin transverse sections were investigated and correlated with the MR images of the specimen as well as in vivo MR images, which were obtained from 20 normal Chinese male adult volunteers by a 3.0 T GE MR scanner. The base lines of the sectioning and the MR scan were all parallel to the AC-PC line. A total of 320 transverse sections and 10–12 transverse MR images related with the sellar region were obtained, respectively. We investigated the sectional anatomy of the sellar region and divided it into three parts: supra hypophysial area, hypophysial area and infra hypophysial area. The cavernous sinus was a venous passage full of blood and it could be divided into four interspaces according to its position relation with the internal carotid artery. The third, fourth, sixth cranial nerves and trigeminal branches ophthalmic nerve, maxillary nerve displayed from the anterior to the posterior in the lateral wall of cavernous sinus in transverse planes. Comparing continuous thin sections with MR images offers a better understanding of the complex anatomical structures and provides practical submillimeter anatomical data for imaging diagnosis and clinical treatment in this region. [ABSTRACT FROM AUTHOR]

Abstract: Lymphomas can occur throughout the body, but are relatively rare in the sphenoid region. The clinical presentations are atypical, ranging from nasal symptoms, pituitary hormone dysfunction and neurological impairment. We report a 63-year-old female patient who suffered nasal discharge, retro-ocular pain and left lateral gaze palsy for 3 months. Cranial MRI revealed sellar and suprasellar lesions involving the clivus, cavernous sinus and sphenoid sinus. The patient was treated for chronic sphenoid sinusitis. Histopathological review for possible misdiagnosis was arranged owing to treatment failure 1 month later. The final diagnosis was primary large B-cell lymphoma, which was confirmed by immunohistochemical study and systemic survey. The symptoms of sellar lymphoma resemble those of chronic sphenoid sinusitis. MRI and hematoxylin and eosin histological examination can accurately diagnose most cases. Immunohistochemistry assay is recommended in equivocal cases and provides a more detailed tumor classification. [Copyright &y& Elsevier]

Only single examples of lymphoma associated with pituitary adenoma have been reported. In our patient, a precursor T-lymphoblastic lymphoma developed within a recurrent pituitary adenoma 17 years after the first resection. Histomorphologically, lymphoma and adenoma components were tightly admixed. The features harbour remarkable similarity to the previous report by Kuhn et al. [5]. In both patients the lymphomas were composed of T-cells, there was no evidence of further sites involved, and both adenomas expressed follicle-stimulating hormone. The hormone may have posed a proliferative and transforming effect on lymphatic cells and could have played a crucial role in “lymphomagenesis” as an exceptional phenomenon. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the effectiveness of the supraorbital "keyhole" approach with endoscope assistance in surgical treatment of benign tumors around the sellar region. Thirty-five patients, including 19 pituitary tumors, 11 craniopharyngiomas and five tuberculum sellae meningiomas, were enrolled in this study. The tumors were resected through an endoscope-assisted supraorbital keyhole approach via a small skin incision within the eyebrow. Complete removal of the sellar region tumors was achieved in all 35 cases by endoscope-assisted supraorbital keyhole approach. Mean length of hospital stay after surgery was 10.2 days (range 5 - 17). There was no patient with evidence of residual or recurrent tumor during the follow-up period. There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery. Though some patients suffered from insipidus, hyperprolactinemia, subcutaneous edema or other postoperative complications, they eventually recovered with or without drug administration. The supraorbital "keyhole" approach with endoscopic assistance in the surgical treatment of benign tumors around the sellar region is an ideal pattern. [ABSTRACT FROM AUTHOR]

Abstract: Background: The interest in endoscopic endonasal transsphenoidal surgery for the treatment of sellar and perisellar lesions is growing as a consequence of the results achieved in the past 10 years and of the interest by patients, endocrinologists, and neurosurgeons. Furthermore, the special ability of the endoscope to offer a wider and detailed view of anatomic structures is a major advantage that increases the attention of neurosurgeons who seek less invasive procedures and better results. Most neurosurgeons performing transsphenoidal surgery, however, are not used to endoscopy, and changing from microsurgical to endoscopic technique can be difficult and even discouraging, often because of difficulties in the initial phase of the procedure. Technique: With the purpose of helping minimize some of the difficulties, we describe herein useful tips and tricks that mainly concern familiarization with the endoscopic equipment, details of the transsphenoidal anatomy, and endoscopic skills. We stress the steps and details that we judge most important. Conclusion: We believe that by following these recommendations neurosurgeons can overcome, or even avoid, the difficulties frequently encountered transsphenoidal surgery, allowing them to safely and efficiently perform endonasal transsphenoidal endoscopic procedures. [Copyright &y& Elsevier]

Neoplasms of the sellar region are entities with a large differential diagnosis. Although paraganglionic cells have not been demonstrated in the pituitary or adjacent structures, the existence of sellar region paragangliomas is well-documented. To elucidate, in this area the nature of these unusual tumors is relatively difficult. Clinical history, physical examination, radiographic investigation as well as intraoperative gross observation are the same as those of sellar meningioma or pituitary adenoma. Immunohistochemistry, using neuroendocrine markers and electron microscopy are the two definitive diagnostic methods to differentiate among these entities. The clinical management, the possible pathogenesis of the tumor, the importance of immunohistochemistry in making the diagnosis and the clinical outcome of these patients are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of study is to examine correlations between the morphometric characteristics of the anatomical structures of the sellar region. Methods: Ethic approval was obtained from Gaziantep University Clinical Research Ethics Committee (decision no: 2020/377). Cone-beam computed tomography images of 50 adults (mean age: 38.44±13.08, 25 males, 25 females) in Gaziantep University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology were analyzed retrospectively with the Planmeca Romexis Viewer program. In the study, the basal angle of the skull base, the interoptic distance, and the sulcal angle and length were measured. In addition, the optic canal angle was measured on the sagittal and axial plane. Using Pearson correlation tests, direction of relationship between parameters identified. Statistical analyses were performed with SPSS for Windows version 22.0 package program and p<0.05 was considered statistically significant. Results: The mean sulcal angle and length were measured as 35.15±6.48° and 6.75±1.65 mm, respectively. The mean angle of the optic canal was 11.35±1.63° in the sagittal plane and 40.32±5.02° in the axial plane. The mean basal angle and interoptic distance were measured as 128.75±4.94° and 15.73±3.39 mm, respectively. A weak positive correlation was found between the angle of the optic canal in the axial plane and the interoptic distance (r=0.305, p=0.031), the sulcal length (r=0.316, p=0.025), and the basal angle (r=0.356, p=0.011). In addition, a strong negative correlation was found between the sulcal angle and the basal angle (r=0.376, p=0.007). Conclusion: Our data set examining the relationship between sellar region structures, may be useful for understanding the complex anatomy of the region. [ABSTRACT FROM AUTHOR]

La región selar es sitio de asiento de lesiones diversas; las tumorales son las más comunes. Entre ellas, los adenomas hipofisarios constituyen el tercer tipo de tumor primario más frecuente en el sistema nervioso central. Los abordajes quirúrgicos empleados para su solución son transcraneales y transesfenoidales. Analizamos aquí los resultados de la cirugía selar durante los últimos 8 años en el hospital "Hermanos Ameijeiras", a través de variables como abordaje, tipos de lesión, características imagenológicas y endocrinológicas, evolución posoperatoria, mortalidad y complicaciones. Se intervinieron 273 lesiones (18 transcraneales y 255 transesfenoidales), 222 adenomas (150 funcionantes y 72 no funcionantes), 27 Aracnoidoceles, 13 fístulas de líquido cefalorraquídeo y otras 11 lesiones tumorales. Los adenomas no funcionantes fueron 70 macroadenomas y 2 microadenomas, y los funcionantes 84 macroadenomas y 66 microadenomas. El control fue siempre superior en los microadenomas. Se resolvieron el 53,8 % de las fístulas. En pacientes con silla turca vacía, mejoró el defecto campimétrico en el 69,2 % y se resolvió la fístula en el 71,4. La evaluación por imágenes en el posoperatorio del resto de las lesiones arrojó que de 6 craneofaringiomas, en 5 predominantemente quísticos se logró exéresis total y en uno parcial. El resto de las lesiones se resecaron totalmente. La morbilidad operatoria fue 18,31 % en toda la serie, notablemente inferior en los abordajes transesfenoidales; la mortalidad, solo presente entre los abordajes transcraneales, representó el 0,73. Los resultados en este estudio avalan los abordajes transesfenoidales, como métodos más útiles y confiables para tratar lesiones selares.The tumoral injuries are the most common of the diverse injuries appearing in the sellar region. Among them, the hypophyseal adenomas are the third type of the most frequent primary tumor in the central nervous system. The surgical approaches used for their solution are transcranial and transsphenoidal. We analized the results of sellar surgery during the last 8 years at "Hermanos Ameijeiras" Hospital through variables such as approach, type of injury, imaging and endocrinological characteristics, postoperative evolution, mortality and complications. 273 injuries were operated on (18 transcranial and 255 transphenoidal), 222 adenomas (150 functioning and 72 nonfunctioning), 27 arachnoidoceles, 13 fistulas of cerebrospinal fluid and other 11 tumoral injuries. The nonofunctioning adenomas were 70 macroadenomas and 2 microadenomas, whereas the functioning were 84 macroadenomas and 66 microadenomas. The control was always higher in microadenomas. 53,8 % of the fistulas were resolved. In patients with empty sella, the campimetric defect improved in 69,2 % and fistula was solved in 71,4 %. The evaluation by images in the postoperative of the rest of the injuries showed that of 6 craniopharyngiomas, total exeresis was attained in 5 predominantly cystic, and partial exeresis in one. The rest of the injuries were totally resected. Operative morbidity was 18,31 % in the whole series. It was significantly lower in the transsphenoidal approaches. Mortality was only present in transcranial approaches and it accounted for 0.73. The results in this study show that the transsphenoidal approaches are useful and reliable methods to treat sellar injuries.

Abstract: We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed. [Copyright &y& Elsevier]