Preoperative Workup

Sagittal Mri Hypothalamus Germinal Tumor

Once the need for surgery has been determined the minimum surgical workup for every patient includes the following. 1. First, the surgeon and the endocrinologist must be sure of an accurate endocrine diagnosis before proceeding with surgery. In cases of hormone excess, it is essential to have adequate evidence of a pituitary source. It should not be assumed that all referring physicians will have completed the appropriate tests before referral. Aside from the risks to the patient of unnecessary...

Empty Sella Syndrome

The term empty sella refers to the anatomic state occurring as the result of intrasellar herniation of the subarachnoid space through an incompetent and enlarged diaphragma sellae. The result is a compressed and posteriorly displaced pituitary gland housed within an enlarged and demineralized sella. These features lend a seemingly empty appearance to the sella, both grossly and radio-graphically. It is of clinical, pathophysiologic, and occasionally therapeutic importance to distinguish those...

Diagnosis of Cushings Syndrome

Cushing Algorithm

Determination of 24-h UFC excretion is the best screening test available for documentation of endogenous hypercortisolism 52,53 . Values consistently in excess of200 g d 550 nmol are virtually diagnostic of CS Fig. 2 . Medications or synthetic steroids other than cortisol do not interfere with the performance of high-performance liquid chromatography HPLC in measuring urinary cortisol. Assuming complete collections have been performed, there are virtually no false-negative results. In patients...

Complications of the Transsphenoidal Approach

Mri Scan Aneurysm

The transsphenoidal approach is safe and has a low complication rate. In fact, it is one of the safest procedures in contemporary neurosurgical practice. As determined by several retrospective cumulative series, operative mortality and major morbidity rates are 0.5 and 2.2 , respectively 6 . In one of the most recent series of transsphenoidal surgeries performed for CD during the current decade, mortality and permanent morbidity rates were 0.9 and 1.8 , respectively 7 . Operative deaths, though...

Diagnostic Investigations

The causes of hyperprolactinemia can be divided simply into physiologic, pharmacologic, and pathologic Table 2 . The normal PRL range for nonpregnant women is lt 500 mU L 20 g L and for men lt 300 mU L 12 g L . Pregnancy is the most common cause of hyperprolactinemic amenorrhea, and serum PRL concentrations may rise as high as 8000 mU L 320 g L during the third trimester. Normal lactation is also associated with quite marked elevation of serum PRL. As predicted from the physiologic dopaminergic...

Preoperative Assessment Pituitary Adenoma Surgery

Anesthesia for surgery, 120, 122 dopamine agonists, 46, 184 Gamma Knife radiosurgery, 223-225, 227, 228 goals, 49 pegvisomant, 47 postoperative evaluation, 45 postoperative management following tumor removal, 182-184 radiation therapy, 47, 48, 184, 211, 212 repeat surgery, 183 somatostatin analogs, 46, 47, 184 transsphenoidal surgery, 44, 45 ACTH, see Adrenocorticotropic hormone Adrenalectomy, Cushing's syndrome management, 67, 68 Nelson's syndrome after bilateral adrenalectomy, 68, 69...

Dermoid Tumor Cyst

Suprasellar Cystic Tumor

Occurring with one tenth the frequency of epidermoid cysts, dermoid cysts are rare. Given their affinity for midline intracranial sites, their occasional occurrence in the sellar and parasellar regions is well recognized, although published Fig. 5. Massive suprasellar and sellar epidermoid presenting with epilepsy and irregular menses. Axial CT A and sagittal unenhanced T1 MRI B, facing . Fig. 5. Massive suprasellar and sellar epidermoid presenting with epilepsy and irregular menses. Axial CT A...

Procedure

Anterior Nasal Septum

The procedure is performed under general anesthesia, with the patient placed in a semirecumbent position Fig. 2A . Some surgeons prefer to operate from the head of the table, with the patient's head in extension, facing toward the patient's feet Fig. 2B . Because pituitary reserve for the pituitary-adrenal axis may be impaired, it is customary to administer a regimen of stress dose exogenous corticosteroids both during surgery and in the immediate postoperative period. The indications for this...