Abstract：
BACKGROUND:Today, transcranial (TC) approach indications are particularly rare in pituitary adenomas (PA), representing 1.1% of all PA surgeries in our experience. In these rare and selected cases, the complications, advantages, and disadvantages of TC approach were also analyzed. METHODS:Nineteen cases of giant PA (≥40 mm) operated via TC approach alone or combined with transsphenoidal (TS) approach between 2000 and 2016 were selected. RESULTS:The most frequently observed symptom was visual disturbance. Most PA (79%) were non-secreting. Only one tumor was aggressive. Maximal diameter average was 51.5 mm. Tumor removal was total, subtotal and partial in respectively 21%, 68.5%, and 10.5% of cases. Mean follow-up was 57 months. No recurrence was observed after total tumor removal. Visual improvement was observed in 53% of patients. Visual impairment rate was 21% after TC approach. New cases of panhypopituitarism were reported in 26.5% of patients in the TC approach. Total (including definitive and transient) postoperative diabetes insipidus occurred in 42% of patients in the TC approach. Ischemic and hemorrhagic complications were observed in 16% and 10.5% of patients, respectively, in the TC approach. Preoperative neurocognitive disturbance was identified in 31.5% of patients and only 16.5% of them showed postoperative improvement. Neurocognitive examination showed impaired results in 7.5% of patients with normal preoperative examination. CONCLUSIONS:TC approach remains a requirement in giant and invasive PAs non-accessible via TS approach. However, the high morbidity associated with TC approach, including ischemic complications and visual impairment, has to be balanced with patient preoperative symptoms, and benign features of the tumor.
journal_name
J Neurosurg Scijournal_title
Journal of neurosurgical sciencesauthors
Graillon T,Castinetti F,Fuentes S,Gras R,Brue T,Dufour Hdoi
10.23736/S0390-5616.16.03889-3subject
Has Abstractpub_date
2020-02-01 00:00:00pages
25-36issue
1eissn
0390-5616issn
1827-1855pii
S0390-5616.16.03889-3journal_volume
64pub_type
杂志文章abstract：:Substantia nigra (SN) hyperechogenicity has been proved to be a characteristic finding for idiopathic Parkinson's disease (PD), occurring in more than 90% of the patients. This echofeature is owed to increased amounts of iron in the SN region and reflects a functional impairment of the nigrostriatal dopaminergic syste...
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abstract：:Subependymoma was first described by Scheinker in 1945; it frequently occurs in the ventricles and rarely in the spinal canal representing 0.7% of all central nervous system tumours. Most of these intraventricular tumours are subclinical entities, remaining of small size and discovered at autopsy with 0.4%incidence. W...
journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
pub_type： 杂志文章,评审
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abstract：:Hyponatremia is a frequent occurrence after pituitary surgery, having been described in 9% to 35% of the patients. It is produced by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or, more frequently, by the cerebral salt-wasting syndrome (CSWS). The clinical presentation of both syndromes is ...
journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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abstract：:Occurrence of internal carotid artery injuries associated with skull base fracture has been reported. A. report a case of fatal intracranial carotid dissection related to petrous fracture involving the carotid canal. Identification of carotid lesions may be difficult and generally related to appearance of unexpected n...
journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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pub_type： 临床试验,杂志文章
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journal_title：Journal of neurosurgical sciences
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更新日期：1994-12-01 00:00:00
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journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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doi：
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journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
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journal_title：Journal of neurosurgical sciences
pub_type： 杂志文章
doi：
更新日期：1988-01-01 00:00:00
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journal_title：Journal of neurosurgical sciences
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更新日期：1987-07-01 00:00:00
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journal_title：Journal of neurosurgical sciences
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更新日期：1987-10-01 00:00:00
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journal_title：Journal of neurosurgical sciences
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