• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1204-1208
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• 2000

Objectives : At the closure of the transsphenoidal approach(TSA), the proper sellar floor reconstruction plays an important role in preventing postoperative complications. The septal cartilage, perpendicular plate of nasal septum, and the sphenoid sinus bone are usually used to repair the sellar floor as a bone splint. The authors evaluate the usefulness of a silicone plate as a substitute for bone splint to close a defect of the sellar floor. Materials and Methods : A silicone plate was used to repair the sellar floor in 7 patients with sellar lesions which included four pituitary adenomas, two Rathke's cleft cysts and one metastatic tumor. Among seven cases, five cases underwent a standard TSAs and two received a extended TSAs. The trajectories of the approach were sublabial in four cases and endonasal routes in three cases. The silicone plate for implantation was cut to a size of slightly larger than that of bone window and inserted with a three-pronged fork, and then adjusted precisely. Results : In six patients, there were no complications which related to sellar floor reconstruction. A postoperative cerebrospinal fluid(CSF) rhinorrhea was observed in one patient with pituitary macroadenoma. Conclusions : From the authors' experience, the advantages of the silicone plate are its simplicity of molding to fit any size of sellar floor defects, and easy detection of previously created bone window at reoperation.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.425-428
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• 2007

Hemangiopericytoma [HPC] is a rare tumor with uncommon location in the central nervous system. We report a rare case of sellar and suprasellar HPC mimicking pituitary adenoma in a patient initially seen with the symptoms of bitemporal hemianopsia, headache, and panhypopituitarism. Magnetic resonance imaging of the brain revealed a contrast-enhancing soft tissue mass arising from the pituitary fossa, with apparent compression of the chiasm and involving the cavernous sinus. Subtotal resection of the tumor was achieved via a pterional approach. Histopathological examination identified the tumor as a HPC. Nine years later, the tumor recurred. To our knowledge, this is the first reported case of sellar and suprasellar HPC in Korea.

• Journal of Korean Neurosurgical Society
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• v.53 no.4
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• pp.218-222
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• 2013

Objective : To clarify the anatomical correlations of the sphenoid sinus with surrounding structures in the normal Korean population, and to identify surgical landmarks for safe sellar floor dissection in the anterior skull base by endoscopy and microscopy. Methods : We reviewed the 196 brain magnetic resonance imaging findings showing a normal appearance, and measured the distances between anatomical landmarks. Results : The mean distances from the base of the columella to the anterior wall of the sphenoid sinus and the sellar floor were $69.71{\pm}4.25$ mm and $86.26{\pm}4.57$ mm, respectively in the over 15 age group, and showed the smallest degree of variation among the measurements. The mean angles between the floor of the nasal cavity and the straight line connecting the base of the columella and the sellar floor were $29.45{\pm}3.25^{\circ}$ and $24.75{\pm}4.00^{\circ}$ in the over 15 and under 15 age groups, respectively. The mean values of both distances and angles increased with age until 15 years after which no further increases were evident. There were no significant differences in the measurements between males and females or among subjects with different degrees of pneumatization in the over 15 age group. Conclusion : The distances from the base of the columella to the sellar floor and the anterior wall of the sphenoid sinus, which were consistent among individuals, could be used as a surgical indicator to investigate the sellar floor in endoscopic or microscopic transsphenoidal approaches.

• Investigative Magnetic Resonance Imaging
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• v.25 no.3
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• pp.183-188
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• 2021

Tumors that metastasize to the pituitary gland are unusual and metastasis of neuroendocrine neoplasm to the sellar region is extremely rare. We report a 59-year-old man with pituitary metastasis from pulmonary carcinoid tumor who presented with left progressive deterioration of visual field. Sellar dynamic magnetic resonance imaging revealed an enhancing sellar mass invading the left cavernous sinus. We report this unusual case with a review of the relevant literature.

• Journal of Korean Neurosurgical Society
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• v.37 no.2
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• pp.157-159
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• 2005

The authors present two cases of intrasellar schwannoma, a condition rarely reported in the literature. The patients presented with symptoms of hypopituitarism. Sellar magnetic resonance imaging(MRI) revealed intrasellar masses extending into the suprasellar region, with the normal pituitary gland also identifiable in the imaging study. The tumors were removed via trans-sphenoidal route, and found to be very firm, unlike usual pituitary adenomas. Tissue diagnosis confirmed the tumors as schwannoma.

• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.4
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• pp.207-218
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• 2022

Objectives: This study aimed to define the prevalence and characteristics of skull base anomalies and the features of sphenoid sinus pneumatization (SSP). Materials and Methods: Five hundred cone-beam computed tomography scans were evaluated retrospectively for the presence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), sphenoid emissary foramen (SEF), and/or Onodi cells (OC). Patterns of the SSP and sphenoid sinus mucosa dimensions (SSMD) were also recorded. Results: The prevalence of FNM, CBM, SEF, and OC was 26.0%, 22.4%, 47.4%, and 18.4%, respectively. Two hundred sixty-two (52.4%) sellar-type SSP were defined, followed by post-sellar 191 (38.2%), pre-sellar 31 (6.2%), and conchal 16 (3.2%) types. The frequency of SSMD less than 1 mm, 1-3 mm, and greater than 3 mm was 40.6%, 38.4%, and 21.0%, respectively. An SEF was detected more frequently in females, while SSMD greater than 3 mm was more frequent in males. An FNM was more prevalent in the 18-29 and 30-39 age groups and SEF was significantly less frequent in patients over 60 years of age compared to other age groups. A sinus mucosa larger than 3 mm was more common in the younger than 18 year group. The frequency of post-sellar-type pneumatization was lower in patients younger than 18 years. Conclusion: Skull-base anomalies are common and may be detected incidentally during imaging procedures. The sphenoid sinus, its variations, and pneumatization patterns should also be taken into consideration in imaging procedures performed for various purposes.

• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.58-61
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• 2016

Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.

• Brain Tumor Research and Treatment
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• v.6 no.2
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• pp.82-85
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• 2018

Extremely massive sellar xanthogranuloma (XG) are rare, and the surgical outcome and prognosis are not well known. XG remain unknown whether they are derived from Rathke's cleft cysts (RCCs) or craniopharyngiomas (CPs) following extensive inflammation and metaplasia, to the point that no epithelium is readily identifiable. These lesions usually tend to occur in younger patients (mean 28.3 years), have a smaller diameter, and remain primarily intrasellar region with infrequent calcification. This 36-year-old man presented our hospital with visual deterioration. At the time of visit, there were no neurological problems other than visual field defect and hormonal disorder. He visited our hospital in 2007 due to headache and decreased vision, and underwent transphenoid surgery for pituitary RCC. Since then, he has received treatment at our hospital for postoperative hormonal disorders. Through preoperative imaging study, the author suspected CP and underwent surgery. During the operation, the adhesion of the tumor to the surrounding major neurovascular structures was severe in the naked eyes, but the tumor could be removed more easily than expected. The postoperative histological findings were confirmed as XG. The postoperative course was uneventful. Compared to the previous literature, this case is a case where the size of XG is very large in a sellar region and it can be proved that it originated from the RCC. And regular follow-up is necessary to confirm the prognosis after surgery.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.459-462
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• 2006

We report a very rare case of atypical granular cell tumor arising in the neurohypophysis of a 56-year-old woman. The tumor was seen on radiology to be lobulated, soft and diffusely enhanced, the same as pituitary macroadenoma, but it was anatomically localized within the posterior part of the hypophysis. We partially removed the tumor via the transsphenoidal approach. The pathology showed nuclear pleomorphism, spindling features, and lymphoplasmacytic infiltration. Ki-67 and S-100 protein were focally positive in tumor cells. Histological diagnosis confirmed an atypical granular cell tumor in the sellar region, which is a rare tumor that often has the clinical appearance of a pituitary adenoma. Ophthalmologic symptoms are the most common, followed by endocrinologic manifestations. Here we describe its symptoms and radiological and pathological features.