Observation of the neurohypophysis, pituitary stalk, and adenohypophysis during endoscopic pituitary surgery: demonstrative findings as clues to pituitary-conserving surgery.

Abstract

BACKGROUND:

High-definition imaging in endoscopic transsphenoidal pituitary surgery accounts for significantly better identification of anatomic structures. This report presents the clinical images of the adenohypophysis and neurohypophysis under high-definition endoscopic observation, and provides some clues for pituitary-sparing surgery.

METHODS:

Ten demonstrative cases of pituitary lesions, including three cases of gonadotropin-producing pituitary adenoma, two cases of somatotropin-secreting pituitary adenoma, and five cases of Rathke's cleft cysts, were entered in this study. From these cases, we extracted helpful intraoperative findings that affected the surgeon's decision about surgical procedures and led to favorable results.

RESULTS:

The extracted findings contain the following lessons: (1) to find a boundary plane that separate a lesion from the pituitary; (2) to mark the difference of color between the adenohypophysis and the neurohypophysis; (3) to identify the location of the pituitary stalk connecting to the neurohypophysis; (4) to observe the color change of the pituitary induced by decompression; (5) to know pathological findings of the pituitary surface; (6) to distinguish the parenchyma of the neurohypophysis from pathological tissues; and (7) to recognize the intrasellar findings at the completion of removal. Recognition of these findings led to an excellent result in each case.

CONCLUSIONS:

Despite being shown in a limited number of cases, on the basis of HD endoscopic images, accurate identification of the neurohypophysis and the pituitary stalk as well as adenohypophysis during surgery contributes to pituitary-conserving operations.

• Authors: Yuichiro Yoneoka, Naoto Watanabe, Masayasu Okada, Yukihiko Fujii
• Journal: Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 155 Issue 6 Pg. 1049-55 (Jun 2013) ISSN: 0942-0940 [Electronic] Austria
• PMID: 23532346 (Publication Type: Journal Article)

Topics

• Adult
• Diagnostic Imaging
• Endoscopy (methods)
• Female
• Humans
• Male
• Middle Aged
• Pituitary Gland (pathology, surgery)
• Pituitary Gland, Anterior (pathology, surgery)
• Pituitary Gland, Posterior (pathology, surgery)
• Pituitary Neoplasms (pathology, surgery)