(A) clinical study of sellar and parasellar lesions
[영문]Lesions arising within and around the sells turcica have always provided something of a challenge for the neurosurgeon, not only because of their diverse nature, but also because their extirpation often involves maneuvering around some of the busiest neural and vascular crossroads.
The neuroradiological diagnosis of sellar and parasellar lesions is based on changes in the radiographic anatomy of several rather specific areas. The standard diagnostic techniques, familiar to all, are plain skull, pneumographic, and
angiographic delineation of the sella and its environs.
The author has reviewed 58 cases, showing 75 verified sellar and parasellar lesions, at the Department of Neurosurgery, Severance Hospital, Yonsei University from Jan. 1, 1963 to Dec. 31, 1972. These include tumors and pseudolesions, but intracranial aneurysms and inflammatory disease are excluded.
Pituitary adenomas 35
Ectopic pinealomas 2
Metastatic carcinoma 1
Increased intracranial pressure 3
Empty sella syndrome 2
In this series lesions which may occur in sellar and parasellar regions, are discussed and case history, development and progression of the neurological features, spontaneous and steroid induced remission, endocrine disturbance, other laboratory findings, reontgenograms, differential diagnosis, operative method and findings, and pathologic findings are analyzed and reviewed.
The author has only emphasized some important points illustrated in our cases because other result do not differ greatly from previous authors' reports.
1. It is disappointing to find that no correlation exists between the amount of sellar destruction and the occurrence of endocrine disturbances. There is an increased likelihood that marked endocrine changes are due to cystic formation in pituitary adenomas.
2. With angiograms of sellar and parasellar lesions, opening of the siphon and lateral displacement of the supraclinoid portion of the internal carotid artery are important rather than a dome shaped elevation of the A^^1 portions of the anterior cerebral artery in the diagnosis, especially in the event that the posterior communicating and the posterior cerebral arteries are not very well visualized.
3. During an operation in the supratentorial region, the most likely lesion is a pituitary adenoma when a cyst is accidently found.
4. Intracapsular bleeding is very hard to control on ocassions in pituitary cystic adenoma because of the remaining increased vascular network.
5. The boundary of the empty sella is always obscure in intracranial exploration under the diagnosis of pituitary adenoma when no tumor is found.
6. In a patient with hydrocephalus due to raised intracranial pressure with an enlarged third ventricle extending into the sella turcica or the middle fossa, ventriculostomy of the third ventricle is the ideal procedure.