Endoscopic Endonasal Resection of a Suprasellar Pituitary Adenoma Mimicking Tuberculum Sellae Meningioma in a Patient with an Intrasellar Persistent Trigeminal Artery

Alaa S. Montaser; Alexandre B. Todeschini; Juan M. Revuelta  Barbero; Mostafa Shahein; E. Antonio Chiocca; Bradley A. Otto; Ricardo L. Carrau; Daniel M. Prevedello

doi:10.1055/s-0038-1625943

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S285-S286
DOI: 10.1055/s-0038-1625943

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Resection of a Suprasellar Pituitary Adenoma Mimicking Tuberculum Sellae Meningioma in a Patient with an Intrasellar Persistent Trigeminal Artery

Alaa S. Montaser

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

²Department of Neurosurgery, Ain Shams University Faculty of Medicine, Cairo, Egypt

,

Alexandre B. Todeschini

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

Juan M. Revuelta Barbero

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

Mostafa Shahein

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

E. Antonio Chiocca

³Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States

,

Bradley A. Otto

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

⁴Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

Ricardo L. Carrau

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

⁴Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

Daniel M. Prevedello

¹Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

⁴Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, United States

› Author Affiliations

Abstract

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Keywords

endoscopic endonasal - persistent trigeminal artery - pituitary adenoma - suprasellar

Fig. 1 Initial brain magnetic resonance imaging (MRI) sagittal (A) and coronal (B) views with gadolinium contrast showing the presence of a suprasellar enhanced lesion which was significantly enlarged (C and D) over 4 years period. Preoperative computed tomography angiogram sagittal view (E) with three-dimensional reconstruction (F) is showing the persistent trigeminal artery (arrow) tracking through the tuberculum sellae and forming the entire blood supply of the posterior circulation, with absence of the vertebral arteries. Brain MRI sagittal (G) and coronal (H) views with gadolinium contrast performed 4 years after the surgery demonstrating complete resection of the suprasellar adenoma. Note the enhancement of the nasoseptal flap used for skull base reconstruction.

Fig. 2 Intra-op resection of the suprasellar pituitary adenoma. Meticulous dissection of the tumor (A) from the optic chiasm with complete preservation of the superior hypophyseal arteries (B). Complete resection of the tumor (C) was accomplished.

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Fig. 1 Initial brain magnetic resonance imaging (MRI) sagittal (A) and coronal (B) views with gadolinium contrast showing the presence of a suprasellar enhanced lesion which was significantly enlarged (C and D) over 4 years period. Preoperative computed tomography angiogram sagittal view (E) with three-dimensional reconstruction (F) is showing the persistent trigeminal artery (arrow) tracking through the tuberculum sellae and forming the entire blood supply of the posterior circulation, with absence of the vertebral arteries. Brain MRI sagittal (G) and coronal (H) views with gadolinium contrast performed 4 years after the surgery demonstrating complete resection of the suprasellar adenoma. Note the enhancement of the nasoseptal flap used for skull base reconstruction.

Fig. 2 Intra-op resection of the suprasellar pituitary adenoma. Meticulous dissection of the tumor (A) from the optic chiasm with complete preservation of the superior hypophyseal arteries (B). Complete resection of the tumor (C) was accomplished.