Pituitary Stalk Hemangioblastoma: Complete Resection through Orbitozygomatic Approach with Extradural Anterior Clinoidectomy

Raffaella Messina; Giovanni Cirrottola; Leonello Tacconi; Jacques Guyotat; Francesco Signorelli

doi:10.1055/s-0042-1757618

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

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2022; 83(S 03): e661-e662
DOI: 10.1055/s-0042-1757618

Skull Base: Operative Videos

Pituitary Stalk Hemangioblastoma: Complete Resection through Orbitozygomatic Approach with Extradural Anterior Clinoidectomy

Raffaella Messina

¹Division of Neurosurgery, Neurosciences and Sense Organs, Department of Basic Medical Sciences, “Aldo Moro” University of Bari Medical School, Bari, Italy

,

Giovanni Cirrottola

¹Division of Neurosurgery, Neurosciences and Sense Organs, Department of Basic Medical Sciences, “Aldo Moro” University of Bari Medical School, Bari, Italy

,

Leonello Tacconi

²Division of Neurosurgery, Azienda Sanitaria Universitaria Integrata di Trieste, University Hospital of Trieste, Trieste, Italy

,

Jacques Guyotat

³Groupement Hospitalier Est, Hôpital Neurologique et Neurochirurgical “P. Wertheimer”, Service de Neurochirurgie D, Lyon, France

,

Francesco Signorelli

¹Division of Neurosurgery, Neurosciences and Sense Organs, Department of Basic Medical Sciences, “Aldo Moro” University of Bari Medical School, Bari, Italy

› Author Affiliations

Abstract

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Keywords

pituitary stalk - hemangioblastoma - orbitozygomatic approach - extradural anterior clinoidectomy

Fig. 1 Intraoperative picture, microscopic view through the R orbitozygomatic approach. Aspirator (A) and Rhoton ball-tip probe are into the R opticocarotid triangle. White arrow: pituitary stalk; black arrow: clinoidal segment of R CA; white arrowhead: R optic nerve; black arrowhead: L optic nerve; white asterisk: R PComA; black asterisk: Al segment of R ACA; A: aspirator; R: Rhoton ball-tip probe. White-shaded area: projection of R anterior clinoid. R, right; CA, internal carotid artery; L, left; PComA, posterior communicating artery; ACA, anterior cerebral artery.

Fig. 2 From left to right: Preoperative magnetic resonance imaging (MRI); sagittal (A), coronal (B), and axial (C) T1-weighted (T1W) gadolinium enhanced and coronal T2W (D) showing an avidly enhancing lesion attached to the pituitary stalk and occupying the right basal cisterns with multiple flow voids. “Reprinted from, Clinical Neurology Neurosurgery, Vol.168, Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F, Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case, Pages No. 147−152, Copyright 4314191018836 (2018), with permission from Elsevier”; Orbito-fronto-temporal bone flap; Intraoperative picture, microscopic view; postoperative MRI confirms complete tumor removal with stalk preservation (white arrow). “Reprinted from, Clinical Neurology Neurosurgery, Vol.168, Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F., Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case, Pages No. 147-152, Copyright 4314191018836 (2018), with permission from Elsevier.”

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Fig. 1 Intraoperative picture, microscopic view through the R orbitozygomatic approach. Aspirator (A) and Rhoton ball-tip probe are into the R opticocarotid triangle. White arrow: pituitary stalk; black arrow: clinoidal segment of R CA; white arrowhead: R optic nerve; black arrowhead: L optic nerve; white asterisk: R PComA; black asterisk: Al segment of R ACA; A: aspirator; R: Rhoton ball-tip probe. White-shaded area: projection of R anterior clinoid. R, right; CA, internal carotid artery; L, left; PComA, posterior communicating artery; ACA, anterior cerebral artery.

Fig. 2 From left to right: Preoperative magnetic resonance imaging (MRI); sagittal (A), coronal (B), and axial (C) T1-weighted (T1W) gadolinium enhanced and coronal T2W (D) showing an avidly enhancing lesion attached to the pituitary stalk and occupying the right basal cisterns with multiple flow voids. “Reprinted from, Clinical Neurology Neurosurgery, Vol.168, Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F, Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case, Pages No. 147−152, Copyright 4314191018836 (2018), with permission from Elsevier”; Orbito-fronto-temporal bone flap; Intraoperative picture, microscopic view; postoperative MRI confirms complete tumor removal with stalk preservation (white arrow). “Reprinted from, Clinical Neurology Neurosurgery, Vol.168, Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F., Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case, Pages No. 147-152, Copyright 4314191018836 (2018), with permission from Elsevier.”