Summary Objective The management of Rathke's cleft cyst (RCC), particularly in patients with no symptoms or with only minor endocrinopathies, has not yet been established. We retrospectively analysed patients with RCC to elucidate correlations between the clinical manifestations, magnetic resonance imaging (MRI) findings, histology and therapeutic outcomes. Methods We retrospectively studied 37 patients with RCC, who underwent computed tomography (CT), MRI and endocrinological examinations, of whom 27 patients underwent surgical intervention. Results The presence of frontal headaches and anterior pituitary dysfunction was unrelated to the cyst size but was more frequent in patients with high‐ and isointensity cysts on T1‐weighted images (WIs) than those with low‐intensity cysts ( P = 0·0159 and P = 0·0249, respectively). All three patients with posterior pituitary dysfunction had a high‐intensity cyst on T1‐WI ( P = 0·0385), whereas pituitary dysfunction was not observed in patients with a low‐intensity cyst on T1‐WI. In contrast to the excellent therapeutic outcomes with regard to visual disturbance and hyperprolactinaemia, recovery of pituitary dysfunction was rare; only three of nine patients with hypopituitarism showed improvement. Among six patients with histologically recognized intense chronic inflammation in the cyst wall, five patients had an RCC of T1 high intensity ( P = 0·0161), two patients had distinct rim enhancement on MRI ( P = 0·0060), all patients had frontal headaches ( P = 0·0130), and four patients had associated hypopituitarism ( P = 0·0243), none of which improved after surgical intervention. Conclusion RCCs of high‐ and isointensity on T1‐weighted images, which contain mucous material within the cyst, may be associated with chronic inflammation that can potentially cause irreversible endocrine dysfunction. In asymptomatic patients with RCCs of these MR intensities, close follow‐up with precise endocrinological evaluation and gadolinium‐enhanced MRI is necessary to avoid occult progression of the inflammation.
Although delayed hypopituitarism is a common complication of conventional radiotherapy of sellar tumours, histological changes that may account for it have been rarely reported. To elucidate the changes, hypofunctional pituitary glands following irradiation were studied.Two pituitary glands obtained at autopsy from patients who had been irradiated for adenoma and exhibited hypopituitarism were examined. In both cases diffuse fibrosis was observed in the adenohypophysis, whereas the neurohypophysis remained unchanged. Immunohistochemistry showed that stellate-shaped S100 protein-positive cells were increased in number and distributed among the endocrine cells. Some irradiated endocrine cells showed dense granular immunoreactivity for mitochondrial protein, cytochrome oxidase and manganese-superoxide dismutase. In addition to faint reactivity with anti-cytokeratin 8, 18 antibody, many cells were densely positive with anti-cytokeratin 1, 5, 10, 14 antibody.These results indicate that radiation- induced fibrosis is associated with an increased number of folliculo-stellate cells and the presence of metabolic dysfunctional mitochondria resembling mitochondria in oncocytes. Squamous metaplasia in the irradiated endocrine cells was also noted. Various intracellular changes may participate in delayed pituitary hypofunction following radiotherapy.
In 1975, the Brain Tumor Registry of Japan (BTRJ) was founded to investigate the statistical characteristics of brain tumors in Japan.The Committee of the BTRJ (Ex-Chairpersons: Keiji Sano, Kintomo Takakura, and Kazuhiro Nomura) has published 12 reports.The 12 th report of the BTRJ, which includes 82,844 primary and metastatic brain tumor cases from 1984 to 2000, was issued in 2009.Here, we publish the 13 th edition of the BTRJ.This edition contains the statistical data of 16,338 patients in Japan with primary and metastatic brain tumors from 2001 to 2004.These data were collected via the Internet Data and Information Center for Medical Research in the University Hospital Medical Information (UMIN) system, instead of via a paper registration form.We hope that these data will be more reliable, given the use of computerized systems.This edition includes the frequency, anatomical distribution, patient age and sex, and survival data for all brain tumor cases, according to the World Health Organization (WHO) 2007 brain tumor classification.We hope that this edition will provide internationally valuable information to the fields of neurosurgery and neuro-oncology and contribute to the development of successful treatments for patients with brain tumors.
Background: Oculomotor ophthalmoplegic migraine (O-OPM) occurs in many children, and in some cases MRI shows a small mass in the root exit zone (REZ) of the oculomotor nerve. This mass is considered to result from nerve hypertrophy caused by repeated demyelination. Case results: A 51-year-old man has been on oral medication for O-OPM, which he had from 6 years of age. However, the frequency and intensity of his migraine attacks have gradually increased. Brain magnetic resonance imaging (MRI) revealed a small nodular mass in the REZ of the oculomotor nerve. The mass was initially diagnosed as oculomotor schwannoma and tumor resection was attempted. However, as the mass was tightly adhered to the oculomotor nerve and hemorrhagic, biopsy was performed. The pathological diagnosis was neuromuscular hamartoma. Conclusion: The small nodular mass in the REZ of the oculomotor nerve may be a hamartoma associated with congenital factors and may possibly be the primary pathology of O-OPM in this case.
The purpose of this study is to describe a new technique for en bloc temporal bone resection using a diamond threadwire saw (T-saw) as an alternative to cutting the temporal bone with an osteotome. This technique has been performed in 10 patients with external auditory canal and middle ear cancers without any injury to the internal carotid artery or jugular vein. The authors conclude that the use of a diamond threadwire saw after transposing the internal carotid artery anteriorly is a safe, simple, and reliable technique for en bloc temporal bone resection.
