[Surgical techniques for neuroendoscopic procedures].
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Cerebral Hemorrhage↗
Biomedical subjects
Shinsuke Tominaga
Publications and source records attributed to Shinsuke Tominaga.
[Endonasal endoscopic chiasmapexy for secondary empty sella syndrome following fenestration of a Rathke's cleft cyst].
Drainage by fenestration of the cyst wall via the transsphenoidal apporach is the most commonly used treatment for symptomatic Rathke's cleft cyst (RCC). The same procedure is usually adopted for recurrence of RCC. We have encountered a case of secondary empty sella syndrome presented with visual field defects after repeated surgery for RCC. Secondary empty sella syndrome following the surgery of RCC is rare. The condition was explained by the mechanism that the optic nerve adhered to the cyst wall and it was tethered downward as the cyst shrank after the surgery. We treated the patient via the endonasal endoscopic transsphenoidal approach by placing holed silicone plates under the sellar floor to elevate the sellar contents and the optic nerve. Silicone plate is hard enough to support the sella and the small holes on it would facilitate drainage of the cyst contents. This method has proved useful as chiasmapexy for secondary empty sella syndrome after the surgery of RCC.
Adult↗
Endonasal endoscopic transsphenoidal chiasmapexy with silicone plates for empty sella syndrome: technical note.
Silicone plates sutured together to form blocks were used for extradural elevation of the sella floor in two patients who underwent chiasmapexy for visual disturbance associated with empty sella syndrome. A 36-year-old woman had been treated for prolactinoma for about 19 years with bromocriptine and then presented with left visual disturbance. A 79-year-old man presented with right blurred vision of unknown cause other than empty sella. The sella turcica was accessed via the endonasal transsphenoidal approach under endoscopic guidance. The bony sellar floor was opened with a drill. Two or three pieces of 1-mm-thick silicone plate were sutured to make a block. Two or three blocks were inserted into the epidural space to elevate the sellar contents. Visual symptoms improved in both patients. Silicone is biocompatible and not absorbable. Silicone plates are elastic and easy to handle during insertion, but firm enough to support the sella. The elevation can be adjusted by changing the number of plates in the block. The endonasal endoscopic approach is minimally invasive and particularly suitable for transsphenoidal extradural chiasmapexy for empty sella syndrome.
Adult↗
Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery. Technical note.
Reconstruction of the sellar floor after pituitary tumor removal is sometimes difficult because the repair graft is difficult to handle in the narrow space. This is especially problematic if the endonasal endoscopic approach is used. The authors devised a technique to facilitate this procedure by placing a suture knot on the repair splint. This allows the material to be grasped securely with forceps and improves manipulation even within the narrow nasal cavity. This technique has proved useful when performing the endonasal endoscopic approach, and it is also expected to be useful when conducting the conventional sublabial transsphenoidal approach.
Endoscopy↗
[Pachymeningoencephalitis: case report].
A 59-year-old man presented with generalized convulsion. MR imaging demonstrated a homogeneously enhanced dural lesion infiltrating the parenchyma in the right parietal region. He had no history of sinusitis and the lesion a resembled malignant tumors, so surgical treatment was performed. The histopathological studies showed pachymeningitis extending to the cerebral parenchyma, so the diagnosis of pachymeningoencephalitis was made. After the operation, the patient had no neurological deficits and anticonvulsant therapy was continued. We report the third case of idiopathic local pachymenigoencephalitis that we could range extensively in the world. The clinical features and pathogenesis are discussed.
Brain↗