Search Results (76)

Background/Objectives: Pituitary tumors account for over 90% of all sellar region masses. However, a spectrum of rare neoplastic, inflammatory, infectious, and vascular lesions—benign and malignant—can arise in the intra- and parasellar compartments and clinically and radiologically mimic PitNETs. We report a cohort of 47 such rare and cystic midline intracranial lesions, emphasizing their distinctive morphological, clinical, and imaging features and the personalized treatment strategies applied. Methods: In this retrospective single-center study, we reviewed all patients treated for suspected PitNETs via transsphenoidal approach between 2015 and 2024. Of 529 surgical cases, we excluded confirmed PitNETs, meningiomas, and classical intradural craniopharyngiomas. Collected data encompassed patient demographics, tumor characteristics, presenting symptoms, extent of resection or medical therapy, endocrine outcomes, and follow-up information. Results: Among all 529 patients who underwent surgical treatment for sellar lesions from 2015 to 2024, 47 cases (8.9%) were identified as rare or cystic masses. Forty-six underwent transsphenoidal resection; one patient with hypophysitis received corticosteroid therapy alone. Presenting symptoms included headache (n = 16), dizziness (n = 5), oculomotor disturbances (n = 2), and visual impairment (n = 17). Endocrine dysfunction was found in 30 patients, 27 of whom required hydrocortisone replacement. Histopathological diagnoses were led by colloid cysts (n = 14) and Rathke’s cleft cysts (n = 11). The remaining 22 cases comprised plasmacytoma, germinoma, lymphoma, pituicytoma, inverted papilloma, metastatic carcinoma, chordoma, nasopharyngeal carcinoma, chloroma, and other rare entities. Preoperative imaging diagnosis proved incorrect in 38% (18/47) of cases, with several lesions initially misidentified as PitNETs. Conclusions: Nearly 9% of presumed PitNETs were rare, often benign or inflammatory lesions requiring distinct management. Most could be safely resected and demonstrated excellent long-term outcomes. Yet, despite advanced imaging techniques, accurate preoperative differentiation remains challenging, with over one-third misdiagnosed. Clinical red flags—such as early hormone deficits, rapid progression or atypical imaging findings—should prompt early interdisciplinary evaluation and, when indicated, image-guided biopsy to avoid unnecessary surgery and ensure tailored therapy. Full article

Background: Endonasal endoscopic approaches to the skull base are still under investigation, with research aiming to achieve minimally invasive procedures that maximize resection while minimizing complications. This study shares our experience with a mononostril technique and compares it with the existing literature on mononostril approaches for sellar lesions. Methods: A systematic review of eight large series, totaling 1520 patients who underwent endoscopic mononostril transsphenoidal surgery, was performed. The surgical technique was detailed, and parameters such as resection completeness, operative time, complications, and nasal symptoms were analyzed. Results: Gross total resection ranged from 56% to 100% for non-functioning adenomas, 54% to 89% for hormone-secreting adenomas, and 83% to 100% for other sellar lesions. The most common complications were CSF leaks (1.5–4.1%) and nasal issues, such as epistaxis or sinusitis (0–6%). Internal carotid artery injury occurred in 0–1% of cases. The average surgical duration was 87 to 168 min. Conclusions: The mononostril approach offers comparable resection rates, CSF leak risks, and morbidity to binostril or microsurgical methods. The mononostril approach is fast, minimally invasive, and preserves the nasal mucosa, making it a viable option for many sellar lesions. Full article

Posterior pituitary tumors (PPTs) are rare, non-neuroendocrine neoplasms derived from pituicytes of the neurohypophysis or infundibulum. According to the 2025 WHO classification, PPTs comprise four distinct but related low-grade entities: pituicytoma, granular cell tumor of the sellar region, spindle cell oncocytoma, and ependymal pituicytoma. All share nuclear TTF-1 expression, confirming their common origin, but differ in morphology, immunophenotype, and ultrastructure. Histologically, pituicytomas consist of bipolar spindle cells in fascicles; granular cell tumors show polygonal cells with PAS-positive, diastase-resistant cytoplasmic granules; spindle cell oncocytomas display oncocytic change and abundant mitochondria; and ependymal pituicytomas exhibit perivascular pseudorosettes and EMA positivity in apical or dot-like patterns. Immunohistochemically, all are S100 and vimentin positive, and negative for pituitary hormones and lineage-specific transcription factors. Clinically, PPTs are typically non-functioning but may be associated with corticotroph or somatotroph hyperfunction. Imaging features are nonspecific. Surgical resection is the treatment of choice, although hypervascularity and adherence—especially in spindle cell oncocytomas—can hinder complete excision. Radiotherapy is reserved for recurrences. Molecular analyses reveal recurrent alterations in MAPK/PI3K pathways (e.g., HRAS, BRAF, FGFR1, NF1, TSC1) and suggest a shared histogenesis. Copy number imbalances correlate with reduced progression-free survival in some subtypes. Despite a generally favorable prognosis, recurrence—particularly in spindle cell oncocytomas—necessitates long-term follow-up. The WHO 2025 update provides a unified framework for classification, diagnosis, and prognostic stratification of these rare tumors. Full article

Background: Differentiating pituitary adenoma (PA) from Rathke’s cleft cyst (RCC) on magnetic resonance imaging (MRI) remains challenging due to overlapping imaging features such as the cystic appearance, and location within the sellar region. A magnetic resonance image compilation (MAGiC) sequence can simultaneously acquire R1 and R2 relaxation rates. This study evaluated the diagnostic performance of MAGiC-driven imaging parameters for distinguishing PA from RCC. Methods: In total, 108 patients (54 each with PA or RCC) who underwent MRI using the MAGiC sequence were included in this study. The R1 and R2 relaxation rates were measured from the regions of interest identified in the MAGiC images. The relaxation rates between the PA and RCC groups were compared and diagnostic performance was assessed. Results: The relaxation rates of PA and RCC differed significantly. PA exhibited lower R1 (0.71 vs. 1.31, p < 0.001) and R2 (13.62 vs. 11.38, p = 0.029) relaxation rates than RCC. The R1 relaxation rate demonstrated superior diagnostic performance, with an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.65–0.82), surpassing the R2 rate (AUC 0.62; 95% CI: 0.52–0.71). The optimal threshold for R1 was determined to be 0.82, which provided a sensitivity of 79.6% and specificity of 74.1% (p < 0.001), whereas the optimal threshold for R2 was 14.89 (p = 0.030). Conclusions: MAGiC-driven parameters, particularly the R1 relaxation rate, show promise for improving the differentiation between PA and RCC. These findings suggest the potential for the broader application of MAGiC imaging in clinical practice to improve diagnostic accuracy. Full article

Background/Objectives: Granular cell tumors (GCTs) are rare neurogenic tumors with Schwann cell differentiation. Although most are benign, 1–2% exhibit malignant behavior. The imaging features of GCTs remain poorly characterized due to their rarity and anatomic variability. This study aims to elucidate the manifestations of GCTs in multimodal imaging across different anatomic locations. Methods: We retrospectively analyzed 66 histopathologically confirmed GCT cases (2011–2024), assessing their clinical presentations, pathological characteristics, and imaging findings from ultrasound (n = 31), CT (n = 14), MRI (n = 8), and endoscopy (n = 15). Two radiologists independently reviewed the imaging features (location, size, morphology, signal/density, and enhancement). Results: The cohort (mean age: 42 ± 12 years; 72.7% female) showed tendency in location towards soft tissue (48.4%), the digestive tract (30.3%), the respiratory system (7.6%), the breasts (7.6%), and the sellar region (6.1%). Six cases (9.1%) were malignant. The key imaging findings by modality were as follows: Ultrasound: Well-circumscribed hypoechoic masses in soft tissue (96.1%) and irregular margins in the breasts (80%, BI-RADS 4B) were found. MRI: The sellar GCTs exhibited T1-isointensity, variable T2-signals (with 50% showing “star-like crack signs”), and heterogeneous enhancements. The soft tissue GCTs were T1-hypointense (75%) with variable T2-signals. CT: Pulmonary/laryngeal GCTs appeared as well-defined hypodense masses with mild/moderate enhancements. Endoscopy: Submucosal/muscularis hypoechoic nodules with smooth surfaces were found. Malignant GCTs were larger (mean: 93 mm vs. 30 mm) but lacked pathognomonic imaging features. Three malignant cases demonstrated metastases. Conclusions: GCTs exhibit distinct imaging patterns based on their anatomical location. While certain features (e.g., star-like crack signs) are suggestive, imaging cannot reliably differentiate benign from malignant variants. Histopathological confirmation remains essential to diagnosis, particularly given the potential for malignant transformations (at 9.1% in our series). Multimodal imaging guides the localization and biopsy planning, but clinical–radiological–pathological correlation is crucial for the optimal management. Full article

Introduction: The group of so-called “sellar-region masses” consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in “common” and “uncommon” lesions. The choice of a correct treatment strategy is still arduous and requires histological analysis. Gamma Knife Radiosurgery (GKRS) has already been reported as a safe and effective treatment in these cases. The objective of this study is to evaluate single-center pre-operative data, post-operative outcomes, and long-term follow-up in patients treated with GKRS for unusual sellar tumors. Methods: We retrospectively identified and analyzed nine patients treated with GKRS from 2004 to 2015, according to a standard protocol. Lesions consist of hypothalamic hamartoma (HH), Rathke’s cleft cist (RCC), Langerhans cell histiocytosis (LCH), spindle cell oncocytoma (SCO), choroid plexus papilloma (CPP), and ossifying fibroma (OF). The diagnosis was histologically confirmed in six patients that underwent surgery, while in three patients, diagnosis was based on characteristic clinical and radiological findings (two HH and one RCC). Pre-operative and post-operative data were retrieved from medical archives, and long-term follow-up was obtained through clinical and neuroradiological periodic examination. Results: In our series, all the “rare” sellar lesions treated, had a successful radiographic and clinical response in a medium-long follow-up period. Conclusions: The long-term follow-up results suggest that GKRS is a safe and effective treatment in rare sellar lesions, with very low toxicity. To the best of our knowledge, this report represents the largest series of unusual sellar lesions treated with GKRS in a single high-volume center, suggesting that GKRS might be an effective non-invasive adjuvant treatment option. Further studies and a larger number of patients are needed to confirm if residuals of these rare sellar lesions might regress on their own without treatment or if other non-invasive treatments could be as effective as GKRS. Full article

Introduction: Craniopharyngiomas are rare sellar embryonic malformational tumors of low-grade histological malignancy. Despite high overall survival rates (92%), quality of life is frequently reduced due to adverse late effects caused by hypothalamic obesity. It is well known that morbid hypothalamic obesity is associated with the grade of hypothalamic damage. Accordingly, craniopharyngioma should be considered a paradigmatic disease, reflecting challenges in the diagnosis and treatment of acquired hypothalamic obesity. Methods: A narrative review was performed after searching the MEDLINE/PubMed, Embase, and Web of Science databases for initial identifying articles. The search terms childhood-onset craniopharyngioma and hypothalamic obesity were used. Results: Despite the availability of promising therapeutic approaches, such as medication with central stimulating agents, antidiabetic drugs, glucagon-like peptide 1 (GLP1) receptor agonists, and Setmelanotide, it must be emphasized that there is currently no pharmaceutical treatment for hypothalamic obesity in craniopharyngioma proven to be effective in randomized controlled trials. For Setmelanotide, a prospective blinded randomized trial over a 12-month treatment period is ongoing. Bariatric interventions are effective, but non-reversible procedures such as bypass operations are controversial in the pediatric age group due to legal and ethical concerns. Recently, a treatment algorithm was introduced to improve the management of hypothalamic syndrome/obesity by offering more personalized treatment. Decisions on treatment strategies focusing on the preservation of visual, neuroendocrine, and hypothalamic integrity should be made by experienced multidisciplinary teams. Conclusions: Treatment approaches for hypothalamic obesity are limited. Further research on novel treatment approaches for hypothalamic obesity is warranted to improve the quality of life after childhood-onset craniopharyngioma. Full article

Background: Rathke’s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke’s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to investigate the correlations between clinical, radiological and histological features of RCCs to propose a novel management model. Methods: We conducted a retrospective analysis from patients who underwent surgery for cystic lesions between 2013 and 2023 in the Neurosurgery Department of Treviso Hospital (Italy) using for our purpose only those confirmed by histological specimen as RCCs. Results: 20 patients for a total of 24 procedures (20 primary surgeries/4 cases for recurrence) were performed for RCCs. A gross total resection was achieved in 23 cases, resulting in improvement of headache and visual symptoms in all patients. Hyperintensity on T1-weighted MRI sequences is more strongly correlated with inflammation and with intralesional metaplasia (p = 0.009). Both characteristics are involved in the development of hypopituitarism (p = 0.057), headache, and visual impairment (p = 0.082) compared to cysts with CSF-like content, even when the latter are smaller in size (p = 0.078). Discussion and Conclusions: RCCs are rare lesions whose management is challenging due to a lack of established guidelines. Intraoperative cystic content and MRI cystic characteristics seem to correlate with clinical presentation and long-term outcome in these patients. The transsphenoidal endoscopic approach is a safe and effective treatment, especially in cysts with inflammatory aspect in histopathological specimens and in dedicated MRI sequences that could take advantage of an early surgical resection. A decision-making model based on clinical, radiological and histopathological features of cysts could be useful to guide RCCs’ treatment, underlining the role of inflammation that seems to be involved in the onset of visual and hormonal impairment and in recurrence risk. Full article

Chronic fungal sinusitis (FS) can cause bone erosion and extend to the sellar region, often misdiagnosed as pituitary tumors or malignancies. We report a 56-year-old immunocompetent female with sphenoid FS presenting as a giant sellar mass compressing the optic chiasm, with normal pituitary function. The surgery successfully resolved her symptoms, and a histological examination confirmed the presence of a fungal hyphal mass. We conducted a literature review of 52 publications on FS cases with bone erosion and inflammatory extension to the sellar region, which included analyses of 67 patients (35 females, mean age 49.6 years, half immunocompetent). The most common symptom was headache (73.1%), followed by visual complaints (71.7%), visual deterioration (40.3%), ophthalmoplegia (38.8%), and visual field defects (13.4%). Symptom duration averaged 4.5 months in 65.7% of cases. Aspergillus was the most frequent (71.6%). Hormonal abnormalities included hypopituitarism (25.4%) and hyperprolactinemia (13.4%). Surgery was performed in 92.5% of patients. Common diagnoses included pituitary abscess (41.8%), fungal granuloma (16.4%), aspergillosis (16.4%) and allergic FS (14.9%). Antifungal therapy was administered in 53.7% of cases. Cure was achieved in 67.2%, while the mortality rate was 10.4%. Early recognition of fungal involvement, supported by a multidisciplinary approach, is essential for the accurate diagnosis and effective treatment. This highlights the need for vigilance to improve the outcomes in similar cases. Full article

Purpose: The purpose of this study was to assess the relationship between the radiological criteria determining an primary empty or primary partial empty sella and the pituitary hormone levels. Methods: Out of 594 patients who underwent pituitary magnetic resonance imaging (MRI), we selected 43 patients with primarily empty and partial empty sella and conducted a prospective evaluation of pituitary MRI in 2022. Pituitary craniocaudal (CC) diameter, pituitary volume, sellar volume, pituitary volume expressed as a percentage of sellar volume (bony sella), and pituitary height expressed as a percentage of sellar height (craniocaudal) were assessed. Serum pituitary hormone concentrations were measured, and a logistic regression analysis was performed to assess a relationship between the radiological and hormonal parameters. Results: Only six patients (14%) exhibited abnormal hormone levels. None of the assessed radiological parameters were correlated with the presence of the hormonal disorders either in the univariate or multivariate logistic regression analysis. The univariate logistic regression analysis revealed a significant relationship between age and the hormonal disorders (OR 0.916 [0.844–0.993]; p = 0.034), but this was not confirmed in the multivariate analysis. Conclusions: These findings suggest that radiological parameters alone are insufficient to predict hormonal dysfunction in patients with empty or partial empty sella. However, younger patients may be at a higher risk, warranting closer hormonal monitoring. Full article

Background: Alberta Cancer Exercise (ACE) is a hybrid effectiveness–implementation study evaluating a cancer-specific community-based exercise program across urban sites in Alberta, Canada. The purpose of this paper is to describe the baseline characteristics of participants. Methods: Adults with any type and stage of cancer, who were undergoing cancer treatment or up to three years post treatment completion, were eligible. ACE was delivered in person at 18 sites across 7 cities in Alberta, with video conferencing introduced during the COVID-19 pandemic. Participants took part in 60 min of mild-to-moderate intensity exercise twice weekly for a 12-week period and were encouraged to increase overall physical activity. Results: From January 2017 to February 2023, 2570 individuals enrolled. Participants were a mean age of 57.8 years, 71.3% were female, 45.4% had breast cancer, and 49.4% were undergoing cancer treatment. At baseline, only 22.4% of participants self-reported meeting recommended physical activity levels, 66.0% were overweight/obese, and 71.4% reported one or more comorbidities. Most participants were below normative levels for the six-minute walk and 30 s sit-to-stand tests, and 75.9% reported fatigue. Conclusion: Participants were largely inactive, unfit, and symptomatic. ACE attracted more females and individuals with breast cancer but was otherwise representative of the Alberta cancer population. Full article

Introduction: A supraorbital keyhole craniotomy (SOKC) is a novel alternative to frontal craniotomies for accessing the anterior fossa for resecting tumors and clipping aneurysms; however, its implementation is limited in patients at a high risk of complications. We present two cases involving the use of augmented reality (AR) and virtual reality (VR) for patient selection and preoperative planning for a supraorbital tumor resection of anterior fossa meningiomas. Methods: This is a prospective, single-center case series at a research institute. We identified patients with an anterior or middle fossa meningioma regardless of age, gender, and tumor characteristics who could undergo an SOKC and MRI. The preoperative planning was performed with the BrainLab Magic Leap AR/VR platform. The meningiomas were resected through the SOKC under neuronavigation. Results: We identified two cases: a 37-year-old male with a meningioma in the sellar region and an 84-year-old male with a right anterior fossa meningioma, both confirmed by MRI. Both patients had a complete tumor resection by a minimally invasive SOKC after preoperative planning with the AR/VR platform. Postoperatively, hyponatremia complicated the first case, while the second case developed an intracranial hemorrhage. They both recovered after the appropriate interventions. Conclusions: The use of an SOKC for anterior skull base meningiomas should be individualized after considering the lesion characteristics, vascular control needs, and the surgeon’s expertise. VR/AR-assisted preoperative evaluation and planning will optimize the patient selection and surgical outcomes. We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations. Full article

Incident flow measurement is key in the tidal industry for conducting power performance assessments. This paper explores the use of a horizontally mounted Nortek Signature 500 Acoustic Doppler Current Profiler (ADCP) as a means for incident flow measurement onboard a utility-scale tidal turbine. This study shows that the measurement range of an ADCP mounted horizontally in highly dynamic tidal flow (up to 4 m/s) is less than the maximum range stated by the manufacturer. The ability for the horizontal ADCP to accurately resolve velocities in a multi-beam configuration is also analysed. Effects from both vertical shear and beam selection result in incident flow velocities that differ from a single horizontal beam recording. The maximum measurement range of the instrument is found to depend on current speed and on the proportion of data loss that is acceptable to the user. The ability of the ADCP to record data from the free-stream velocity two equivalent diameters upstream of the O2, as set out by IEC TS 62600-200, is considered. It is found that at this distance, there is 90% data loss. Accepting only 10% data loss across all flow speeds resulted in a maximum range of 31 m for a Nortek Signature 500 in this study. While some limitations of an ADCP deployed horizontally in highly energetic tidal flow are identified, the benefits of mounting the sensor close to the rotor facing horizontally into the incoming flow mean that valuable data are still produced for tidal turbine operators. Full article

Background and Objectives: A magnetic resonance imaging (MRI) scan is part of the diagnostic protocol in pituitary adenoma patients. The goal of the present study is to present and analyse the MRI appearances of the sphenoid sinus (SS) in patients with non-functioning pituitary adenoma (NFPA). Materials and Methods: This is a retrospective case–control study conducted between January 2015 and December 2023 in a tertiary referral hospital. Forty NFPA patients were included in the study group, while the control group consisted of 30 age- and gender-matched cases. Results: The sellar type of SS pneumatization was the most frequently encountered pattern among both groups. The presence of the lateral recess of the SS, mucosal cysts, and sphenoethmoidal cells was similar in both patient groups. The proportion of patients with SS mucosal thickness greater than 3 mm was 42.5% in NFPA group and 3% in the control group, and this difference was statistically significant (p < 0.001). The space between the two optic nerves was significantly larger in the NFPA group as compared to the control group (p < 0.001). Conclusions: Our study was able to establish a statistically significant association between the presence of NFPA and both the thickening of the SS mucosa and increased space between optic nerves. Full article

Clinically non-functioning pituitary adenomas (CNFPAs) are the second most frequent sellar tumor among studies on community-dwelling adults. They are characterized by the absence of hormonal hypersecretion syndrome, and patients present with compressive symptoms, such as a headache and visual field defects. Immunohistochemically, most CNFPAs are of gonadotrope differentiation, with only a few of them being truly null cell adenomas. Although these tumors express receptors for one or more hypothalamic releasing hormones, to what extent this has an impact on the biological and clinical behavior of these neoplasms remains to be defined. In this research, we evaluated the basal and hypothalamic secretagogue-stimulated intracellular calcium mobilization in 13 CNFPAs, trying to correlate this response to the phenotypic features of the patients. Our results indicate that the recurrence of a CNFPA correlates positively with cellular responsiveness, as measured by spontaneous intracellular calcium activity and the ability to respond to multiple hypothalamic secretagogues. We conclude that this finding may be a useful tool for predicting the clinicopathologic behavior of CNFPAs, by testing the variation of cellular responsiveness to hypothalamic secretagogues. Full article