Overview

Master of all endocrine activity and executive organ of one's quality of life, the pituitary gland is tightly lodged in the"" turkish saddle. "" As a bony container, the sella turcica is to the hypophysis what the skull is to the brain; it can therefore be looked upon as a little vault within the cranial vault. Just as the cranium is moulded by the growth of the brain, so is the sella fashioned by its content. It becomes locally enlarged in response to expanding intrasellar lesions, and it tends to return to its original size and shape upon their removal or destruction. Pituitary adenomas have in the past been diagnosed upon enlargement of the sella turcica. In the past decade, as a direct result of interdisciplinary coopera- tion, we have learned that tiny adenomas, the immediate cause of some cases of acromegaly, amenorrhea-galactorrhea syndrome, or Cushing's disease, can exist with minimal or no observable effect on the size of the sella. The break- through started when radioimmunoassay, as a new method of accurately measur- ing specific hormonal output, indicated selective pituitary oversecretions in pa- tients with normal-sized sellae. Neurosurgeons highly skilled in the transsphenoi- dal approach with the surgical microscope were obliged to operate on some of these patients and confirmed the presence of tiny oversecreting adenomas in their pituitary glands.

Full Product Details

Author:   J. Metzger ,  J. C. Demandre ,  A. Wackenheim ,  M. Gaudron
Publisher:   Springer-Verlag Berlin and Heidelberg GmbH & Co. KG
Imprint:   Springer-Verlag Berlin and Heidelberg GmbH & Co. K
Weight:   1.180kg
ISBN:  

9783540103196

ISBN 10:   3540103198
Pages:   284
Publication Date:   01 December 1980
Audience:   Professional and scholarly ,  Professional & Vocational
Format:   Hardback
Publisher's Status:   Active
Availability:   Out of stock  
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Table of Contents

1 Embryology of the Sellar Region.- A. Development of the Sphenoid Bone.- I. Membranous Stage.- II. Cartilaginous Stage.- III. Stage of Ossification.- 1) Ossification Centers, Ossifying Periods, and Fusion.- 2) Prenatal Development of the Pre- and Postsphenoid Ossification Centers.- IV. Postnatal Development of the Basisphenoid.- 1) Postsphenoid.- 2) Presphenoid.- B. Development of the Sphenoid Sinus.- I. Prenatal Development.- II. Postnatal Development.- C. Development of the Pituitary Gland.- I. Neurohypophysis.- II. Adenohypophysis.- III. Capsule of the Pituitary Gland.- D. Main Anomalies in the Fetal Development of the Sellar Region.- I. In the Postsphenoid.- II. In the Pre- and Orbitosphenoid.- III. In the Pituitary Gland and the Pituitary Stalk.- 2 Anatomy of the Sellar Region.- A. Descriptive Anatomy of the Sellar Region.- I. Sella Turcica.- 1) Dorsum Sellae.- 2) Floor of the Sella Turcica.- 3) Anterior Wall of the Sella Turcica.- 4) Tuberculum Sellae.- 5) Middle Clinoid Processes.- 6) Anterior Clinoid Processes.- 7) Carotid Sulcus.- II. Presellar Region.- 1) Chiasmatic Sulcus.- 2) Planum Sphenoidale.- 3) Limbus Sphenoidale.- III. Ligaments and Unusual Ossifications of the Sellar Region.- 1) Interclinoid Ligaments.- 2) Petroclinoid Ligaments.- 3) Unusual Ossifications of the Sellar Region.- B. Relationships Between the Sella Turcica and the Surrounding Structures.- I. Structures Above the Sella Turcica.- 1) Dura Mater of the Sella Turcica.- 2) Pituitary Gland.- 3) Suprasellar Vascular and Nervous Structures.- II. Lateral Structures: The Cavernous Sinus.- 1) Walls of the Cavernous Sinus.- 2) Contents of the Cavernous Sinus.- 3) Afferent and Efferent Veins of the Cavernous Sinus.- III. Structures Below and Anterior: The Sphenoid Sinus.- 1) General Shape and Size of the Sphenoid Sinus.- 2) The Septa in the Sphenoid Sinus.- 3) Important Variations in the Walls of the Sphenoid Sinus.- 4) Recessus Sphenoethmoidalis.- IV. Posterior and Anterior Structures.- C. Vascular Supply of the Sellar Region.- I. Dura Mater and Osseous Structures.- 1) Sellar Floor.- 2) Cavernous Sinus.- 3) Presellar Region.- II. Pituitary Gland.- 1) Superior Hypophyseal Group.- 2) Inferior Hypophyseal Arteries.- III. Optic Chiasm.- D. Innervation of the Sellar Region.- 3 Radiographic Techniques.- A. Plain Radiography.- I. Equipment and Film Quality Factors.- II. Projections.- 1) The Two Basic Projections for the Sella Turcica.- 2) Direct Magnified Views.- 3) Other Projections.- B. Tomography.- I. Tomographic Devices.- 1) Linear Blurring Movement.- 2) Pluridirectional Blurring Movement.- II. Tomographic Projections.- 1) Lateral Tomograms.- 2) Frontal Tomograms.- 3) Axial Tomograms.- III. When is Tomography Required?.- 1) Clinical or Laboratory Findings.- 2) Radiologic Signs.- 4 Radiologic Anatomy.- A. Radiologic Anatomy of the Sella Turcica and of the Presellar Region.- I. Children.- 1) Sellar Region During the First Year of Life.- 2) Sellar Region From One to Four Years.- 3) Sellar Region From Four Years to Adulthood.- II. Adults.- 1) Lateral Projection.- 2) Frontal Projection.- 3) Half Axial View.- 4) Axial View.- 5) Other Projections.- B. Regional Radiologic Anatomy.- I. Vascular Anatomy.- II. Ventricular and Cisternal Anatomy.- 5 Variations and Normal Limits.- A. Variations in the General Appearance of the Sella Turcica.- I. Variations in Shape.- II. Variations in Size.- III. Unusual Configurations.- 1) Lack of Visibility of the Floor of the Sella on the Routine Posteroanterior Projection.- 2) Vertical Chiasmatic Sulcus.- 3) Bridged Sella Turcica.- 4) Sella Turcica with Thin Cortical Bone.- 5) Small Sella Turcica on One Side.- IV. Normal Limits.- 1) Empty Sella in the Early Stage.- 2) Sella Turcica and Multiparity.- 3) Sella Turcica and the Internal Carotid Artery.- 4) Sella Turcica in Old Age.- 5) Sella Turcica and Craniostenosis.- B. Variations in Different Anatomic Structures.- I. Variations in the Sphenoid Sinus.- II. Variations in the Presellar Region.- III. Variations in the Sella Turcica Itself.- 1) Tuberculum Sellae, Anterior and Middle Clinoid Processes.- 2) Dorsum Sellae and Posterior Clinoid Processes.- 3) Calcification of the Ligaments and the Dura Mater of the Sellar Region.- 4) Floor of the Sella.- 6 Intrasellar Pathology.- A. The Empty Sella Turcica.- I. Primary Empty Sella Turcica.- 1) History.- 2) Pathogenesis.- 3) Clinical Symptomatology.- 4) Radiology.- II. Special Types of Empty Sella Turcica.- B. Pituitary Adenomas.- I. General Considerations.- II. Clinical Findings.- 1) Nonsecreting Adenomas.- 2) Secreting Adenomas.- III. Radiology.- 1) Nonsecreting (Chromophobe) Adenomas.- 2) Prolactin-Secreting Pituitary Adenomas.- 3) Growth Hormone Secreting (Eosinophilic) Adenomas.- 4) Other Hypersecreting Adenomas.- IV. Development of Pituitary Adenomas.- 1) Spontaneous Progression of Adenomas.- 2) Expansion.- 3) Rapid Growth of Pituitary Adenomas.- 4) Abscess Formation.- 5) Spontaneous Necrosis of Pituitary Adenomas.- 6) Remodeling of the Sella Turcica After Treatment.- C. Intrasellar Craniopharyngiomas.- D. Miscellaneous Disorders.- I. Metastases.- II. Primary Malignant Tumors of the Pituitary Gland.- III. Sarcoidosis.- IV. Abscesses.- V. Pituitary Calculus .- VI. Rathke's Cleft Cysts and Other Intrasellar Cysts .- VII. Granular Cell Tumors.- VIII. Vascular Disease.- IX. Rare Intrasellar Disorders.- 7 Suprasellar Pathology.- A. Craniopharyngiomas.- I. General Considerations.- 1) Pathology.- 2) Topography.- 3) Age, Sex, and Incidence.- II. Symptoms.- III. Radiology.- 1) Calcification.- 2) Changes in the Sella Turcica.- B. Hypothalamic Gliomas.- C. Gliomas of the Optic Chiasm.- D. Miscellaneous Disorders.- 1) Histiocytosis X of the Hypothalamus.- 2) Hypothalamic Sarcoidosis.- 3) Colloid Cysts of the Third Ventricle.- 4) Suprasellar Germinomas.- 5) Suprasellar Arachnoid Cysts.- 6) Dermoid and Epidermoid Tumors.- 7) Hamartomas of the Tuber Cinereum.- 8) Meningiomas of the Diaphragma Sellae.- 9) Esthesioneuroblastomas.- 10) Suprasellar Aneurysms.- 11) Suprasellar Arachnoiditis.- 8 Presellar Pathology.- A. Gliomas of the Optic Pathways (Nerve and Chiasm).- I. General Considerations.- II. Radiology.- B. Presellar Meningiomas.- I. General Considerations.- II. Radiology.- C. Diagnosis of an Abnormal Presellar Region.- I. Excessively Dense or Thick Planum Sphenoidale.- II. Excessively Short or Demineralized Planum Sphenoidale.- III. Depressed or Scalloped Planum Sphenoidale.- IV. Blistering of the Planum Sphenoidale.- V. Abnormal Chiasmatic Sulcus.- 9 Parasellar Pathology.- A. Vascular Disease.- I. Aneurysms of the Internal Carotid Artery.- 1) Bony Changes.- 2) Calcification.- 3) Presence of Soft Tissue Mass Within the Sphenoid Sinus.- II. Carotid-Cavernous Fistulas.- B. Meningiomas.- C. Gasserian Neurinomas and Meningiomas.- D. Diseases of Temporal Lobe.- I. Gliomas.- II. Epidermoids.- III. Lipoid Proteinosis.- 10 Retrosellar Pathology.- A. Chordomas.- I. General Considerations.- II. Radiology.- 1) Bone Changes.- 2) Tumor Calcification.- 3) Soft Tissue Mass.- B. Chondromas.- I. General Considerations.- II. Radiology.- C. Clivus Meningiomas.- D. Aneurysms of the Basilar Artery.- 11 Infrasellar Pathology.- A. Inflammatory, Infectious, and Mycotic Lesions of the Sphenoid Sinus.- I. Acute Sinusitis.- II. Chronic Sinusitis.- III. Mucoceles.- IV. Fungal Infections.- V. Sarcoidosis.- B. Infrasellar Neoplastic Diseases.- I. Malignant Tumors.- II. Nonmalignant Infrasellar Tumors.- 12 Sella Turcica in Raised Intracranial Pressure and Hydrocephalus.- A. Raised Intracranial Pressure.- B. Sella Turcica in Chronic Obstructive Hydrocephalus.- C. Changes in the Sella Turcica in Childhood.- D. Sella Turcica in Craniostenosis.- 13 Generalized Diseases and Changes in the Sella Turcica.- A. Congenital Anomalies of the Sella Turcica.- I. Congenital Skull Dysplasias.- 1) Cleidocranial Dysostosis.- 2) Osteopetrosis.- 3) Achondroplasia.- 4) Apert's Syndrome.- 5) Osteogenesis Imperfecta (Lobstein's Disease).- II. Neurofibromatosis.- 1) Dysplasic Bone Changes.- 2) Bone Changes Related to Neighboring Tumors.- III. Chromosomal Syndromes.- IV. Mental Retardation.- V. Meningoencephaloceles.- 1) Transsphenoid.- 2) Sphenoethmoid.- VI. Persistent Infundibular Recess.- VII. Vascular Anomalies.- 1) Transsphenoidal Communicating Artery.- 2) Persistent Trigeminal Artery.- B. Metabolic Diseases.- I. Mucopolysaccharidoses.- 1) Hurler-Hunter Syndrome (Gargoylism).- 2) Maroteaux-Lamy Syndrome.- II. Hypophosphatasia and Hyperphosphatasia.- III. Idiopathic Infantile Hypercalcemia and Hypervitaminosis D.- IV. Fluorine Intoxication.- V. Alcoholism.- C. Endocrine Diseases.- I. Hypopituitarism.- 1) Hypopituitary Dwarfism.- 2) Congenital Absence of Pituitary Gland.- 3) Postpartum Pituitary Necrosis (Sheehan's Syndrome).- II. Small Sella Turcica and Infertility.- III. Primary Target Gland Insufficiency.- 1) Hypothyroidism.- 2) Hypogonadism.- 3) Hypoadrenalism.- IV. Hyperparathyroidism.- V. Cushing's Syndrome.- D. Hematologic Diseases.- I. Histiocytosis X.- II. Multiple Myeloma.- E. Neoplasms.- I. Secondary Neoplasms.- II. Primary Neoplasms.- 1) Malignant.- 2) Benign.- F. Infectious Diseases.- G. Fractures of the Sellar Region.- I. Mechanism of Fractures of the Sellar Region.- II. Clinical Picture.- III. Complications.- 1) Rhinorrhea.- 2) Vascular Lesions.- 3) Hypothalamic and Pituitary Lesions.- 4) Pneumocephalus.- IV. Radiology.- 1) Fractures of the Planum Sphenoidale and Chiasmatic Sulcus.- 2) Fractures of the Anterior Wall and Floor of the Sella Turcica.- 3) Fractures of the Dorsum Sellae.- 4) Comminuted Fractures.- H. Miscellaneous.- I. Arterial Hypertension and Atherosclerosis.- 1) Arterial Calcifications.- 2) Vascular Tortuosity.- 3) Arterial Hypertension.- II. Fibrous Dysplasia.- III. Paget's Disease.- IV. Dystrophia Myotonica.- 14 Exercises and Pitfalls.- 15 Advances in CT of the Pituitary Gland.- A. Method of CT Examination.- B. Results.- I. Normal Results.- II. CT of Pituitary Adenomas.- 1) Adenomas with Suprasellar Expansion.- 2) Intrasellar Adenomas.- 3) Treated Adenomas.- C. Bibliography.- References.

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