The Dural Dark-Side Approach for falcine and tentorial meningioma: A surgical series of five patients

Introduction: Falcine or tentorial meningioma can be complex to resect. When large meningiomas are located in eloquent areas, a direct ipsilateral surgical approach may cause brain injury and postoperative neurological deficits. In this series, 5 patients were surgically treated using a contralateral transfalcine or transtentorial approach to minimize brain retraction. This strategy was called the Dural Dark-Side Approach (DDSA). The aim was to analyze the quality of tumor resection and postoperative outcome. Material and methods: In our department, from June 2018 to January 2020, 5 patients underwent microsurgical DDSA for resection of 4 falcine and 1 tentorial meningioma. All tumors were selected on the following two criteria: large>40mm diameter tumor, with surrounding functional cortex. Clinical and radiologic data were retrospectively analyzed. Results and discussion: Mean follow-up was 20 months. No patients required use of a rigid retractor during surgery. Gross total resection was performed in 3 patients and near-total resection in 2. All patients had favorable neurologic outcome. Postoperative MRI showed no ipsilateral or contralateral brain lesions. Conclusion: This series suggested that meticulous DDSA allows excellent resection in selected large falcine or tentorial meningioma. The approach offered a safe and effective surgical corridor without injuring the surrounding healthy parenchyma. Keywords: Approche controlatérale; Approche transdurale; Chirurgie sans écarteur; Contralateral approach; Dural Dark-Side Approach; No-touch strategy; Retractorless surgery; Stratégie « no touch »; Transfalcine; Transfalcoriel; Transtentorial; Transtentoriel

Gonadotropic status in adult women with pituitary stalk interruption syndrome: Gonadotropic function in adult women with PSIS

International audienceObjective Pituitary stalk interruption syndrome (PSIS) is a rare cause of congenital hypopituitarism. Limited data exist on the gonadotropic status and fertility of adult women with PSIS. Our study aims to describe pubertal development and the evolution of gonadotropic function and fertility in adult women with PSIS. Design Retrospective multicentric French study. MethodsWe described gonadotropic function in 56 adult women with PSIS from puberty onwards. We compared live birth rates per woman with PSIS to age-matched controls from the large French epidemiological cohort (CONSTANCES). Additionally, we assessed height, BMI, blood pressure, other metabolic parameters, and socio-economic status. Results and ConclusionsAmong 56 women with PSIS, 36 did not experience spontaneous puberty. Of these, 13 underwent ovarian stimulation resulting in 7 women having a total of 11 children. In the subgroup with spontaneous puberty (n = 20), 4 had a total of 8 pregnancies while 6 developed secondary gonadotropic deficiency. Women with PSIS had fewer children than controls (0.33 versus 0.63, p = 0.04). Median height was also lower (160.5 cm versus 165.0 cm, p < 0.0001). Although mean blood pressure was lower in women with PSIS compared to controls, (111.3/65.9 ± 11.2/8.1 mmHg vs 118.7/72.1 ± 10.1/7.7 mmHg, p < 0.001), there were no significant differences in other metabolic parameters, notably BMI and lipid profile. Employment/academic status was not different in the two groups but fewer women with PSIS were in relationships (42% versus 57.6% in controls, p = 0.02). The fertility prognosis in patients with PSIS needs optimization. Patients should be informed about the likelihood of declining gonadotropic function over time

Pituitary surgery outcome in patients 75 years and older: a retrospective study.

As the population ages, the number of elderly patients with an indication for pituitary surgery is rising. Information on the outcome of patients aged over 75 is limited. This study reports a large series assessing the feasibility of surgical resection in this specific age range, focusing on surgical complications and postoperative results. A retrospective cohort study of patients with pituitary adenomas and Rathke's cleft cysts was conducted. All patients were aged 75 years or over and treated by a single expert neurosurgical team. A control population included 2379 younger adult patients operated by the same surgeons during the same period. Between 2008 and 2022, 155 patients underwent surgery. Indication was based on vision impairment in most patients (79%). Median follow-up was 13 months (range: 3-96). The first surgery was performed with an endoscopic transsellar approach, an extended endonasal transtuberculum approach and a microscopic transcranial approach in 96%, 3%, and 1% of patients, respectively. Single surgery was sufficient to obtain volume control in 97% of patients. From Kaplan-Meier estimates, 2-year and 5-year disease control with a single surgery were 97.3% and 86.2%, respectively. Resection higher than 80% was achieved in 77% of patients. No vision worsening occurred. In acromegaly and Cushing's disease, endocrine remission was obtained in 90% of non-invasive adenomas. Surgical complications were noted in 5% of patients, with 30-day mortality, hematoma, cerebrospinal fluid leak, meningitis, and epistaxis occurring in 0.6%, 0.6%, 1.9%, 0.6%, and 1.3% respectively. New endocrine anterior deficits occurred in only 5%, while no persistent diabetes insipidus was noted. Compared with younger patients, the complication rate was not statistically different. Surgery beyond the age of 75, mainly relying on an endoscopic endonasal transsellar approach, is effective and safe, provided that patients are managed in tertiary centers