(A) pituitary adenoma
1 chromophobe pituitary adenoma chromophobe pituitary adenoma pituitary chromophobe tumor evolved the most breakthrough saddle diaphragm to the saddle on growth. The clinical manifestations of endocrine disorders, vision, vision changes, changes in the sella and headache. With craniopharyngioma clinical manifestations similar, but occurs in adults. Endocrine disorder manifested as loss of libido, menopause, obesity. Papilledema was primary atrophy, often temporal hemianopsia and sella destruction. The patient typically increased intracranial pressure. On the X-ray examination intrasellar and suprasellar no calcification.
2. Eosinophilic pituitary adenoma eosinophilic pituitary adenoma from the pituitary eosinophilic cells (alpha cells) can break through the saddle diaphragm to compress the optic fiber development in the saddle, visual acuity and visual field changes. Since a large number of eosinophils secrete growth hormone, craniopharyngioma different at: tongue increased in adults osteophiphysis acromegaly clinical manifestations of hand, foot mast, prominent jaw, nose increases, wide and often humpback simultaneously visceral hypertrophy. Patients look lumpy, thicker sound. (2) incidence in children and young people, due to the epiphysis is not yet healed, then the performance of gigantism, but the development of the parts of the body evenly.
(B) the optic chiasm Ministry glioma the optic chiasm Ministry of glioma originated in the glial cells of the optic chiasm, optic nerve and hypothalamus, the most common of the astrocytes. More common in young people. Originated in the the hypothalamic glioma down development may compress the optic nerve or chiasm, originated in the optic chiasm glioma upward intrusion hypothalamus between them (in the hypothalamus and optic chiasm glioma) can influence each other. The clinical manifestations were headache, the vision vision changes, endocrine disorders and symptoms of hypothalamus. Headache located in the frontotemporal, often the first symptom, and accompanied by nausea and vomiting. Tumor invasion hypothalamic the lower and pituitary, patients will appear amenorrhea, loss of libido, polydipsia and polyuria. Vision loss, the extent of bilateral hypothyroidism often inconsistent. The vision change Duocheng the bitemporal hemianopia, with hemianopia and a blind other eye vision part of defects is also common. The optic disc Duocheng primary atrophy. In addition, patients may also often lethargy and obesity. X-ray examination is often found in the sellar expansion, some patients calcification spots in the saddle, and therefore with craniopharyngioma identification sometimes more difficult. But if the tumor is intracranial orbital type, the patient often exophthalmos identification easier.
(C) the tuberculum sellae meningiomas of the disease in the clinical major headache, visual disturbances, low pituitary hypothalamus function and increased intracranial pressure. Its vision Duocheng slow sexual dysfunction, as well as the common symptoms of the patient. Patient two asymmetry, irregular visual field defects, or one blind and the other eye is normal, or a blindness in the other eye temporal hemianopia. The optic disc Duocheng primary atrophy. A small number of patients to the late endocrine symptoms, such as impotence, amenorrhea. Headaches are lighter, and more in the frontotemporal. In addition, patients may also hyposmia or disappear and Ⅲ, Ⅴ cranial nerve dysfunction. X skull plain film may show the tuberculum sellae sella anterior wall hyperostosis, the sella generally do not expand. Cerebral angiography shows the level of the anterior cerebral artery segment elevation, sometimes visible outline of a tumor by microvascular tuberculum sellae, tuberculum sellae radial vascular shadow. Tuberculum sellae meningiomas therefore may be considered for patients with temporal hemianopsia, optic nerve was primary atrophy, the sella no exception.
(D) The third ventricle tumor incidence in children and young people more tumor obstruction of cerebrospinal fluid circulation pathway and oppression around the third ventricle structure and the corresponding clinical symptoms. Typical manifestations of increased intracranial pressure, paroxysmal headache and disturbance of consciousness. Sideways growth of the tumor may compress the optic tract and decreased visual acuity and visual field defects. Patients with paroxysmal headache with postural closely related to the patient supine easily cause seizures. Tumor invasion of the superior colliculus, obesity, lethargy or diabetes insipidus. Skull X-ray visible pineal calcification shift. Normal sella, saddle pathological calcification. The ventriculography visible third ventricle filling defect or showed only one side of the lateral ventricle to developing and expanding, but no shift. Craniopharyngioma is not difficult to identify.
(E) lateral ventricle choroid papilloma choroid papilloma occurred in the lateral ventricles triangle. Tumors secrete large amounts of cerebrospinal fluid communicating hydrocephalus. The tumor may be floating in the ventricle, caused by obstruction of cerebrospinal fluid circulation pathway sudden increased intracranial pressure, the patient showed severe headache, accompanied by nausea, vomiting, dizziness or even coma. Therefore, the patient often presents forced head position; hemiplegia, unilateral sensory disturbances often appear due to the oppression of the tumor to surrounding tissue, with hemianopia, etc., sometimes there may be a change in hearing and cerebellar signs. The ventriculography display the lateral ventricles expand, shift, or a filling defect, sometimes the side room Triangle tumor calcification. Lumbar puncture pressure broadening, cerebrospinal fluid containing protein.
(F) saddle chondroma intracranial chondroma occur in the dura mater of the cranial base, it is generally believed that the residual from the base of the skull suture outside embryonic cartilage cells evolved. The saddle chondroma patients without intracranial hypertension, the Clinical Changbiaoxianwei proptosis and eye off the pain, oculomotor nerve palsy, impaired vision and visual field defects. The fundus examination optic nerve was primary atrophy. Skull plain film suprasellar the common calcification. Cerebral angiography carotid artery siphon passage of time and deformation. The disease is rare pituitary symptoms.
(VII) the saddle ectopic pinealoma saddle ectopic pineal tumors more than glioma, multiple children and youth, the majority of the patient’s initial symptoms of diabetes insipidus. Showed polydipsia and polyuria, daily urine output even up to 3000 ~ 5000ml, 10000ml. Thereafter the gradual emergence of visual impairment and visual field defects (mostly bitemporal hemianopia), such as a temporal hemianopsia blindness in the other eye, and with the hemianopia. Fundus examination optic disc was primary atrophy. Patients with pituitary dysfunction, loss of libido, childhood-onset manifested as short stature, and some symptoms of precocious puberty. The small number of patients have fever, respiratory changed. Headache located in the forehead, about half or more accompanied by nausea and vomiting. Some patients may present Ⅲ, Ⅵ cranial nerve dysfunction. Skull plain film X-ray is normal sella, many no calcification in the saddle. Angiography signs of the saddle on a space-occupying lesions.
(H) the saddle area cholesteatoma Intracranial Cholesterol is a development from the the residual embryonic ectoderm skin tissue together. The sellar region as one of the predilection sites, located on the saddle cholesteatoma compress the optic fiber, the occurrence of vision loss and visual field defect, optic nerve was primary atrophy. X-ray showed sellar expansion of the superior orbital fissure, optic foramen at the anterior clinoid bone resorption. Located in the parasellar the cholesteatoma sometimes involving the trigeminal nerve, symptoms of trigeminal neuralgia. Microscope cholesteatoma outer layer of connective tissue, the inner wall of stratified squamous epithelium and shedding keratosis and layered arrangement, identification phase with craniopharyngioma tube.
(Ix) empty sella syndrome empty sella syndrome refers saddle diaphragm hole expand or disappear saddle diaphragm, the emptiness was filled with cerebrospinal fluid are in the saddle, the pituitary atrophy and partial living side. There are two types of primary and secondary, the former no obvious cause of intracranial, may be due to large congenital saddle phrenic hole or saddle diaphragm disappear, the arachnoid hanging into the saddle chamber, occupies its most, and pituitary squeeze pressure on one side. The clinical manifestations of headache, pituitary dysfunction, visual impairment, some patients may be a vision defect. Gas brain imaging showed sellar expansion. Secondary empty sella syndrome may occur after surgery or radiation treatment of pituitary tumors, or pituitary necrosis caused by other causes. Its clinical manifestations associated with primary basically the same, but the more prominent visual impairments. Sometimes pituitary tumors can be accompanied by empty sella syndrome, gas brain imaging shows gas filled sella cavity, accompanied by endocrine disorders, abnormal large visible saddle diaphragm hole surgery.
(10) temporal lobe tumor temporal lobe tumor predilection in young people, more common to meningioma and glioma. The major clinical manifestations of visual field changes, sensory aphasia, seizures. Temporal lobe tumors can occur due to optic radiation or compression failure of the optic tract the isotropic upper quadrant of the visual field defect or with hemianopia. Temporal gyrus sensory speech center, damage to this area often appear sensory aphasia, and performance to be able to speak for the patient, but often an error, do not understand the meaning of what others are saying, sometimes naming aphasia patients. Seizures and more various hallucinations, visual hallucinations and hearing voices. When the sac tumor compression and brain limb hemiplegia. Individual patients may have ataxia and appear athetosic psychosis. Cerebral angiography: the front part of the temporal lobe tumors, like the images of the anterior cerebral artery and middle cerebral artery of the “V” shape formed in the anteroposterior. The forward lateral as the middle cerebral artery on shift. Shift to the contralateral temporal lobe tumor at the rear of the anterior cerebral artery lighter, but common anterior cerebral artery and middle cerebral arteries horizontal section, the sylvian section and clinoid segment constituted “U”-shaped image.
(11) occipital lobe tumor occipital lobe tumor clinical decreased visual acuity and visual field defect. Showed a lesion contralateral hemianopia or quadrant hemianopia, while visual agnosia and visual hallucinations. Its the phosphenes multi shapeless, such as lightning, Mars or circle, and can fluctuate. Hallucinations can also be a harbinger for epilepsy. At the the parietooccipital junction of a head and eye rotation hub, the area affected head eye to the contralateral rotation and easy to identify, and craniopharyngioma.
(12) sphenoid ridge meningioma and craniopharyngioma need to identify those that occurred in 1/3 of the sphenoid ridge meningioma. The sphenoid ridge meningioma good site and incidence rates of 1/3 accounted for about 25%. The clinical manifestations of visual field defects, eye movement disorder, mydriasis, ptosis, unresponsive to light. This is the oculomotor nerve, optic nerve and the superior orbital fissure due to compression. In addition, patients often anosmia, few patients had contralateral hemiplegia. Fundus examination can be found in the lesion side of the optic nerve was primary atrophy the side nipple edema. Skull radiograph shows the lesion side orbital bone density reduced the superior orbital fissure expanding and blurring the optic foramen constant partial pressure becomes. Cerebral angiography shows the brain arteries proximal segment back above the light shift the the intracranial epidural segment of the internal carotid artery back on shift and siphon opening.
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