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Diagnosis and Treatment of Parasellar Lesions.
Neuroendocrinology ( IF 4.1 ) Pub Date : 2020-03-04 , DOI: 10.1159/000506905
Federico Gatto 1 , Luis G Perez-Rivas 2 , Nicoleta Cristina Olarescu 3, 4 , Pati Khandeva 5 , Konstantina Chachlaki 6 , Giampaolo Trivellin 7 , Manuel D Gahete 8, 9, 10, 11 , Thomas Cuny 12 ,
Affiliation  

The parasellar region, located around the sella turcica, is an anatomically complex area representing a crossroads for important adjacent structures. Several lesions, including tumoral, inflammatory vascular, and infectious diseases may affect this area. Although invasive pituitary tumors are the most common neoplasms encountered within the parasellar region, other tumoral (and cystic) lesions can also be detected. Craniopharyngiomas, meningiomas, as well as Rathke's cleft cysts, chordomas, and ectopic pituitary tumors can primarily originate from the parasellar region. Except for hormone-producing ectopic pituitary tumors, signs and symptoms of these lesions are usually nonspecific, due to a mass effect on the surrounding anatomical structures (i.e., headache, visual defects), while a clinically relevant impairment of endocrine function (mainly anterior hypopituitarism and/or diabetes insipidus) can be present if the pituitary gland is displaced or compressed. Differential diagnosis of parasellar lesions mainly relies on magnetic resonance imaging, which should be interpreted by neuroradiologists skilled in base skull imaging. Neurosurgery is the main treatment, alone or in combination with radiotherapy. Of note, recent studies have identified gene mutations or signaling pathway modulators that represent potential candidates for the development of targeted therapies, particularly for craniopharyngiomas and meningiomas. In summary, parasellar lesions still represent a diagnostic and therapeutic challenge. A deeper knowledge of this complex anatomical site, the improvement of imaging tools, as well as novel insights into the pathophysiology of presenting lesions are strongly needed to improve the management of parasellar lesions.

中文翻译:

鞍旁病变的诊断和治疗。

鞍旁区域位于蝶鞍周围,是解剖学上复杂的区域,代表重要相邻结构的十字路口。包括肿瘤、炎性血管和传染病在内的几种病变可能会影响该区域。虽然侵袭性垂体瘤是鞍旁区域最常见的肿瘤,但也可以检测到其他肿瘤(和囊性)病变。颅咽管瘤、脑膜瘤以及 Rathke 裂囊肿、脊索瘤和异位垂体瘤可主要起源于鞍旁区域。除了产生激素的异位垂体瘤外,这些病变的体征和症状通常是非特异性的,这是由于对周围解剖结构的占位效应(即头痛、视力缺陷),如果垂体移位或受压,则可能存在临床相关的内分泌功能损害(主要是垂体前叶功能减退症和/或尿崩症)。鞍旁病变的鉴别诊断主要依靠磁共振成像,应由擅长基底颅骨成像的神经放射科医生进行解读。神经外科是主要的治疗方法,单独或与放疗联合。值得注意的是,最近的研究已经确定了基因突变或信号通路调节剂,它们代表了靶向治疗开发的潜在候选者,特别是针对颅咽管瘤和脑膜瘤。总之,鞍旁病变仍然是诊断和治疗方面的挑战。更深入地了解这个复杂的解剖部位,改进成像工具,
更新日期:2020-03-04
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