Publications by authors named "Ciro A Vasquez"

4 Publications

  • Page 1 of 1

Functioning Pituitary Adenoma with Xanthogranulomatous Features: Review of Literature and Case Report.

J Neurol Surg B Skull Base 2019 Oct 21;80(5):449-457. Epub 2018 Nov 21.

University of Colorado, Aurora, Colorado, United States.

 We present a patient with a prolactin-secreting adenoma with extensive secondary, noninfectious, xanthogranulomatous changes due to remote intratumoral bleeding and provide a literature review of xanthogranulomas (XGs) of the sellar region with emphasis on prolactinomas with xanthogranulomatous features.  Case report, with PubMed search of cases of sellar XG, focusing on neuroimaging and surgical approach.  A 35-year-old male was found to have a large sellar/suprasellar calcified/cystic mass. Endoscopic transsphenoidal approach for extradural resection was performed and diagnosis made. Review generated 31 patients with the diagnosis of sellar XG. In a minority (6 patients), the underlying lesion for the XG was a pituitary adenoma. Headache was the most common presenting symptom and panhypopituitarism the most common endocrinological abnormality. Examples of hyperprolactinemia associated with sellar XG are also uncommon and due to stalk effect. Neuroimaging of XG on T1-weighted magnetic resonance imaging (MRIs) showed 18 cases (56.3%) were hyperintense, 1 case (3.13%) was isointense, 4 (12.5%) had mixed-signal intensity, and 2 (6.25%) were hypointense. On T2-weighted MRIs, five lesions (15.6%) were hyperintense, three (9.38%) were isointense, nine (28.1%) were heterogeneous, and nine (28.1%) were hypointense. Only one case (3.1%) had calcifications on computed tomography scan similar to ours. In 14 cases (43.7%), the lesions enhanced with contrast administration on MRI.  Prolactinomas with secondary xanthogranulomatous change represent a rare cause of XG of the sella. With no radiological or clinical signs specific for XG of the sellar region, preoperative diagnosis can be challenging, if not impossible.
View Article and Find Full Text PDF

Download full-text PDF

Source Listing
October 2019

Development of a Novel Canine Model of Ischemic Stroke: Skull Base Approach with Transient Middle Cerebral Artery Occlusion.

World Neurosurg 2019 Jul 19;127:e251-e260. Epub 2019 Mar 19.

Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA; Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA; Stem Cell Institute, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address:

Objective: Although canine stroke models have several intrinsic advantages, establishing consistent and reproducible territorial stroke in these models has been challenging because of the abundance of collateral circulation. We have described a skull-base surgical approach that yields reproducible stroke volumes.

Methods: Ten male beagles were studied. In all 10 dogs, a craniectomy was performed to expose the circle of Willis. Cerebral aneurysm clips were temporarily applied to the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery, and/or ophthalmic artery (OA) for 1 hour, followed by cauterization of the distal MCA pial collateral vessels. Indocyanine green angiography was performed to assess the local blood flow to the intended area of infarction. The dogs' neurologic examination was evaluated, and the stroke burden was quantified using magnetic resonance imaging.

Results: High mortality was observed after 1-hour clip occlusion of the posterior cerebral artery, MCA, ACA, and OA (n = 4). Without coagulation of the MCA collateral vessels, 1-hour occlusion of the MCA and/or ACA and OA yielded inconsistent stroke volumes (n = 2). In contrast, after coagulation of the distal MCA pial collateral vessels, 1-hour occlusion of the MCA, ACA, and OA yielded consistent territorial stroke volumes (n = 4; average stroke volume, 9.13 ± 0.90 cm; no surgical mortalities), with reproducible neurologic deficits.

Conclusion: Consistent stroke volumes can be achieved in male beagles using a skull base surgical approach with temporary occlusion of the MCA, ACA, and OA when combined with cauterization of the distal MCA pial collateral vessels.
View Article and Find Full Text PDF

Download full-text PDF

Source Listing
July 2019

The Tentorial Bridge to Deep Skull Base Exposure: Anatomic Morphometric Study.

World Neurosurg 2018 Jun 16;114:e588-e596. Epub 2018 Mar 16.

Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA. Electronic address:

Background: Skull base surgeons split the tentorium to expand exposure, minimize brain retraction, and combine the supratentorial and infratentorial compartments for resection of large skull base lesions. The aim of this study was to describe stepwise techniques for splitting the tentorium to access deeply located skull base lesions and morphometrically assess gained exposure.

Methods: Surgical exposures were performed through transsylvian, subtemporal, posterior transpetrosal, and combined posterior supratentorial/infratentorial-transsinus approaches. A custom software program was used to trace the surgical exposure region of interest for area analysis with the ability to accurately assess most irregular areas. Qualitative morphometric assessment was done of the gain in anatomic exposure achieved by splitting the tentorium.

Results: In the transsylvian transtentorial approach, mean surface area increased 154.17%, from 0.14 cm before expansion to 0.32 cm after expansion. In the subtemporal transtentorial approach, mean surface area increased 137.61%, from 0.66 cm before expansion to 1.52 cm after expansion. In the posterior transpetrosal transtentorial approach, mean surface area increased 171.06%, from 1.08 cm before expansion to 2.81 cm after expansion. In the combined supratentorial/infratentorial-transsinus approach, mean surface area increased 222.03%, from 0.78 cm before expansion to 2.38 cm after expansion.

Conclusions: With splitting of the tentorium, a substantial area of expansion is obtained, minimizing the need for brain retraction and improving visualization of deep neurovascular structures in the skull base.
View Article and Find Full Text PDF

Download full-text PDF

Source Listing
June 2018

Third Ventricular Cerebrospinal Fluid Cysts of Thalamic Origin: Review of Embryologic Origin, Presentation, and Management Strategies with a Case Series.

World Neurosurg 2017 Jul 6;103:210-219. Epub 2017 Apr 6.

Department of Neurosurgery, University of Colorado, Denver, Colorado, USA. Electronic address:

Objective: Third ventricular cerebrospinal fluid (CSF) cysts of thalamic origin are rare. The objective of this study is to review their possible pathogenesis, clinical presentation, and management strategies with a case series describing management via an endoscopic approach with fenestration using a single burr-hole technique.

Methods: A systematic literature review of reported cases of thalamic cysts was conducted with further meta-analysis of CSF cysts that involve the third ventricle. The mode of presentation, pathologic analysis, surgical management, and outcomes were analyzed.

Results: Twenty-two studies reported between 1990 and 2013 described 42 cases of thalamic cyst. Of those cases, 13 were consistent with CSF cyst that originated in the thalamus and involved the third ventricle. Eight cases (61.5%) were treated via endoscopic fenestration, 2 cases (15.4%) were surgically drained, 2 cases (15.4%) were stereotactically aspirated, and 1 case (7.69%) was observed. The most common presenting symptoms were gait disturbance (26.3%) and headaches (26.3%) followed by tremors (15.8%) and weakness (15.8%). In our series, a single burr-hole technique was a successful definitive treatment, with an average period of 23 months.

Conclusions: Third ventricular CSF cysts of thalamic origin most commonly present with hydrocephalus. They can be safely definitively treated via endoscopic fenestration to the CSF circulation using a single burr-hole technique. Long-term follow-up shows lasting improvement in symptoms without reaccumulation of the cyst.
View Article and Find Full Text PDF

Download full-text PDF

Source Listing
July 2017