Figure 3

Pre- and post-operative images and intraoperative findings of each subtype of CPs via endoscopic endonasal approach. (A1-6) A case of Central type CP. (A1-2) Coronal and sagittal postcontrast T1-weighted MR images showing a Central type CP which is located in the midline. (A3-4) Intraoperative photographs showing that tumor grew within and along the stalk, and the characteristic structure of stalk could be clearly identified on the surface of tumor (A3). Bilateral hypothalamus damage limited to tuber cinereum area could be seen after tumor removal (A4). (A5-6) Coronal and sagittal postcontrast T1-weighted MR images obtained after GTR. The pituitary gland was preserved and intact, but the stalk was not preserved. (B1-6) A case of Hypothalamic stalk CP. (B1-2) Coronal and sagittal postcontrast T1-weighted MR images showing a suprasellar CP located slightly toward to the left side and grows into the third ventricle, with the anterior third ventricle shifted to the right side (yellow arrowheads in B1). (B3-4) Intraoperative photographs showing that tumor originated from the junction of the hypothalamus and the stalk (white arrowheads in B3), the stalk was pushed to the right side. After tumor removal, a defect at the left side of the third ventricle floor could be found, and the remnant of stalk was pushed to the right side and connected to the right side of the third ventricle floor, with a relative normal hypothalamus at the right side (B4). (B5-6) Coronal and sagittal postcontrast T1-weighted MR images showing total tumor removal achieved. The stalk was preserved and pushed to the right side (red arrowhead in B5), the right hypothalamus was intact (blue arrowheads in B5-6). Note the vascularized nasoseptal flap at the posterior aspect of the sphenoid sinus on the sagittal image (orange arrowhead in B6). (C1-6) A case of Suprasellar stalk CP. (C1-2) Coronal and sagittal postcontrast T1-weighted MR images showing a suprasellar CP located toward to the left side, with the anterior third ventricle shifted to the right side (yellow arrowheads in C1). (C3-4) Intraoperative photographs showing that tumor derived from suprasellar segment, low portion of the stalk (black arrowheads in C3). After tumor removal, the third ventricle floor was intact, with no hypothalamus damage, and the remanent of stalk was pushed to the right side (C4). (C5-6) Coronal and sagittal postcontrast T1-weighted MR images showing total tumor removal achieved. The stalk was preserved and pushed to the right side (red arrowhead in C5), and the hypothalamus was intact (blue arrowheads in C5-6). Note the vascularized nasoseptal flap at the posterior aspect of the sphenoid sinus on the sagittal image (orange arrowhead in C6). (D1-6) A case of Intrasellar stalk CP. (D1-2) Coronal and sagittal postcontrast T1-weighted MR images showing a typical intrasellar CP. (D3-4) Intraoperative photographs showing that the solid tumor located in the sellar region. Residual pituitary gland and stalk can be seen after tumor removal (D4). (D5-6) Coronal and sagittal postcontrast T1-weighted MR images showing total tumor removal achieved. Ht, hypothalamus; Tu, tumor; Pg, pituitary gland; Ps, pituitary stalk. 3rd V., the third ventricle.