0:00

This is a twelve-year-old, you know,

0:01

rule out microadenoma. Is this case tough or tufted?

0:05

Well, let me just try to show some things.

0:09

Dr. Pomerance,

0:10

we all just benefited from your

0:13

elevated discussion of classic anatomy.

0:16

But I'm not that classic a guy.

0:18

I'm kind of Mr. Practical.

0:20

So there was mention made in your discussion of the

0:24

pituitary. Okay, well, what is the importance of that?

0:28

Well,

0:28

a tuft is one of the first things I look for when I'm

0:31

looking for a pituitary case because it helps you

0:33

straighten out what's normal, what's not.

0:36

Okay, so this is the tuft,

0:38

and you can see the structure,

0:39

vascular structure enhancing. All right,

0:43

so how does that help you?

0:44

Well,

0:46

if you relate it to other things.

0:47

For example, here's the pituitary stalk.

0:50

We talked about that in the last section.

0:53

So you can say, well, if the stalk is deviated,

0:56

is that a problem?

0:57

Well, then you can go right down and look at the tuft and say,

1:01

yeah, but the tuft is not.

1:02

So if there was a mass deviating the stalk,

1:04

why wouldn't the tuft also be deviated?

1:07

It's not. Sure. Okay. Same thing here.

1:10

You get some kind of heterogeneous signal

1:13

is that a tumor comes up a lot.

1:16

Yeah, so that comes up a lot,

1:17

but you don't see mass effect here.

1:20

So the tuft can be a very useful, subtle finding.

1:25

You're going to see it in most cases.

1:26

So if you're trying to make that distinction

1:28

or whether we have a problem or not,

1:30

you can sometimes the tuft can bail you out.

1:32

So let me see if I could summarize it.

1:34

You're a classic guy,

1:35

but in reality, he's a neurosurgeon.

1:38

So he's a heck of a lot smarter than I am.

1:40

If we look at the pituitary gland and I trace it,

1:44

you've got this funny-looking dark spot right here.

1:48

FLDS right there. I'm going to color over it.

1:52

And you say to yourself,

1:53

often this comes up all the time.

1:55

Is that a microadenoma? Especially if somebody says,

1:57

rule out microadenoma. You're really worried about that.

2:00

And what Dr.

2:01

Schupeck is saying is if the stalk happens to be

2:03

oblique in one direction or the other,

2:06

like this or this,

2:07

or the stalk is deviated to one side or the other,

2:10

this way or that way.

2:11

You then go look inside and you look at this portal

2:13

plexus blush of vascularity, the pituitary tuft.

2:17

And if it's right smack dab in the midline, no worries,

2:21

everything's good. You don't have a microadenoma.

2:24

Let's move on, shall we?