Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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23-AUGUST-2009 IBRAHEEM ALI IBRAHEEM 63 YEARS
HUGE CHROMOPHOBE PITUITARY ADENOMA WITH MASSIVE INFRASELLAR EXTENSION.
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The son of the patient came 7
days ago, telling that his father after diarrhea
attack got fainting and headache. CT-scan
performed to him showed sellar mass.
MRI of the sella with
endocrine and visual functions were performed
and a huge chromophobe pituitary adenoma with
massive infrasellar extension and compressing
the chiasm upward and the pituitary stalk
posteriorly. Bitemporal hemianopsia with
panhypopituitarism were identified. The patient
is not known to have diabetes mellitus nor
arterial hypertension. He is claiming that he
has headache for more than 10 years and not
noticing the visual defects.
The son was urging not to
tell his father about the tumor, for what his request
through the left nostril was performed and using
image-intensifier the retractors were inserted
anterior to the sphenoid sinus, which was
drilled and opened. The floor of the widened
sella was opened and the pituitary gland was
exposed 10X10 mm. The tumor was opened and
removal of the friable tumor was done. Some
fragments were sent for biopsy and the remaining
parts were sucked easily. It was possible to see
the wall of the tumor cavity, which is actually
is the pituitary gland. Insertion of Omnipaque
to the tumor bed was performed and check was
performed with image-intensifier. Further
insertion of the contrast to the sphenoid sinus
was done to rule out the presence of
considerable remnants. No CSF leak was noted
during the procedure.
Routine closure of the
wound and smooth
and the patient sent to
The tumor could be
coincidental finding during investigation for
diarrhea, but considering that it has huge
volume with signs of panhypopituitarism and
visual defects, surgery was indicated.
Frontal lobe syndrome could
have place, since the patient was sent to the
theater to wash the wax from his ear, as urged
his son, this hold the suspicion of frontal lobe
syndrome, because a patient with normal frontal
lobes will ask many times, why to wash the wax
under G.A. and from the nose?
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Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .