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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15-JANUARY-2012 ABDEL-SATTAR MUHAMED MISLEH 33 YEARS
HUGE INFRA-SUPRASELLAR CHROMOPHOBE PITUITARY ADENOMA.
patient came to the clinic 03-January-2012
complaining of visual disturbances for 18 months
with bitemporal hemianopia with decrease visual
acuity, more the left with bifrontal
headache. The headache decreased after dramatic
deterioration of visual functions.
MRI of the
brain done 25-December-2011 showing huge
pituitary adenoma with supra and infrasellar
extension more to the left. There is also left
maxillary polyp with sinusitis.
examination, the patient visual acuity is 0.63
in the right and 0.03 in the left with
bitemporal anopia more dense in the left.
Hormonal studies performed showing decreased
levels of LH, FSH, testosterone and GH.
Prolactine was 21.8 ng/ml.
patient was given antibiotics to resolve the
infectious process in the sinuses, to avoid
possible postoperative inflammatory
Using C-arm, transsphenoidal approach achieved
from the left nostril. The tumor was seen
destroying the pituitary floor in the left side.
Generous bony opening of the floor to expose
most of the infrasellar extension. All the
sellar and infrasellar parts were removed.
Several fragments sent for histologic studies
and the tumor mass was soft, but suckable with
difficulty. he pituitary gland, which is
actually the tumor wall was preserved. Using the
endoscopic facilities with straight and 30
degree endoscopes, the suprasellar was removed
with caution, so as not to violate the neural
structures and not to allow CSF leak. Using
Valsalva maneuver and putting the head of the
patient head down below the heart level , the
suprasellar part was pushed down and removed.
Check for CSF leak was negative. The cavity of
the resected tumor was filled with contrast and
checked with the image-intensifier.
closure of the wounds. Smooth postoperative
recovery with improvement of the vision of the
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The patient have a huge tumor with rounded shape
and with infrasellar growth. There are no signs
of cavernous sinus invasion. In this case the
transsphenoidal approach is justified.
It is possible through this approach to see the
most posterior parts of the suprasellar
component of the tumor. The anterior parts are
not seen and only the feeling by the curette and
guising of the neurosurgeon remain to weight
between radical resection and avoidance of CSF
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 .
Postoperative MRI showing dramatic reduction of the
tumor mass and the tumor wall is actually the pituitary gland with
pituitary stalk are preserved.