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14-NOVEMBER-2015 AZZAM MUHAMED KURDI 60 YEARS
PITUITARY MIXED PROLACTINOMA WITH LEFT SUPRA AND RIGHT PARASELLAR EXTENSION.
Anamnesis
The patient is a doctor of psychiatry came
11-November-2015 complaining of general weakness
and fainting attacks for 4 years and diagnosed
as having prolactinoma. He is diabetic for 10
years with hypertension for 20 years. Signs of
panhypopituitarism were found and treated with
L-thyroxin, testosterone and Dystinox 1/2 tab
every 2 days. MRI sella done 29-December-2013
and repeated 14-October-2015 showing the
macroadenona is progressing in size and start to
compress the optic chiasm from the left and
right parasellar extension. The patient noticed
visual disturbances of the left eye the last 3
months. PRL level was 6.3
µIU/ml
performed 14-October-2015.
The patient was sent for investigations and MRI
done 11-November-2015 showing the pituitary
adenoma and the MRA showed the relation of the
vascular relation to the mass.
Transsphenoidal approach
guided with the C-arm until the anterior wall of
the sphenoid sinus reached through the right
nostril. The floor of the sella turcica was
partially removed to reach the tumor. The tumor
is soft in consistency and it was sent for
histologic verification. The tumor was removed
trying to preserve the pituitary gland, which is
actually the tumor capsule. The eroded dorsum
sella was seen. A cavity was obtained inside to
pituitary gland. MRI control showed
remnant of the tumor at the left side. This part
was removed and further removal of the tumor was
obtained. 2 Eonmedltech nasal packs with tubes
were inserted and another control MRI was
performed. The almost radically removed, but
packs are directed toward the tumor. They were
removed and reinserted to the pharyngio-nasal
cavity. The patient then was extubated.
Smooth postoperative recovery. The patient was
sent to the ward.
Comments
The tumor is not responding to Dystinox ,
which means that it is not a pure prolactinoma. The earlier
the resection the better the outcome.
Intraoperative MRI not only confirm the
radical removal of the tumor, but also detect other events
such as misdirection of the nasal tubes, which were
corrected accordingly.
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Control MRI of the sella performed 23-December-2015 demonstrating
radical resection of the pituitary adenoma. Frontal view.
Sagittal view.
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 .
