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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  neurosurgery.tv

 

 

08-OCTOBER-2006  RAAFAT YOUSEF ZOMA  39 YEARS  ACROMEGALY- MACROADENOMA WITH INFRASELLAR EXTENSION.    

The patient came to the clinic 30-September-2006 complaining of numbness all four limbs for 4 years. MRI performed 12-January-2002 showed coincidental left arachnoid cyst with pituitary macroadenoma MRI repeated 04-August-2003 and 07-September-2006 which confirmed the progressive enlargement of the macroadenoma, despite the fact he was treated for long time by parlodel without effect and despite the fact, that prolactine was within normal range and the presence of elevated GH even without provocative tests. The last MRI showing the macroadenoma touching the chiasm, but the patient was not complaining of visual disturbances, but the visual fields showed early changes of bitemporal scatomas.

Transsphenoidal approach directly from the left nostril was performed and the anterior wall of the sphenoid sinus was opened from the left side. The floor of the sellar wall was opened 4X4 mm lateral to the medial septum , dividing the sphenoid sinus to 2 identical parts. The dura was opened and the tumor was friable and succable.  Meticulous cleaning of the tumor was achieved and preservation of the pituitary gland was respected.  No CSF came out and considering the small bony defects, no special closure was done. 

Comments:

1.  Direct  insertion of the specula to the anterior wall of the sphenoid, prevent  further damage to the anatomy of the nasal cavity and it is more easy for the surgeon to reach the pathological target.

2.  Performing small bony defect in the floor of the sella with small opening of the dura, most of the time is sufficient, since most of these tumors are easily resectable and succable. This make it unnecessary to perform special closure procedures and give the tumor in case of recurrence  an open way for regrowth (theoretically speaking).

3. For detailed discussion about acromegaly, please click here!

 

 


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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved