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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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!
