Endoscopic Transsphenoidal Surgery For Pituitary Adenoma

Chordomas are considered rare neoplasms with an incidence of 0.08/100 000.(1) chordomas arise from remnant notochord cells found mainly within the clivus and sacrococcygeal regions . But also, can be found at any site along the vertebral column (2). The presentation of clival chordomas tend to be late, associated neurological impairment due to involvement of the lower cranial nerves (3). Clival chordomas are also challenging to treat due to their site , anterior to the brainstem, and their aggressive locally invasive nature (4,5) and they are radioresistant lesions . clival chordomas have relatively poor survival of 0.9 years without treatment (6). Extended open skull base approaches to the clival region are traditionally the mainstay for achieving gross total resection in chordoma. Extended subfrontal transbasal, anterior transfacial, and lateral transtemporal or far-lateral approaches have been described, as well as staged surgical approaches. (7-9) . These approaches to the anterior midline skull base often require extensive removal of skull base bone and brain retraction, and they put critical neurovascular structures between the operating surgeon and the pathology. With the advent and incorporation of the rigid endoscope into neurosurgical practice and the active collaboration between ENT surgeons and neurosurgeons, extended endonasal endoscopic approaches have become well-accepted, minimally invasive routes to the midline and paramedian skull base. The endoscopic

Serum cholesterol rates have been the most reliable means of predicting remission after pituitary surgery to manage Cushing's. However, this study suggests that surgery is not always the best option, and often results in a cyclic form of hypercortisolism.

“The pituitary adenoma itself may put pressure on the remaining normal part of the pituitary gland and limit or destroy its ability to produce hormones appropriately” (Stewart & Vance). With the increase in tumor pressure the patient may experience nausea and vomiting. The pituitary adenoma may cause body hair loss, sexual dysfunction, increase frequency and increase amount of urination. The pituitary adenoma is growth hormone secreting tumor causing the hands and feet to enlarge (www.mayoclinic.org). A growth hormone adenoma is the reason for the unexplained weight gain and the change in shoe size from 10 to 12.

12/19/15 Brain MRI report showed no acute intracranial abnormality. No acute infarct, hemorrhage, midline shift, mass-effect, or abnormal extra-axial collection was seen.

Fundi were benign. Visual fields full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation, and movement. Tongue and uvula were midline. Normal auditory acuity. Normal shoulder shrug.

Some people have this surgery to loose weight and deal with other health problems. But this study deals with people who have diabetes and having

Cushing Disease is the result of the excessive production of corticosteroids generally caused by ACTH-secreting benign pituitary microadenoma. Treatment of cushing disease is usually challenging. In some reccurent and permanent cases or sometimes in life-threatening conditions for rapid hormonal control even we have to use bilateral adrenolectomy.

Neurologic: Mental status: intact, normal. Appearance and behavior are normal. Speech is clear and audible. Alert and oriented x3. Clear thought process. Memory intact. All cranial nerves intact. Normal sterognosis and graphnosis results. Sensory: touch to face, intact. No atrophy, weakness or tremors. Normal gait, no limp. Able to walk with and without shoes. Negative Romberg’s sign. No history of seizures, strokes or fainting. No weakness or tremors. No paralysis. No difficulty walking or speaking. Coordination intact. No numbness or tingling. Denies any suicidal

If possible, surgery may be necessary to remove the pituitary tumor. After surgery, the pituitary gland may slowly start to work again and return to normal. Radiation therapy of the pituitary gland may also be used if the tumor is not completely removed. If these treatments are not successful, the adrenal glands may need to be removed to stop the high levels of cortisol from being produced, in Cushing’s Disease. (Wisse, 2013)

Based on the progress report dated 08/27/15, the patient has consulted with neurosurgery, and reports that no surgery was

The pituitary gland is part of the Endocrine system and secretes hormones for growth, metabolism, reproduction, etc. It works with the hypothalamus in cognitive functions and is widely important for memory, emotional behavior and a multitude of tasks to maintain homeostasis in our bodies.

All except one patient had a complete excision of tumor. There were no major surgical complications.

Clinical Case - Deep Back & Spinal Cord, University of Michigan Medical School. Accessed 9 Sept. 2017.

Fitzgerald, M.J. Turlough FitzGerald, Gregory Gruener, Estomih Mtui (2012). Clinical neuroanatomy and neuroscience (6th ed.). [Edinburgh?]: Saunders/Elsevier. p.

The surgeon should have identified the recurrent laryngeal nerve before performing the partial thyroidectomy so as to avoid damaging it during the surgery.