PITUITARY TUMOUR WITH APOPLEXY//ENDOSCPOPIC TRANSSPHENOIDAL PITUITARY SURGERY скачать в хорошем качестве

PITUITARY TUMOUR WITH APOPLEXY//ENDOSCPOPIC TRANSSPHENOIDAL PITUITARY SURGERY

Case Presentation Pituitary Apoplexy in a 30-Year-Old Male Managed with Urgent Endoscopic Transsphenoidal Surgery” Introduction • Pituitary apoplexy is a rare but life-threatening condition caused by sudden hemorrhage or infarction of a pituitary adenoma. • Incidence: ~2–12% of all pituitary adenomas. • Requires rapid diagnosis and timely neurosurgical intervention. Case Details Patient Profile • Age / Gender: 30-year-old male Background: No prior major illnesses or comorbidities. Chief Complaints • Sudden-onset severe headache — diffuse, throbbing, 15 days . • Recurrent vomiting — non-bilious, non-bloody. • Sudden diminution of vision — bitemporal hemianopia noticed by patient’s relatives. • right complete opthalmoplegia MRI Brain + Sella • Findings: • Pituitary macroadenoma (~2.5 cm). • Heterogeneous signal intensity with areas of hemorrhage. • Compression of optic chiasm. • Extension into the right cavernous sinus. • Consistent with pituitary apoplexy. Hormonal Profile • Cortisol: normal • TSH: Mildly ↓. • Prolactin, GH: Within normal limits. Visual Field Charting • Confirmed bitemporal hemianopia. Diagnosis ( Pituitary Apoplexy secondary to hemorrhage into a pituitary macroadenoma, presenting with headache, bitemporal hemianopia, and right CN III palsy. Management Initial Stabilization • High-dose IV hydrocortisone to prevent adrenal crisis. • IV fluids and electrolyte correction. • Analgesia and antiemetics. • Neurosurgical and endocrinology team involvement. Definitive Surgical Management Procedure: Urgent Endoscopic Transsphenoidal Pituitary Surgery Steps: 1. Nasal Phase • Binostril endoscopic approach. • Elevation of nasoseptal flap. 2. Sphenoidotomy • Wide opening of sphenoid sinus. 3. Sellar Phase • Dura opened carefully. • Evacuation of hematoma. • Removal of residual tumor tissue. 4. Hemostasis & Reconstruction • Hemostasis secured. • Sellar floor reconstructed with fat graft + fibrin glue. • Nasoseptal flap repositioned. Postoperative Course (3 • Headache relieved within 24 hours. • Vision improved significantly over the first 48 hours. • Pupil size reduced gradually; ptosis partially recovered over 2 weeks. • No CSF leak, meningitis, or diabetes insipidus. • Hydrocortisone tapered under endocrinology supervision. Discussion • Pituitary apoplexy presents acutely with: • Severe headache (80–90% cases) • Visual deficits (60–70%) • Cranial nerve palsies (CN III thanCN IV thanCN VI). • CN III is most commonly affected due to its medial location in the cavernous sinus. • Early steroid therapy and urgent decompression are key to preventing permanent deficits. • Endoscopic transsphenoidal approach offers: • Better visualization. • Minimal morbidity. • Faster recovery compared to microscopic approach. Conclusion ( Pituitary apoplexy is a neuro-endocrine emergency. Early diagnosis using MRI, prompt steroid therapy, and timely endoscopic transsphenoidal surgery are crucial for optimal visual and neurological recovery. Key Takeaways • Most common nerve involved: CN III • Most common symptom: Sudden severe headache • Gold standard imaging: MRI brain with sellar cuts • Definitive treatment: Early endoscopic transsphenoidal decompression #anatomy #biology #ear #ent #nose #nosebleed #otolaryngology #science #throathealth #tonsils