Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain / Tumor Case

Endoscopic transphenoidal resection of pituitary tumor

63 year-old woman presents with headache

Description

63 year-old woman presents with headache
No visual change or complaint
Reports prior history of pituitary tumor
Examination unremarkable
Visual field full to confrontation
Labs unremarkable
Prolactin 9.0 ng/mL (normal 2 – 20)

Gallery

Images

Figure 1Recent MRI brain with pituitary protocol: Postcontrast T1 images in sagittal (left and axial (right) planes. Shows pituitary lesion within the sella turcica elevating and compressing the pituitary gland. Tumor is round, grey lesion (gold arrow) and pituitary gland is white curved line on top of lesion.
Figure 2MRI 1 year prior. Similar to Figure 1, but shows some mild growth of lesion over 1 year interval when compared to Figure 1.
Figure 3MRI brain from 2 year prior. Non-contrast sagittal T1 (left) and axial T2 (right) images show relatively normal appearance of pituitary gland within the sella turcica (gold arrow); demonstrates definitive growth over imaging interval, when compared with Figure 1.
Figure 4CT head in sagittal, axial, and coronal planes (left-to-right). They demonstrate the sella turcica in which the tumor resides (gold arrow). They also demonstrate the transnasal surgical corridor (pink arrow) used to access the sphenoid sinus (pink star(*)).
Figure 5iagram demonstrating the transnasal, transphenoidal route used to access the pituitary tumor. An endoscope (blue arrow) is passed from the nasal opening to the back opf the nose, through the sphenoid sinus and into the sella turcica.
Figure 6Image captured from the intraoperative stereotactic navigation system. It shows how the pituitary tumor is located and access through the shenoid sinus (crosshairs are within the sphenoid sinus).
Figure 7Intraoperative video captured form the navigation system. It shows how instruments are tracked in real time by the navigation workstation and how the information is relayed to the surgeon accessing the sphenoid sinus.
Figure 8Intraoperative image captured through the surgical endoscope. It shows the opened floor of the sella turcica. The purple-ish bulge is the dura mater covering the pituitary gland and tumor.
Figure 9Intraoperative video showing resection of the tumor with a pituitary ring curette. The tumor is soft is carefully removed piece by piece.
Figure 10Intraoperative video taken after the tumor has been largely resected. The endoscope is advanced into the sella turcica and the right wall of the sella is inspected. The glistening pink object is the right internal carotid artery. The tan-ish tissue is pituitary gland. There is still a small piece of tumor between the carotid and the gland that needs to be removed. Also visible is the pink supra-selalr arachnoid membrane hanging down into the sella. This is the great advantage of the endoscope- the ability to look within the resection cavity.

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