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Case Report LARGE pituitary tumor with straight suprasellar extension, even with firm consistency can be removed completely through transsphenoidal approach without any post opera- tive CSF leak. Normal pituitary gland with its stalk can be preserved even in large pituitary tumors. A 44-year-old male was admitted with history of progressive diminution of vision in both eyes for 1½ years. Clinically, there was no overt endocrinopathy. Visual assessment revealed acuity of hand movement perception in right eye and 6/6 in left eye. On perimetry, he had complete temporal field defect in left eye. Fundus examination showed primary optic atrophy in right eye. The left optic disc was normal . CT and MRI brain showed sellar and suprasellar mass lesion suggestive of pituitary macroadenoma. X-ray skull showed enlarged sella. Hormonal studies were within nor- mal limits. ANATOMICAL AND PHYSIOLOGICAL PRESERVATION OF PITUITARY IN LARGE PITUITARY TUMOR Sunil Sharma*, Raj Kumar**, P.P. Mishra* and K. Dash** From the Senior Consultant Neurosurgeon*, Junior Consultant Neurosurgeon**, Department of Neurosurgery Consultant ENT surgeon*, Department of ENT, Consultant Endocrinologist**, Department of Endocrinology, Apollo Hosptials, Bilaspur (C.G.), India. Correspondence to Dr. Sunil Sharma, Department of Neurosurgery, Apollo Hospitals, Bilaspur (C.G.), India. Large pituitary tumor with straight suprasellar extension, even with firm consistency can be removed completely through transsphenoidal approach without any post operative CSF leak. Normal pituitary gland with its stalk can be preserved even in large pituitary tumors. A 44-year-old male was admitted with history of progressive diminution of vision in both eyes for 1½ years. Clinically, there was no overt endocrinopathy. Visual assessment revealed acuity of hand movement perception in right eye and 6/6 in left eye. On perimetry, he had complete temporal field defect in left eye. Fundus examination showed primary optic atrophy in right eye. The left optic disc was normal. The patient was operated and sublabial rhinoseptal transsphenoidal excision of pituitary tumor was done on 5 April 2004. Tumor was soft suckable and partly firm in consistency. Complete excision of tumor was achieved. At the end of the procedure suprasellar arachnoid was bulg- ing in the sella. In the post operative period the patient’s vision im- proved in right eye, with improvement in the temporal field defect in left eye. There was no diabetes insipidus or CSF leak Post op CT Scan Brain which was done as a part of rou- tine protocol did not show any residual mass lesion or hematoma. MRI brain (plain and contrast) was done at four month follow up. It showed normal pituitary gland with its stalk. Although the stalk was displaced to one side, no en- Fig. 1. Pre-op MRI brain showing pituitary macroadenoma. 73 Apollo Medicine, Vol. 2, March 2005
