Case Study : Pituitary Apoplexy Surgery

By Dr. Gurneet Sawhney, Neurosurgeon in Mumbai
Consultant Neuro & Spine Surgery, Fortis Hospital

I. Introduction :


The purpose of this case study is to highlight key clinical findings in a patient diagnosed with pituitary apoplexy. Recent advances in minimally invasive endonasal endoscopic skull base surgery have revolutionized surgery for pituitary tumors. Visualization is significantly improved with a direct endoscopic view, and patients recover much faster with less discomfort. Typically this has reduced hospital stay to one or two days, even following complex surgery. Dr. Sawhney specializes in performing complex brain surgeries and has successfully performed a variety of parasellar tumor resections and brain tumor surgery in Mumbai,in this fashion for more than fourteen years. Dr. Gurneet Sawhney, regarded as one of the best neurosurgeon in Mumbai for performing Microneurosurgery, Neuroendoscopy, and Minimally Invasive Spine Surgeries.




II. Abstract :


The current case study describes a patient with pituitary apoplexy. Its a rare but life threatening condition caused by sudden haemorrhage or infarction of the pituitary gland. Pituitary apoplexy is a medical emergency and can be fatal if it is untreated or neglected. With treatment, however, the prognosis is good.




III. Diagnosis :


Pituitary macroadenoma with apoplexy




IV. Physical Examination and Tests :


Brain MRI




V. Symptoms :


Acute headache, vomitting, unable to open left eye.




VI. Treatment and Prognosis :


If prompt neurosurgical intervention with the transsphenoidal approach is available then prognosis is good.




VII. Case Presentation :


February 2020

41 year old man came with a complaint of sudden onset of severe headache associated with vomitting and was unable to open his left eye. MRI of the brain was done and was found to have a pitutary tumor. The condition is called pituitary macroadenoma with apoplexy. On examination he was found to have III new palsy because of which he was unable to open his left eyelid and also move his left eye on either sides.He was optimised and taken up for Endoscopic Transnasal Transsphenoidal surgery under Neuronavigation guidance and complete tumor was removed.




VIII. Post Operative Assessment :


Postoperatively, patient found improvement on day 1 and wasable to move his eye slightly. He was discharged postoperation on Day 3. On followup he was able to open his eye partially with good vision at the left eye.