Golden Nyoman, Niryana Wayan, Awyono Steven, Mardhika Putu Eka, Putra Made Bhuwana, Biondi Made Stefanus
Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia.
Interdiscip Neurosurg. 2021 Sep;25:101153. doi: 10.1016/j.inat.2021.101153. Epub 2021 Feb 25.
In the COVID 19 pandemic, pituitary surgery is one of challenging surgical treatment, especially the involving transsphenoid approach. It was reported that the aerosolisation and mucosal involvement increase the risk of viral transmission during operation. Therefore, transcranial is a safer surgical approach during COVID-19 pandemic. This study aimed to reported transcranial approach to treat giant pituitary adenoma with aggressive visual disturbance which require urgent surgical management.
We reported a 21-year old male, who required urgent surgery because of progressive visual disturbance due to giant pituitary adenoma. On brain MRI with contrast, it was revealed an extraaxial tumor extending anteriorly over plannum sphenoidal with the greatest diameter was 5.34 cm. Transcranial approach was chosen to resect the tumor. Near total removal of the tumor was achieved without damaging vital neurovascular structure. The visual acuity was improved and no significant postoperative complication. Pathology examination revealed pituitary adenoma.
Transcranial surgery for pituitary adenoma is still an armamentarium in neurosurgical practice, especially in the COVID 19 pandemic to provide safer surgical approach.
在新冠疫情期间，垂体手术是具有挑战性的外科治疗之一，尤其是经蝶窦入路手术。据报道，手术过程中的气溶胶形成和黏膜受累会增加病毒传播风险。因此，在新冠疫情期间，经颅手术是一种更安全的手术方式。本研究旨在报告采用经颅入路治疗伴有严重视力障碍的巨大垂体腺瘤，这类患者需要紧急手术治疗。
我们报告了一名21岁男性患者，因巨大垂体腺瘤导致视力进行性减退而需要紧急手术。增强脑磁共振成像显示，鞍上有一轴外肿瘤，向前延伸至蝶骨平台，最大直径为5.34厘米。选择经颅入路切除肿瘤。在未损伤重要神经血管结构的情况下，实现了肿瘤的近全切除。视力得到改善，术后无明显并发症。病理检查显示为垂体腺瘤。
垂体腺瘤的经颅手术仍是神经外科实践中的一种有效手段，尤其是在新冠疫情期间，可为手术提供更安全的入路。
