Javed Zanib, Saeed Zunaira, Khan Sibgha, Ali Laghari Altaf
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Surg Neurol Int. 2024 Sep 6;15:318. doi: 10.25259/SNI_224_2024. eCollection 2024.
Most pituitary neuroendocrine tumors are benign, except some adenomas that show invasiveness and are called invasive pituitary adenomas. These are challenging and rare pathologies.
We present a case of a 40-year-old male who presented to the emergency with seizures, rhinorrhea, headache, and drowsiness. Radiology images showed a sellar mass with supra-sellar extension and pneumocephalus. The pituitary profile was within normal limits. The patient underwent bifrontal craniotomy and maximum safe resection of the lesion with cerebrospinal fluid (CSF) leak repair and lumbar drain insertion. Histological examination and immunohistochemical stain were consistent with pituitary adenoma. Postoperatively, there was no CSF leak, and the patient's Glasgow Coma Scale improved.
Rhinorrhea is a unique presentation for pituitary adenoma. According to the current literature, surgery is the only effective treatment as part of the management of invasive pituitary adenomas, along with a multidisciplinary approach.
大多数垂体神经内分泌肿瘤是良性的，但有些腺瘤具有侵袭性，被称为侵袭性垂体腺瘤。这些是具有挑战性的罕见病理情况。
我们报告一例40岁男性患者，因癫痫发作、鼻漏、头痛和嗜睡到急诊科就诊。影像学检查显示鞍区肿块伴鞍上扩展和气颅。垂体功能检查结果在正常范围内。患者接受了双额开颅手术，对病变进行了最大程度的安全切除，并修复了脑脊液漏，插入了腰大池引流管。组织学检查和免疫组化染色结果符合垂体腺瘤。术后无脑脊液漏，患者的格拉斯哥昏迷评分有所改善。
鼻漏是垂体腺瘤的一种独特表现。根据目前的文献，手术是侵袭性垂体腺瘤治疗的唯一有效方法，同时需要多学科综合治疗。
