Transcript

Let's review the basic principles for resection of micro adenomas, and more specifically resection of those causing acromegaly. This is a 46 year old male suffering from typical features of acromegaly. MRI evaluation revealed a relatively large pituitary micro adenoma along the inferior aspect of the sella. He subsequently underwent an endoscopic transnasal transsphenoidal resection of his tumor, You can see the bone at the floor of the sella. You can see the bone at the floor of the sella. Small bony opening at the floor was created via small osteotome. Pituitary rongeurs were used to remove the rest of the bone. A wide exposure is mandatory A wide exposure is mandatory from one cavernous sinus to the other. That dura was opened in a cruciate fashion. It's important to note that most pituitary micro adenomas causing acromegaly are relatively soft and gelatinous and easily delivered. and gelatinous and easily delivered. Here you can see the tumor was readily accessible within the middle of the gland. Ring curettes were used to mobilize the tumor. Pituitary rongeurs were used to evacuate tumor fragments. Pituitary rongeurs were used to evacuate tumor fragments. After the most obvious portions of the tumor are removed, After the most obvious portions of the tumor are removed, rain curettes are used to further inspect the resection cavity. There are important nuances involved here. One of the most important ones is the use of the endoscope and its superior power of visualization to inspect the gutters and the corners just close to the wall of the cavernous sinus. As you can see, a small amount of residual tumor is being evacuated via the use of the endonasal endoscopes. One has to remain patient, continue to examine every corner. Here's the wall of the cavernous sinus. Septations have to be also inspected to make sure that tumor is not left behind inadvertently. Here is part of the gland and diaphragma sellae. Ring curettes are used to mobilize the gland and diaphragma sellae, so all the corners can be effectively inspected, as you can see here. Small piece of the tumor are also removed using pituitary rongeurs. Especially a small part of the capsule maybe left behind. After the tumor is removed a piece of fat wrapped in surgicell is used to fill in the resection cavity and the postoperative MRI demonstrated complete removal of the tumor and the patient achieved biomechanical remission. Thank you.

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