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Microadenomectomy for Acromegaly: Postresection Inspection

August 13, 2016


Let's review another video example of microadenoma resection for acromegaly. This is a 34 year old male who presented with typical structural features of acromegaly. MRI evaluation revealed a microadenoma within the gland and, more specifically, along the inferior and middle aspect of the pituitary gland. This is a typical location for a pituitary macroadenoma producing growth hormone. Endoscopic endonasal approach was attempted. Small osteotome was used to open the floor of the sella. Next, Kerrison rongeurs. Extended bony removal so that a wide exposure of the dura at the level of the sellar floor is possible. You can see exposures from one cavernous sinus to the other. Very wide exposure so that the entire gland can be inspected as well as the medial wall of the cavernous sinuses. Cruciate dural incision was accomplished. The tumor is readily encountered as expected. Very gelatinous. Consistent with a growth hormone producing adenoma. Tumors further debulked, collected by pituitary rongeurs. The most important part of the operation is inspection of the resection cavity after the tumor is debulked. More of the tumor is being delivered. More aggressive tumor removal is pursued using the suction device within the sella. Here's the gland mobilized more superiorly. A little bit of residual tumor that has been curetted away using a sharp ring curette. Hydroscopy was also performed to further inspect the resection cavity. Here's the gland itself. It appears clean. No residual tumor is apparent. Here is now the more important part of the operation where the medial walls or the cavernous sinus are carefully inspected. Let's go ahead and use a 30 degree endoscope to inspect the resection cavity. Here's the medial wall of the cavernous sinus on the right side, the gland, no residual tumor is apparent. Here's the left wall. Again, no residual tumor is apparent. The cavity is very clean. Piece of fat wrapped in Surgicel was placed within the resection cavity. No evidence of a CSF leak is apparent and the post-operative MRI demonstrated gross total removal of the adenoma. You can see the fat within the resection cavity and this patient achieved complete biochemical cure. Thank you.

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