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Let's now discuss management of a pituitary apoplexy. This is a 32 year-old male who presented with a severe acute headache and also acute onset visual dysfunction, CT scan demonstrated evidence of acute blood within the suprasellar space, as well as evidence of a pituitary adenoma that is hemorrhagic. The diagnosis was consistent with pituitary apoplexy due to his visual deterioration. He underwent endonasal transsphenoidal evacuation of the hematoma and their tumor contents. The floor of the sellar was very thin. You can see the hematoma within their sellar, through their dura. Crocheted incision exposed the intersellar contents and the hemorrhagic byproducts. Standard techniques were used to remove the hemorrhagic tumor. You can see the sellar floor was generously exposed. The hemorrhagic tumor is quite soft and suckable Various sezary and curates are used for evacuation of the hemorrhagic neoplasm. This video also illustrates the importance of handling the very patchoulis diaphragma sellae and removing the tumor that is hiding within the faults and corners of the sellar obstructed by the diaphragma. There were small amount of CSF leak, as you can see here, I continue to mobilize the diaphragma. The fear of a minor CSF leak should not deter the surgeon from aggressive removal of the tumor. then you can see the diaphragma sellae being mobilized out of our working zone. And the suction device is used to remove the tumor endoscope provides a panoramic view of the interstellar contents portion of the tumor hiding on the right of the seller is being carefully curated away. Here you can see the wall of cavernous sinus nice view of the cavernous sinus wall again, again the endoscope provides such a panoramic view that the surgeon can more aggressive to remove the tumor. In this case, I harvested fat from the abdomen and wrapped small pieces of fat in surgery cell the wrapping surgery cell allows better handling of their fat globules because of the CSF leak. Ample amount of fat was used to seal the defect. You can see the fat was inserted at the point of the leak rather than just filling the sellar with the fat blindly. Next the piece of allograft dura was also used a piece of bony septum that was available was also utilized to keep the fat in place and avoid it's delayed post operative displacement. Here's the final product after reconstruction bounced salvo maneuvers revealed no evidence of further leakage. Three months, MRI revealed gross tore removal of the tumor, and this patient had dramatic improvement in his vision. Thank you.
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