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Possible Pituitary Tumor Surgery

Hi

I need help in what the following means. This is what is on the report from the CT scan

There is a large enhancing mass present in the region of the sella and extending into the suprasellar cistern. This measures approximately 22.3mm in height, 17,8mm AP and 25.9mm traverse.

This demonstrates marked enhancement post IV contrast. The appearance os most likely due to a pituitary macro-adenoma. An aneurysm

The sella is expanded as a result. Lamina dura is thinned. No significant extension into the sphenoid sinus is demonstrated. There is minimal mucosal thickening related to the left lateral aspect of the sphenoid sinus which does not relate.

No focul oedema is seen. No extra-axial collections are present.

I am going for an MRI on the 29th of March. My nerves are finished. especially after reading about this pituitary gland tumor. I have done blood tests but will get them on the 29th with my next visit to the specialist. I am in East London, Eastern Cape, South Africa.

There is only two neurosurgeons here and i dont know what sort of experience they have in removing this kind of tumor.

any advise/help?
7 Responses
Avatar universal
COMMUNITY LEADER
Hello.

Normally a pituitary lesion will not show up on a CT unless it is large... Yours is large.

It has grown up and towards the optic nerve. You have not said if you have optic issues but if not, it may happen.

There is a pituitary organization for South Africa and we have had another patient who posted here for her husband find a doctor and get good care. I wil try to find the post but do search for the center. You need those specialists. Get copies of everything.
2 Comments
I dont think there is a centre here in south africa. I did find the post. Unfortunetly i am on the east coast in south africa. She was based in Gauteng. The medical aid will only pay for coastal hospitals. And 70% for inland hospitals.
Can you travel? I went to the west coast of the USA for mine. Even here we travel for competent centers. Some hospitals will accept or offer charity so make some calls.
Avatar universal
Dear DrhouzA,

I am a skull base and pituitary surgeon in the US and happened upon your post. The results of your CT are vague and can be the result of a few things - either a pituitary tumor, a craniopharyngioma, an aneurysm, or potentially something else. 22.3mm in height almost guarantees that it is in contact with the optic nerves or chiasm - which are the nerves for vision. The evaluation, workup, and treatment is not simple and generally requires a team of physicians - endocrinologists, neurosurgeons, ophthalmologists, and ENT-otolaryngologists. I strongly suggest you find a tertiary care center with high level care and expertise to address this problem. Unfortunately, I am not familiar with South Africa, but if you are able to travel to the US - I can recommend several places that are reputable.
Avatar universal
Thanks skullbase for the reply.

I will be going for the MRI on Tuesday, so i think i will have a better idea of what really is going on. In the meantime i am just reading and finding as much info as i can about this condition.

I did find a neurosurgeon in Cape Town, that is also a professor at and he also works at GrooteSchuur Hospital. I have send him an email and is awaiting a reply. GrooteSchuur is also a teaching hospital.
Avatar universal
Another question

What is the difference between a pituitary tumor and a craniopharyngioma? How would one know if you have one and not the other. I am waiting to see the doctor now. Have done the MRI scan. He will be sharing the results with me. And I think my options.

My nerves is killing me.
Avatar universal
Update.

I went for the MRI today. It reads as follows.
Findings:
A homogeneously T1 intermediate signal intensity, T2 slightly hyper intensive mass arises out of the pituitary fossa expanding the pituitary fossa more to the left of midline with suprasellarextention, with dimensions of 2.3cm in supero-inferior dimension, 2.2cm in traverse dimension and 1.8cm in AP dimension.

This exerts mass effect on the optic chasm which is bowed superiority. There is some lateral bowing of the wall of the left cavernous sinus and I suspect there may be left cavernous sinus invasion and encasement of the  Intracarvernous portion of the left ICA.

There is no evidence of pituitary apoplexy. There is no typical features to suggest that this lesion represents an aneurysm and is most likely a pituitary macro-adenoma.

There is a single spot of right periventricular white matter focal hyper intensity which is of dubious significance. Normal ventricles with no hydrocephalus identified. Preserved grey/white matter differentiation is present. There is no obvious extension of the presumed pituitary macro-adenoma into the sphenoid sinus although there is bowing of the left sphenoid sinus roof.

Comment:
The intra- and suprasellar mass displays imaging characteristics compatible with suprasellar extension and suspected early left cavernous sinus invasion.

Technique:
Axial whole brain FLAIR, SFOV, coronal and saggital T1 pre- and post-gadolinium, coronal and saggital  T2 SFOV.

I now have to take my scans to the neurosurgeon that will do the surgery. Our neuro's is on holiday and will only be back next week. I am thinking of going to the neuro surgeon in Cape Town. Dr P Semple. His speciality is Pituitary Surgery.

What are yourr thoughts on the above. Also the part about the "single spot of white mass of dubious significance" I am unsure about. What do you think the radiologist meant with that part. The specialist said its nothing to worry about.
Avatar universal
So have seen the neuro now. He is oldish, think he is close to retirement. Told me he has done many of this type of surgeries before. He will be doing  microscopic transphenoidel surgery to remove the tumor. He said there is a chance he might not get everything out. So I will probably have to go for another MRI afterwards.

The surgery is scheduled for the 21st of this month (April). I am booked for 8 days in hospital for the following procedures.

1. Hypo sectors or excision of pituitary tumor, transnasal or transept all approach,  non stereotactic.

2. Bone graft

3. Excision or destruction(e.g.laser) intra nasal lesion; external approach( lateral rhinotomy)

4. Craniofacial approach to anterior cranialfossa, extramural, including lateral rhinotomy, ethmoid tony, spenoidectomy, without maxillectomy or orbital exenteration

5. Creation of shunt, ventricular-peritoneal -pleural, other terminus.


What's does all this mean in layman terms?
Avatar universal
Update:

I am at home now, the surgery was successful. Spent 5 days in ICU and 1 day in the surgical wards.

My follow up with the doc is this Tuesday.

I have problem with breathing as my nose is blocked, lots of dried blood. Not sure if I can use saline drops and gauze to remove some of the dried blood. The doc did say I should leave it. Problem is breathing through my mouth leaves it dry during the night.

Any suggestions
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