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|Year : 2021 | Volume
| Issue : 2 | Page : 532-533
Giant Pituitary Adenoma Causing a Split in Optic Chiasm
Hitesh I S Rai1, Manmohan Singh1, Pankaj K Singh1, Aruna Nambirajan2, Amit Sharma1, Ankit Jain1
1 Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||30-Sep-2020|
|Date of Decision||13-Dec-2020|
|Date of Acceptance||17-Jan-2021|
|Date of Web Publication||24-Apr-2021|
Dr. Manmohan Singh
Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
S Rai HI, Singh M, Singh PK, Nambirajan A, Sharma A, Jain A. Giant Pituitary Adenoma Causing a Split in Optic Chiasm. Neurol India 2021;69:532-3
Giant pituitary adenomas are generally nonfunctional adenomas defined commonly by the presence of the largest dimension of ≥4 cm in any axis. These tumors are known to compress and displace the optic pathways; however, splitting of optic pathways is a rarest phenomenon. Only four cases have been reported till date.,, We report a similar case of splitting of optic chiasm by a giant non-functional pituitary adenoma.
| » Case|| |
A 45-year-old man presented with a history of gradually progressive visual loss of 4-year duration with temporal field defects. His hormone profile was suggestive of hypopituitarism. After hormonal normalization, he was operated through a trans-sphenoidal route at a private hospital. Histology was suggestive of pituitary adenoma. Follow up contrast MRI head revealed a large residual tumor in the sella & suprasellar region extending up to Foramen of Monro [Figure 1]. At presentation to our hospital, patient had persistent visual symptoms and his visual acuity was 6/24 in right & 2/60 in left eye [Figure 3]. He was re-operated via left pterional approach. Inter-optic, optico-carotid and trans-lamina terminalis corridors were utilized for tumor excision. Gross total tumor excision was achieved. An interesting intra-operative finding of split optic chiasm on right side by the tumor was observed [Figure 2]. The defect seen here in the chiasm has smooth margins indicating that it is not an iatrogenic defect (which shall be having irregular margins). The patient had visual decline (PL+) in his left eye postoperatively as left optic nerve was adherent to the tumor. Rest of the post-operative period was uneventful.
|Figure 1: Contrast MRI brain showing a T2 hyperintense (a and b) enhancing (c-e) giant residual tumor in sella, parasellar (right Knosp 3) and suprasellar region extending into 3rd ventricle reaching the foramen of monro. (f) Post-operative contrast MRI head showing near total excision with very small residual in right side of sella|
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|Figure 2: Intra-operative image showing tumor splitting the optic chiasm on right side (yellow arrow). [Rt Op N- right optic nerve, Lt Op N- left optic nerve, ACA- anterior cerebral artery]|
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Histology revealed features of a gonadotroph pituitary adenoma. The MIB 1 proliferative index was approximately 2–3% in the highest labeling areas.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
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Gagliardi F, Boari N, Losa M, Mortini P. Longitudinal splitting of optic pathways by non-functioning pituitary macroadenoma: Report of two cases. Acta Neurochir (Wien) 2010;152:1065-8.
[Figure 1], [Figure 2], [Figure 3]