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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 532-533

Giant Pituitary Adenoma Causing a Split in Optic Chiasm


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 Submission30-Sep-2020
Date of Decision13-Dec-2020
Date of Acceptance17-Jan-2021
Date of Web Publication24-Apr-2021

Correspondence Address:
Dr. Manmohan Singh
Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314530

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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

How to cite this URL:
S Rai HI, Singh M, Singh PK, Nambirajan A, Sharma A, Jain A. Giant Pituitary Adenoma Causing a Split in Optic Chiasm. Neurol India [serial online] 2021 [cited 2021 May 16];69:532-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/532/314530




Giant pituitary adenomas are generally nonfunctional adenomas defined commonly by the presence of the largest dimension of ≥4 cm in any axis.[1] 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.[2],[3],[4] We report a similar case of splitting of optic chiasm by a giant non-functional pituitary adenoma.


  Case Top


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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Figure 3: Postoperative visual field charting of right eye

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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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: Histological types, clinical features and therapeutic approaches. Endocrine 2018;61:407-21.  Back to cited text no. 1
    
2.
Kunieda K, Nishimura Y, Kondo H, Shikinami A, Funakoshi T, Tanabe Y, et al. Scotomatous defects in the central visual field, associated with pituitary tumor. A case report. Brain and Nerve 1982;34:275-9.  Back to cited text no. 2
    
3.
Hanalioğlu Ş, Işıkay İ, Berker M. Splitting of the optic nerve by a pituitary macroadenoma. World Neurosurg 2016;89:726.e11-14.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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