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| Name | Direct Trans-Nasal Trans-sphenoid excision of pituitary adenoma |
| Video Uploader | Video From Sherif ElWatidy |
| Upload Date | This Video Uploaded At 05-07-2015 14:46:10 |
| Video Discription | This is 20 years old young lady presented with 2ry amenorrhea and progressive enlargement of her hands & feet, on examination she has typical features of acromegaly . Her GH and IGF-2 were elevated . MRI scan showed Macroadenoma with evidence of old hemorrhage. Operation: Image guided (Neuronavigation),Microscopic , direct trans-nasal, trans-sphenoid excision of the pituitary adenoma. Surgical procedure 1- Patient is supine, head is neutral & slightly extended and fixed in a Mayfield head clamp, Setting up neuronavigation and registration. 2. Preparation of the nose & Rt. thigh 3- Septal incision at the anterior end of nasal cartilage & extending to the nasal floor, in small nostril & children incision could be extended laterally under ala of the nose. 4- submucous dissection along the lower half of the nasal septum till the junction of the bony & cartilaginous septum. Cartilage is detached from the bone and submucous dissection is continued on both sides of the septum to the anterior wall (keel) of the sphenoid- guided by x-ray /or Neuronavigation. 5 - identification of the sphenoid Ostia 6- Removal of the sphenoid keel (anterior wall) & sphenoid mucosa together with the sphenoid septum 7 -- opening the sellar floor with osteotome and 2 mm bone rongeures 8 - continuous checking the position with Neuronavigation /or x-ray 9 - Opening the dura 10 - Tumor removal with Curettes and suction 11- preserve any remaining normal pituitary tissue (pinkish in color & different texture) 12 - Hemostasis with surgicell 13 - Filling the cavity with fat graft (from Rt. thigh) 14- Recostruction of the sellar floor with septal bone / cartilage 15 - closure of the wound with inverted 4/0 vicryl (2-3 interrupted sutures) 16 - Nasal pack (using two fingers of a glove filled with thin gauze) and outer surface painted with xylocaine gel & Fucidine ointment |
| Category | Education |
| Tags | Pituitary Adenoma (Disease Or Medical Condition) | Pituitary Gland (Anatomical Structure) | Transsphenoidal Surgery (Medical Treatment) | medical operation | operation | acromegaly | Image guided surgery | Microscopic surgery | direct trans-nasal |
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