Typical case The patient, female, 50 years old, was admitted to the hospital with the chief complaint of “blurred vision with dizziness in both eyes for 3 years”.
History The patient had blurred vision with dizziness in both eyes with no obvious cause 3 years ago, which was persistent, without visual rotation and double vision, without limitation of eye movement, without headache, without nausea and vomiting, without any special treatment, and the above symptoms persisted since then. Half a month ago, the patient sought further treatment at 321 Hospital of the Chinese People’s Liberation Army, where a cranial CT was performed, suggesting that the saddle area was occupied, and the possibility of pituitary tumor was considered to be high. Now the patient has blurred vision in both eyes and dizziness symptoms persist, for further surgical treatment, he came to the Armed Forces General Hospital and was admitted to the neuro-oncology surgery department with “saddle area occupancy”. He had no history of hypertension or diabetes mellitus, and had undergone “thyroidectomy” 15 years ago due to hyperthyroidism. The neurosurgical examination showed decreased visual acuity in both eyes on the crude side and temporal hemianopia in both eyes, but the rest of the examination showed no significant abnormalities.
Imaging examination showed that the butterfly saddle area was a mass-like soft tissue density shadow with a clear border and uniform density within it, and the dorsum of the saddle was compressed and thinned. The midline structure was centered without displacement. Impression: occupancy in the pterygoid saddle area, the nature of which is considered to be a pituitary adenoma.
The cranial MRI scan+enhancement suggested that: irregularity was seen in the saddle area, suprasaddle, and pituitary me, with the edge please, the size was about 4.1cm*3.4cm*2.8cm, equal short T1 equal long T2 signal, the signal within the lesion was not homogeneous, the lesion was not clearly demarcated from the pituitary gland, and the visual cross was not shown. The cavernous sinus was bilaterally encircled, with the right side being the most prominent, and the focal inscription was obviously inhomogeneously enhanced after enhancement.
After admission, the preoperative examination was completed. According to the impact examination, it was found that this case was different from the conventional pituitary tumor, the dorsal saddle was compressed and thinned, and the bilateral cavernous sinuses were invaded.
The tumor was completely removed during the operation. The operation went smoothly and the patient returned to the ward safely after the operation. Postoperative pathology: pituitary adenoma.
The postoperative CT showed that the patient was given symptomatic supportive treatment such as rehydration, hemostasis, seizure prevention, etc. After the operation, the patient was treated with fluid and electrolyte stability, and the changes of urine volume and hormone level were monitored. The family and the patient were more satisfied with the surgical treatment and were discharged on September 30, 2015. After discharge, he was reviewed regularly and continued to be followed up.