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Year : 2021  |  Volume : 69  |  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

Correspondence Address:
Dr. Manmohan Singh
Department of Neurosurgery and Gamma-Knife, All India Institute of Medical Sciences, New Delhi - 110 029
India




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;69:532-533


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 Jun 23 ];69:532-533
Available from: https://www.neurologyindia.com/text.asp?2021/69/2/532/314530


Full Text



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



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}{Figure 2}{Figure 3}

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

1Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: Histological types, clinical features and therapeutic approaches. Endocrine 2018;61:407-21.
2Kunieda 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.
3Hanalioğlu Ş, Işıkay İ, Berker M. Splitting of the optic nerve by a pituitary macroadenoma. World Neurosurg 2016;89:726.e11-14.
4Gagliardi 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.