Neurological Surgery No Shinkei Geka Volume 28, Issue 11 (November 2000)

Endonasal Transsphenoidal Surgery under Local Anesthesia for Elderly Patient with Pituitary Tumor : case report Toshinari ARAI 1 , Kyoko OKADA 2 , Takekane YAMAGUCHI 3 , Atsushi SAKUMA 4 1Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital 2Department of Psychology, Tokyo Metropolitan Matsuzawa Hospital 3Department of Neurosurgery, Tokyo Metropolitan Toshima Hospital 4Department of Otolaryngology, St. Marianna University, School of Medicine Keyword: pituitary tumor , endonasal transsphenoidal approach , local anesthesia , pituitary apoplexy , elderly patient pp.991-995
Published Date 2000/11/10
  • Abstract
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We present a surgical case under local anesthesia of an 88-year-old woman suffering from visual distur-bance caused by pituitary adenoma. Magnetic resonance (MR) imaging showed a large pituitary tumor with suprasellar extension compressing the chiasmatic nerve. Neither she nor her family would agree to surgical therapy. However, when we proposed surgery under local anesthesia, they accepted it. Partial re-moval of the tumor via the endonasal transsphenoidal approach was carried out, uneventfully. The nasal surface was infiltrated with 4%-Xylocaine® prior to the ordinary xylocaine injection to the nasal mucosa.The patient did not complain of any pain associated with the surgical procedure, including saline injection to the subarachnoicl space through spinal drainage. The postoperative course was fine except for the tem-poraly appearance of diabetes insipidus. Postoperative MR imaging showed complete relief of compression to the chiasmatic nerve. Her visual field was improved dramatically.

Endonasal transsphenoidal surgery under local anesthesia is thought to be one of the most useful methods of choice, especially in cases of elderly patient with pituitary tumor.

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Neurological Surgery 脳神経外科
28巻11号 (2000年11月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院