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Doctors help septuagenarian get back his vision

11:55 PM Oct 27, 2020 | Swapnil Mishra

A septuagenarian with a large pituitary tumour underwent safe endoscopic endonasal Surgery in times of Covid-19 at Wockhardt Hospital. The patient was diagnosed with 4 cm pituitary adenoma pressing on his optic nerve causing blindness. Doctors said the patient had a history of bilateral blurred vision for the last few months following which his vision deteriorated over days and was unable to see things beyond afoot. However, the timely intervention by the neuro-oncology department gave him a fresh lease of life.

Dhansukhlal Dedhia, a resident of Mumbai developed prostate cancer earlier after which he underwent Transurethral resection of the prostate (TURP) in May and was on chemotherapy and steroids. But after a few months, he started encountering vision problems following which he was dependent on his family members for carrying out his daily chores. However, his health deteriorated further and was referred to Wockhardt Hospital, Mumbai.

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Dr Mazda Turel, Neurosurgeon, Wockhardt Hospital, said the patient was admitted on September 8, with a history of bilateral blurred vision for the last few months following which they conducted MRI that revealed a 4 cm tumour pressing against the optic nerves causing visual loss.” The oncologist collaborated that the prostate cancer was under control and it would be worth going ahead with surgery to restore vision. “The patient was scheduled to undergo endoscopic endonasal tumour resection. His COVID test done a day before surgery was negative. The patient underwent Endoscopic transnasal trans-sphenoidal radical excision of pituitary macroadenoma under general anaesthesia on September 8,” he said.

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“An endoscope with light and camera was inserted in one nostril and advanced it to the back of the nasal cavity. A small portion of the nasal septum that divides the left and right nostril is removed. At the back wall of the sphenoid sinus, there is the bone overlying the pituitary gland known as the sella and is removed to expose the tough lining of the skull called the dura. The dura is opened to expose the tumour and pituitary gland and the tumour is extracted. Tumour removal corrects vision problems and restores normal hormone balance. He had also developed transient hyponatremia which was corrected,” Dr Turel said while explaining the procedure.

He further said that they had removed the tumour completely relieving the pressure from his optic nerves. Following the patient was back to reading the newspaper within four days of surgery and later they discharged the patient with near-normal vision.

“This surgery is particularly challenging in times of Covid given that the nasal passage is a harbinger of infection and operating through the nose and drilling the base of the skull generates aerosols. The level of precaution even in Covid negative patients is extremely heightened since the entire operation theatre is at great risk of receiving or transmitting the infection from an asymptomatic person,” added Dr Turel.

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