Srinagar, September 30: An 82-year-old woman with severe hyponatraemia, a pacemaker and a history of blood-thinner medication underwent surgery for a complex pituitary tumour at PARAS Health Srinagar, doctors said.
The patient had presented with sudden loss of vision, severe headache and altered sensorium. Her sodium level was recorded at 102 at the time of admission.
An MRI revealed a pituitary macroadenoma with apoplexy, a complication involving bleeding or infarction within a pituitary tumour.
According to doctors, the patient’s condition required medical stabilisation before surgery. She was managed by a multidisciplinary team involving neurosurgery, ENT, endocrinology, cardiology, anaesthesia and critical care.
Under the care of the endocrinology team, her electrolyte imbalance was corrected over five days. Her cardiac condition and blood-thinner medication were also assessed and managed before the procedure.
The tumour was subsequently removed through an extended endoscopic transsphenoidal approach, which provides access to the pituitary region through the nasal passage.
Dr Danish Andrabi, Director, ENT & Endoscopic Skull Base Surgery, said the patient’s age and multiple medical conditions made the procedure challenging.
“Once she was adequately stabilised, we decided to take up the surgical challenge,” he said.
Dr Andrabi said the tumour was firm and closely related to critical structures, including the carotid and cavernous areas. He said the tumour was completely removed and the optic chiasm was decompressed.
The patient was extubated immediately after surgery, and doctors said she developed neither cerebrospinal fluid (CSF) leakage nor diabetes insipidus, which can occur following pituitary surgery.
She was discharged three days after the procedure in a stable condition, with doctors reporting improvement in her vision and resolution of her headache.
Dr Basharat Kanth, Consultant Neurosurgery, said advanced age and multiple co-morbidities required careful medical optimisation before undertaking complex neurosurgical procedures.
Dr Murtuza Habib, Facility Director, PARAS Health Srinagar, said the case involved coordination between neurosurgery, ENT, endocrinology, cardiology, anaesthesia and critical care teams.
The hospital said the Anaesthesia, Operation Theatre and ICU teams also contributed to the patient’s peri-operative management.
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