A Septuagenarian with a large Pituitary Tumor Underwent safe endoscopic endonasal Surgery in times of Covid-19

Mumbai: A team headed by Dr. Mazda Turel, Neurosurgeon, Wockhardt Hospital, South Bombay, along with ENT specialist Dr. Neepa Vellimutam successfully performed a complicated brain tumor resection surgery on a 72-year-old septuagenarian from Mumbai who was brought with a progressive vision loss. It was revealed that the patient was diagnosed with 4 cm pituitary adenoma pressing on his optic nerve causing blindness. A timely intervention by the neuro-oncology department gave him a fresh lease of life. He has been discharged on September 18, 2020, with no complications.

Dhansukhlal Dedhia, a resident of Mumbai developed prostate cancer earlier this year for which he underwent Transurethral resection of the prostate (TURP) in May 2020 and was on chemotherapy and steroids. Life was smooth but a few months ago, he started encountering vision problems and that took a toll on his active life. The patient was dependent on his family members for carrying out his daily chores. However, his health deteriorated further and he was referred to Wockhardt Hospital, South Bombay.

Dr. Mazda Turel, Neurosurgeon, Wockhardt Hospital, South Bombay said, “On September 8, 2020, the patient presented with the history of bilateral blurred vision for the last few months. His vision deteriorated over days and was unable to see things beyond afoot. The MRI showed a 4cm tumor pressing against the optic nerves causing visual loss.” The oncologist collaborated that prostate cancer was under control and it would be worth going ahead with surgery to restore vision.

Dr. Turel added, “The patient was scheduled to undergo endoscopic endonasal tumor resection. His COVID test done a day prior to surgery was negative. The patient underwent Endoscopic transnasal trans-sphenoidal radical excision of pituitary macroadenoma under general anesthesia on September 9, 2020.

An endoscope with light and camera was inserted in one nostril and advancing 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 tumor and pituitary gland and the tumor is extracted. Tumor removal corrects vision problems and restores normal hormone balance. He had also developed transient hyponatremia which was corrected

Dr. Turel explained, “We removed the tumor completely relieving the pressure from his optic nerves.  He made a good recovery and was back to reading the newspaper within 4 days of surgery. He was discharged 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.”

“I was disheartened when I had blurred vision and was not able to recognize who was standing in front of me as I couldn’t see. My vision problems were going on increasing as the days passed. Fortunately, Wockhardt Hospital came to my rescue. I thank the doctors for helping me gain my vision back and giving me a new way of life,” concluded patient Dhansukhlal Dedhia.


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