[Downward migration of the optic system after transsphenoidal approach of a giant eosinophilic adenoma (author's transl)].
Headache and visual impairment resulting from downward migration of the optic system in an acromegalic patient, occurred after one year postoperatively. A 25-year-old woman with eosinophilic adenoma was operated on via transsphenoidal approach and irradiated (5,000 rads) following the operation. After the operation, bitemporal hemianopia was thoroughly improved and serum HGH level was also markedly decreased after radiation therapy. One year later, headache and visual impairment recurred. Pneumoencephalogram revealed that the infundibular and optic recessus of the third ventricle were elongated and descended into the sella turcica. The second operation was performed by subfrontal approach and the optic system was found to be migrated into the sella, which we assumed to be the cause for the recurrence of the headache and visual field defect. In order to prevent this type of complication, it would be recommended to fill up the dead space in the sella with bone or cartilage fragments in addition to muscle pieces, as was suggested by Guiot et al.
D000239:Adenoma, Acidophil / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D009897:Optic Chiasm; D009901:Optic Nerve Diseases / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D013101:Sphenoid Sinus