Okülomotor Sinir İnfiltrasyonu Gösteren Rekürren Fonksiyonel Hipofiz Adenomu: Olgu Sunumu

Salih Gülsen; Cem Yılmaz; Hakan Caner; Nur Altınörs

Recurrent Functional Pituitary Adenoma Presenting as Oculomotor Nerve Infiltration: Case Report

Yıl 2009, Cilt: 2009 Sayı: 3, 277 - 280, 01.03.2009

Salih Gülsen Cem Yılmaz Hakan Caner Nur Altınörs

Öz

It is estimated that pituitary tumors account for 10% to 15% of all primary brain tumors. Patients with pituitary adenoma and cranial nerve involvement should be evaluated regarding possible oculomotor nerve infiltration. We present this case to emphasize the importance of diagnosing infiltration to the oculomotor nerve in patients with pituitary adenoma. Evacuation of the tumor can be beneficial to decrease the level of hormone secreted and its clinical consequences, and also for the recovery of oculomotor nerve function in cases with pressure effect on the oculomotor nerve, but it is not effective for such recovery in cases with direct infiltration to the nerve by the tumor as in the present case. Turkish Başlık: Okülomotor Sinir İnfiltrasyonu Gösteren Rekürren Fonksiyonel Hipofiz Adenomu: Olgu Sunumu Anahtar Kelimeler: Cushing hastalığı; Gamma Knife cerrahisi; hipofiz adenomu; okülomotor sinir tutulumu Hipofiz tümörleri primer beyin tümörlerinin %10-15&#39;ini oluşturur. Hipofiz adenomu olan hastalar okülomotor sinir infiltrasyonu açısından değerlendirilmelidir. Sunulan olguda okülomotor sinir infiltrasyonun hipofiz adenomu gibi benign bir patolojinin sonucunda da gelişebileceği vurgulanmıştır. Hormon sekresyonunun azaltılması ve baskı altında kalmış olan okülomotor sinir fonksiyonunun geri dönüşümü için cerrahi dekompresyon etkili olmaktadır, ancak; okülomotor sinirin tümör ile infiltre olduğu durumda okülomotor sinir fonksiyonunun geri dönüşümü mümkün olmamaktadır. Sunulan olguda da ameliyat sonrası dönemde okülomotor sinir fonksiyonu geri dönmemiştir.

Anahtar Kelimeler

Cushing's disease; Gamma Knife surgery; pituitary adenoma; oculomotor nerve infiltration

Kaynakça

Ebersold MJ, Quast LM, Laws ER Jr, Scheithauer B, Randall RV. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 1986;64:713-9.
Jagannathan J, Kanter AS, Sheehan JP, Jane JA Jr, Laws ER Jr. Benign brain tumors: sellar/parasellar tumors. Neurol Clin 2007;25:1231-49.
Kontorinis N, Holthouse DJ, Carroll WM, Newman M. Third nerve palsy after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2001;122:400-1.
Chen Z, Murray AW, Quinlan JJ. Pituitary apoplexy presenting as unilateral third cranial nerve palsy after coronary artery bypass surgery. Anesth Analg 2004;98:46-8.
Park YM, Cho JH, Cho JY, Huh JS, Ahn JY. Non- Hodgkin's lymphoma of the sphenoid sinus present- ing as isolated oculomotor nerve palsy. World J Surg Oncol 2007;5:86.
Itshayek E, Perez-Sanchez X, Cohen JE, Umansky F, Spektor S. Cavernous hemangioma of the third cra- nial nerve: case report. Neurosurgery 2007;61:E653.
Kim SH, Lee KC, Kim SH. Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci 2007;14:1158-62.
Mixson AJ, Friedman TC, Katz DA, Feuerstein IM, Taubenberger JK, Colandrea JM, et al. Thyrotropin- secreting pituitary carcinoma. J Clin Endocrinol Metab 1993;76:529-33.
Pernicone PJ, Scheithauer BW, Sebo TJ, Kovacs KT, Horvath E, Young WF Jr, et al. Pituitary carci- noma: a clinicopathologic study of 15 cases. Cancer 1997;79:804-12.
Pamir MN, Kiliç T, Belirgen M, Abacioğlu U, Karabekiroğlu N. Pituitary adenomas treated with gamma knife radiosurgery: volumetric analysis of 100 cases with minimum 3 year follow-up. Neurosurgery 2007;61:270-80.
Minniti G, Brada M. Radiotherapy and radiosurgery for Cushing's disease. Arq Bras Endocrinol Metabol 2007;51:1373-80.