Pituitary Adenomas & Transsphenoidal Surgery

[unknownquantity]

Hi,

Am looking for a little help on a rather complex assignment I am looking at; it is based around a girl of 13 years old who has been diagnosed with an acidophil tumour of the anterior pituitary gland. I am told that "the tumour was removed using a surgical approach that split the nasal septum, opened the sphenoidal air sinus and broke through into the sella turcica. The girl made a good recovery, but complained that since her operation her left eye and left nostril had become dry and sore".

I have managed to pick my way through journals and texts to find answers to most of the questions I was trying to answer, but am still a little confused about one of them. I am asked "Using your anatomical knowledge and applying it to the approach taken by the surgeon, explain the post-operative signs exhibited by the patient". Considering there is dryness, I associated this with a lack of secretomotor innervation to the eye / nasal mucosa, which led me to believe the gtr petrosal nerve may have been damaged. Is this correct, and if so, how could the damage have been caused? I can't work it out!

Thanks for your help,

Kev.

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[Nerdoscience]

Um, I think that's it. Just look at the course of the nerve.

 

[unknownquantity]

Ok, thanks.. I've been digging around a little more, and the best I could come up with was that the damage had occurred somewhere between the geniculate ganglion and the foramen lacerum, as I THINK that's where the nerve passes closest to the sphenoid sinus? If anyone could confirm / clarify, would much appreciate it.

 

[Nerdoscience]

It wouldn't have to be in the sphenoid. In that procedure, you break the septum, drill thru the sphenoid, and into the suprasellar cistern.